The Management of Small Renal Masses and Kidney Cancer

 

kidney-cancer
Earlier detection of small renal masses has led to new treatment options for kidney cancer. Join Johns Hopkins urologist Phil Pierorazio, M.D., as he discusses advances in the diagnosis and treatment of the small renal mass.
Monday, September 12, 2016
7–8 p.m. EST

 

http://ow.ly/Yw1B303JuF1

Menopause sometimes requires a survival guide

Menopause has gotten a bad rap. Women in their 40s and 50s who have any symptoms – from moodiness to insomnia and headaches – may believe that it’s a normal part of aging and there’s not much they can do about it.

Fluctuating hormones caused by the normal decline of ovarian function can trigger the typical symptoms associated with menopause. One approach is to give the body a drug that mimics ovarian function, such as estrogen or hormone replacement therapy. This was a common treatment, until multiple studies showed increased risk of urinary incontinence, stroke, dementia and breast cancer from using menopausal hormone therapy.

Fortunately, there is another approach to improving the body’s ability to adjust to hormone fluctuations that doesn’t increase the risk of breast cancer and dementia. This approach looks at the other organ systems that are involved in addition to the ovaries. For instance, hot flashes will be greatly exaggerated in a woman who has blood-sugar problems – even if those don’t show up on a standard blood test.

BIOIDENTICAL HORMONES

Some women use bioidentical hormones instead. While they appear to have fewer immediate side effects, there is no evidence that they have fewer long-term risks.

At a recent functional medicine conference I attended, there were several discussions on how to address hormone “saturation” – the experience many women have after being on bioidentical hormones for several years and then having a return of their previous symptoms. We’re learning that underlying imbalances in gut function, adrenal hormones and blood sugar can have a major effect on a woman’s experience of her perimenopausal years.

IT’S NOT JUST THE OVARIES

Technically, menopause occurs when a woman hasn’t had a period for 12 consecutive months. The symptoms that can occur for years before that are due to the ovaries becoming less predictable in their hormone production. This means that estrogen levels can spike and fall like a roller coaster.

Unfortunately, once a woman knows that her hormones are fluctuating, she is likely to explain away all her symptoms as perimenopausal. But ovaries are not the only glands affected by hormone changes. The pancreas, thyroid and adrenal glands play key roles in determining how easy or difficult the perimenopausal years will be.

The most common, end-stage effect of pancreas dysfunction is diabetes. But long before the body reaches a disease state, there are more subtle effects. For instance, a woman with low blood sugar or insulin resistance will experience more severe hot flashes than a woman with normal blood-sugar regulation.

Following are common symptoms associated with perimenopause and factors that can determine the severity of those symptoms.

• Heavy or frequent periods. These can be worsened by blood-sugar and thyroid imbalances that don’t show up on routine blood work. Checking free and total levels of T3 and T4 as well as thyroid antibodies can be helpful.

• Hot flashes or low libido. Underlying adrenal stress can result in cortisol levels that are too high or too low, or reduced DHEA (precursor to several hormones). Cortisol levels are best tested with multiple saliva samples over a 24-hour period.

• Insomnia. With or without hot flashes, insomnia is often due to chronic stress, which causes the adrenals to produce excess cortisol.

• Mood changes and brain fog. Moods can be affected by the stress hormone cortisol as well as imbalanced neurotransmitters. Neurotransmitters such as serotonin are made primarily in the gut and can be evaluated with a urine test. Low levels of serotonin can also increase overall pain levels.

• Hair loss and weight gain. There may be underlying thyroid stress that doesn’t show up on routine blood work but requires a more detailed look at free and total levels of T3 and T4 and thyroid antibodies.

Once these underlying issues are identified, they can be addressed through food choices, lifestyle factors and specific supplements.

Marina Rose, D.C., is a functional medicine practitioner, certified clinical nutritionist and chiropractor with an office at 4546 El Camino Real in Los Altos. For more information,  visit DrMarinaRose.com.

From http://www.losaltosonline.com/special-sections2/sections/your-health/53300-

Go for new cancer treatments

WHEN it comes to cancer, many healthcare professionals advocate early detection to increase the chances of successful treatment. In reality, this is hardly the case. Although there are no Malaysian-centric statistics, research has shown that almost 50% of cancer patients in Britain are diagnosed late, making treatment less likely to succeed and reducing their chances of survival.

What this means is we need to ensure that patients with late diagnosis are able to access treatment without compromising their quality of life.

Renal cell carcinoma (RCC) or kidney cancer is often diagnosed late. This is because the symptoms for RCC are similar to those of other diseases and may only surface in the late stages. In fact, 49% of patients in Malaysia are diagnosed with RCC when the cancer is in the final stage (Stage IV). A study showed that the five-year survival rate of patients with Stage IV RCC was only 13%.

Kidney cancer is among the top 10 cancers in Western communities. According to the 2007 Malaysia National Cancer Registry Report, RCC accounts for 43.8% of new kidney cancers. However, these statistics are quite dated as it has been nine years since the data was collected.

Advances in medical research have led to new treatment modules. A revised healthcare policy should ideally be aligned with innovation in cancer treatments. Despite new targeted therapies being approved for use in the US and Europe, these therapies are still limited in most parts of South-East Asia, including Malaysia. And even if they are available in the market, patients have to purchase the drugs from private medical facilities, excluding the majority of Malaysians (75%) who seek treatment at government hospitals.

In the treatment for RCC, there is only one drug approved in the government formulary. More options are needed because a single drug may not be right for every patient. For those who are not able to respond to this particular treatment, access to an alternative drug is often a lengthy and uncertain process. For some patients, the options available to them are so dismal, there is almost a case of no option at all.

In developed countries, drug choices are fully funded by the government, leading to patients having equal access to various drugs of treatment that best suit them. In Malaysia, drug choices are limited. Patients may have to pay out-of-pocket to access these treatments, putting them in a financial dilemma of cost versus survival.

In fact, a recent study by Universiti Malaya showed that 5% of cancer patients and their families were pushed into poverty, and that cancer resulted in “financial catastrophe” for almost half of the patients who suffered from economic hardship.

The policy of approving new drugs is based on an analysis of the quality of life years patients gain versus the cost of the drug. Unfortunately, drug affordability is determined by pharmaceutical companies based on the affordability of developed countries. This leads to a mismatch in drug affordability in a country like Malaysia, where Malaysians have a diverse range of economic situations. Furthermore, no matter how clinically effective a drug is touted to be, no drug has been approved in the government formulary in recent years.

Cancer is set to be a major burden of disease worldwide and the leading cause of morbidity and mortality. It is imperative for policy makers to review and update the targeted cancer therapy treatments currently available in the national formulary so that efficacious medicines are accessible to the majority of the population in public hospitals.

We hope increased funding will be made available to assist patients in their treatment, allowing them to live longer with a better quality of life and without putting them at risk of financial catastrophe.

While Malaysia’s public healthcare system continues to evolve to meet the needs of a growing and aging population as well as alarming rate of non-communicable diseases (NCD), let us be aware of the imperative need for this country to also keep abreast of breakthrough therapies available for patients and to champion for these therapies to be accessible at our public hospitals.

Cancer does not discriminate. Every patient, regardless of their economic status or cancer stage, deserves access to treatment.

DATUK DR MOHD IBRAHIM ABDUL WAHID

Medical Director, Beacon International Medical Centre

Vice President of College of Radiology (COR) Malaysia

Sciatica

sciatica

 

I’ve veered off-topic yet again with a bit about sciatica.  I’ve dealt with this for years and years and had a bunch of opinions from a lot of people on what to do, what to take.  For me, nothing seems to help except waiting it out for about a week, then it settles down.  I’ve tried heat, cold, Tylenol, prescriptions, exercises, sitting, standing, lying down…

Just wait a week.  Right now, I’m on day 6, so I have high hopes for tomorrow.

I do notice that sitting is marginally worse than lying or standing.  I guess that maybe compresses the nerve more?  I do have a bit of Oxycodone left over from my knee pain (which I still have – luckily, on the same leg – just not as badly), so I take 1/2 of one to help me sleep at night.

kidding1
Whenever I think of Oxycodone, I’m reminded of the night that I was diagnosed with kidney cancer.  I’d just been admitted to a room and someone came to visit me.  She offered to buy my Oxy from me.  I was stunned.  Then, she said she was just kidding.

Um, no.  I can’t think of anyone who would even think of buying Oxy who didn’t have some kind of issue – even as a “joke”.

 

 

Some info from the Mayo Clinic

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.

Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it’s especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.

Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

Read more at http://www.mayoclinic.org/diseases-conditions/sciatica/basics/definition/con-20026478

Is blood in your urine cause for concern?

blood_urine

Oh, yes!  This was my very first indication that I had kidney cancer.  Here’s part of my story…

From https://cushingsbios.com/2016/05/09/maryo-10-years-cancer-free/

April 28 2006 I picked up my husband for a biopsy and took him to an outpatient surgical center. While I was there waiting for the biopsy to be completed, I started noticing blood in my urine and major abdominal cramps. I left messages for several of my doctors on what I should do. I finally decided to see my PCP after I got my husband home.
When Tom was done with his testing, his doctor took one look at me and asked if I wanted an ambulance. I said no, that I thought I could make it to the emergency room ok – Tom couldn’t drive because of the anesthesia they had given him. I barely made it to the ER and left the car with Tom to park. Tom’s doctor followed us to the ER and became my new doctor.

 

The News Item that inspired this post:

The sight of blood in your urine is enough to make anyone panic. It doesn’t always indicate a serious problem, but it’s important you get it checked out with your doctor.

Blood in the urine is known as hematuria. There are two forms of hematuria:

Gross hematuria – This is when you can see blood in the urine. The urine may look pink, red, or cola-colored due to the presence of red blood cells (RBCs). Most of the time, other than the change in appearance in urine, most people do not have other symptoms.

Microscopic hematuria – This is when you cannot see blood in the urine but it can be detected when examined under a microscope. Most people with microscopic hematuria have no symptoms.

Causes of blood in the urine:
When a person has hematuria, the kidneys or other parts of the urinary tract allow blood cells to leak into the urine. Anyone, including children, can be at risk for blood in the urine, and it can occur as a result of many common conditions. Some of those include:

Menstruation
Vigorous or strenuous exercise
Sexual activity
Urinary tract infection
Kidney infection
Kidney or bladder stones
Injury
Family history of kidney disease

More serious problems that could be causing blood in your urine might be:

Kidney or bladder cancer
Polycystic kidney disease
Irritation or swelling in the kidney, prostate in men, or another part of the urinary tract
Blood clots
Sickle cell disease
Enlarged prostate
Medications – the anti-cancer drug cyclophosphamide (Cytoxan) and penicillin can cause urinary bleeding.

Diagnosing hematuria
Hematuria is diagnosed with a urine sample called a urinalysis. The urine sample is collected in a special container at a doctor’s office and usually tested in a lab for analysis. The lab technician places a strip of chemically treated paper called a dipstick in the urine. If RBCs are present, patches on the dipstick change color. When RBCs are noted, then the urine is further examined under a microscope to make the diagnosis of hematuria.

Depending on the circumstances, the doctor may order further testing such as a urinalysis, blood test, biopsy, cystoscopy, or a kidney imaging test.

Treating hematuria
Hematuria is treated by addressing its underlying cause. If no serious health problem is detected, no treatment may be necessary. If your hematuria is caused by a urinary tract infection, it will be treated with antibiotics. A urinalysis should be repeated within 6 weeks after antibiotic treatment ends to be sure the infection is gone.
Dr. Samadi is a board-certified urologic oncologist trained in open and traditional and laparoscopic surgery and is an expert in robotic prostate surgery. He is chairman of urology, chief of robotic surgery at Lenox Hill Hospital and professor of urology at Hofstra North Shore-LIJ School of Medicine. He is a medical correspondent for the Fox News Channel’s Medical A-Team and the chief medical correspondent for am970 in New York City. Learn more at roboticoncology.com. Visit Dr. Samadi’s blog at SamadiMD.com. Follow Dr. Samadi on Twitter and Facebook.

Read more at http://www.foxnews.com/health/2016/06/23/is-blood-in-your-urine-cause-for-concern.html

 

Are there any advantages to human growth hormone?

Harvard Men’s Health Watch

Ask the doctor

Q. I’ve heard about the benefits of human growth hormone (HGH) for older individuals. Is this something I should try?

A. The benefits of HGH supplementation for older adults are unproven, and perhaps most telling is that these products have a negligible effect on HGH levels. In addition, there are concerns about potential side effects.

HGH comes in two forms: injections and pills. Since HGH injections are difficult to administer, pills are often preferred. Yet, these supplements do not actually contain HGH like injections do, because the hormone would quickly break down in the digestive tract. Instead, they contain amino acids that are absorbed by the body, which raises HGH levels. (They are also more expensive and can cost $100-plus for a month’s supply.)

HGH levels naturally decline as people age, which makes sense since our bodies stop growing during the late teenage years. So why would you need higher HGH levels later in life? The hype around HGH comes from a few studies that showed HGH injections can increase lean body mass and shrink body fat, which led to claims of HGH as an “anti-aging” hormone. However, the effects on strength and body weight are quite minimal. In addition, HGH can increase the amount of soft tissues in the body, which can lead to swelling, joint pain, carpal tunnel syndrome, and breast tenderness in men.

There is also a concern that HGH might promote cancer growth. (MaryO’Note:  I always mentioned this to doctors when I was diagnosed with kidney cancer.  Even though I couldn’t take HGH for the first 5 years after diagnosis, none of my doctors would confirm a connection between HGH and my cancer)

If you want to improve your strength, forget about HGH and increase your exercise. Some studies suggest this alone may be more effective than HGH supplementation for raising growth hormone levels in the body.

—William Kormos, MD
Editor in Chief, Harvard Men’s Health Watch

Originally published: July 2016

Adapted from http://www.health.harvard.edu/mens-health/are-there-any-advantages-to-human-growth-hormone

Simple Kidney Cysts vs Polycystic Kidney Disease

polycystic-kidney2

 

A kidney cyst is a swollen, round, fluid-filled sac that develops on one or both of the kidneys. These cysts can be associated with serious conditions that affect the kidney’s ability to function, but usually they do not tend to cause complications and are referred to as simple kidney cysts.

Simple kidney cysts differ from the ones that develop when a person has the genetic condition polycystic kidney disease (PKD). Simple cysts do not enlarge the kidneys, change their structure or reduce their function, as is the case in people with PKD.

Simple Kidney Cysts

It is not fully understood what causes simple kidney cysts, although it is thought that obstruction of the tiny tubules within kidneys may be the cause and a deficient supply of blood to the kidney is suspected to play a role. Also, sacs that form on the tubules, referred to as diverticula, may detach from the tubule and become simple cysts.

Whether or not genetics plays a role in the formation of these cysts has not yet been studied.

Simple kidney cysts do not usually cause symptoms, damage to the kidney, or impair its function. However, if a cyst becomes large enough, it may cause pain between the ribs and hips and press on other organs. Sometimes, the cyst can become infected, in which case a person may develop a fever, as well as pain.

A simple cyst that is causing pain or obstructing urine or blood flow through the kidney may need to be treated. A procedure called sclerotherapy is used, where the cyst is punctured with a long, thin needle and drained.

For cysts that have become very large, a procedure called laparoscopy may be performed, where a surgeon drains and removes the cyst under the guidance of a fibre-optic instrument that helps view the cyst.

PKD

PKD is a genetic condition characterized by the formation of numerous cysts on the kidneys. These cysts can cause significant enlargement of the kidneys and distort their normal structure, giving rise to chronic kidney disease and impaired kidney function. This condition can even lead to kidney failure.

The cysts seen in PKD can also cause high blood pressure, vascular problems in the brain and heart, and liver cysts.

PKD is caused by a gene mutation, which is usually inherited. The remaining cases are caused by a spontaneous gene mutation, where neither parent is a carrier of the mutation. Three different mutations have been discovered that are associated with PKD. These mutations affect proteins that are required for normal kidney development.

There are two forms of PKD: autosomal dominant PKD (ADPKD) and autosomal recessive (ARPKD). These are described in more detail below.

ADPKD

This is the most common type of inherited kidney disease, affecting about 12.5 million individuals worldwide. Cysts filled with a watery fluid form, proliferate and grow in both of the kidneys and often also in the liver and pancreas. Over time, the cysts eventually replace healthy tissue and cause loss of kidney function. Common symptoms include pain in the back and/or abdomen, hematuria, recurrent urinary tract infection, kidney stones, and kidney failure.

This condition is inherited in a “dominant” fashion, which means that there is a 50% chance that an affected parent will pass the condition on to each child they have.

ARPKD

This is a rare condition that occurs in around 1 in every 20,000 newborns. Around one in three babies born with this condition die within the first four weeks of their lives. Fluid-filled sacs form in the tubules of both kidneys and in the liver. Eventually, the cysts cause scarring or fibrosis that replaces the healthy tissue in these organs. If the fibrosis is severe enough, it can lead to kidney and liver failure. ARPKD is inherited in a “recessive” manner, that is, if both parents are carriers of this condition, there is a 25% chance that each of their children will be affected.

Reviewed by Susha Cheriyedath, MSc

Further Reading

From http://www.news-medical.net/health/Simple-Kidney-Cysts-vs-Polycystic-Kidney-Disease.aspx