Kidney - Renal Cancer

Cutaneous B-Cell Lymphoma and Lymphedema, Cutaneous T-cell lymphoma and Lymphedema, Hodgkins Lymphoma, Kidney and Renal Cancer, Cervical Cancer, Renal Cell Carcinoma, Breast Cancer, Ovarian Cancer, Testicular, arm swelling, Skin Cancer, angiosarcoma, kaposi's sarcoma, gallium scan, axillary node dissection, gynecological cancer, axillary reverse mapping, lymphatic cancers, inguinal node dissection, cancer treatment, Complete decongestive therapy for arm lymphedema, lymphedema therapy, intensive decongestive physiotherapy, breast cancer related lymphedema, upper limb lymphedema

Moderators: jenjay, Cassie, patoco, Birdwatcher, Senior Moderators

Kidney - Renal Cancer

Postby patoco » Sun Jun 11, 2006 8:56 am

Kidney - Renal Cancer

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Home page: Lymphedema People

http://www.lymphedemapeople.com

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Special Page Dedication

Steve Dunn

I would very much like to dedicate this page to Steve Dunn - want to share what someone on one of our groups posted in his honor:

A true giant in On-line Advocacy for Cancer patients, Steve Dunn, has
passed away after developing Sepis while in the hospital for treatment.

Here is the article that was posted on ACOR's manager's list about
Steve. We will all miss him dearly.

Bill

Steve Dunn died on August 19, 2005, after ten months of hospitalization
for complications from bacterial meningitis.

Steve was well known in the cancer community for his unique website
www.cancerguide.org which he established after a near-fatal bout with cancer. Experimental treatment resulted in his complete recovery from Stage IV kidney cancer. He became a tireless advisor and advocate for other cancer patients. Steve was vital to the Association of Cancer Online Resources, where hemanaged a number of mailing lists for cancer patients and their families. He served as a member of advisory committees with the FDA and other organizations. Steve's work will go
on through the many people whom he inspired with his dedication and
expertise.

Steve was the proud father of one daughter, now five years old. He was also an avid mountain climber, backpacker, skier, biker, and runner.

Email messages in memory of Steve may be sent to
STEVE-MEMORIAL@ACOR.ORG

These messages are displayed online at

http://listserv.acor.org/archives/steve-memorial.html

((Many of you have asked what you can do in Steve's honor, so here is the information. Steve left his family well taken care of financially, so there is no need for donations to them. They agree the following is what Steve would want:))

Donations in memory of Steve may be made to ACOR, where they will be
used to maintain his Cancerguide website. We all want his work to
continue.

Send a check made out to ACOR with the words "Steve Dunn" in the memo area (at bottom left on the check). The address is:

ACOR
Donor Services
173 Duane St
New York, NY 10013-3334

You can also donate online at: http://tinyurl.com/dgd6q

(This will take you to ACOR's own page at NetworkForGood; or you can go to the main webpage at www.networkforgood.org and enter ACOR or Association of Cancer Online Resources to find the right page for your donations.)

Dedicate your gift to Steve Dunn.

You may forward this information as you see fit.

****See also: ****

http://www.cancerguide.org/kidney.html

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Kidney Cancer

Primary kidney cancer, also called renal cancer, is a malignant tumor that originates in the kidney. There are two main types of primary kidney tumors -- renal-cortical tumors and transitional cell tumors.

Renal-cortical tumors account for nearly 90 percent of all kidney tumors. Transitional cell tumors of the kidneys and ureters are similar to bladder tumors. Kidney cancer rarely strikes children and young adults; the exception is a pediatric kidney cancer called Wilms' tumor.

Risk Factors

Studies have shown that certain lifestyle factors increase the risk of developing renal tumors. Smoking, high blood pressure, eating a high-fat diet, and obesity all may contribute to an increased risk of kidney tumors.

Although we don't know all the causes of kidney cancer, the following factors can also increase the risk of developing this disease:

long-term dialysis, a process in which a machine filters the blood of a person without functioning kidneys

exposure to asbestos, such as occupational exposure

exposure to cadmium, a metal which can increase the cancer-causing effect of smoking

a family history of kidney cancer

von Hippel-Lindau syndrome, a disease that is caused by a genetic mutation that leads to multiple tumors in the kidney, often at an early age

tuberous sclerosis, a disease characterized by several bumps on the skin, seizures, mental retardation, and cysts in the kidneys, liver, and pancreas

If you are exposed to asbestos or cadmium at work, be sure to follow occupational safety practices that limit your exposure.

Symptoms

Kidney cancer usually shows no symptoms in the early stages. It is generally not suspected until the patient begins to experience symptoms; at this point the tumor may have grown fairly large.

As the cancer progresses, symptoms may include some of the following:

blood in the urine

low back pain that cannot be accounted for by something else (such as an injury)

a mass or lump in the abdomen

fatigue

unexplained weight loss, which may be rapid

fever that is not due to a cold or flu

swelling of the ankles and legs (due to an impaired ability to rid the body of liquid waste)

Some of these symptoms may be due to other causes, such as an infection. But you should see your doctor to determine what is causing them and how they should be treated.

Diagnosis

Kidney cancer is less common in the United States than many other cancers, such as those of the breast and colon. Therefore, there are no widely used screening programs for kidney cancer in this country; that is, apparently healthy people do not usually have regular examinations for this cancer. However, people who are on long-term kidney dialysis and those with von Hippel-Lindau disease or tuberous sclerosis may benefit from periodic evaluation of their kidneys to check for early signs of kidney cancer.

Most kidney tumors are found incidentally -- when patients are being evaluated with radiologic imaging studies for other non-specific abdominal complaints (gallbladder pain, for example), or during follow-up for other previously treated malignancies. These "incidental cancers" are often found early, before any symptoms have occurred. Because these cancers are usually detected before they have spread, patients with incidental kidney tumors are often cured of their disease, commonly by surgery alone.

Moreover, as many as 25 percent of kidney masses represent a benign condition. Often, Memorial Sloan-Kettering doctors may repeat radiologic imaging with precise studies aimed at the kidney alone to diagnose a benign mass without the need for a biopsy or any surgical intervention.

If your doctor suspects you have a kidney tumor, you may undergo computed tomography (CT) scanning or magnetic resonance imaging (MRI). Recently developed imaging techniques -- including 3-D CT, 3-D MRI angiography, and CT urography -- reveal detailed anatomy, allowing the doctor to plan surgery, often using a single imaging test. Radiologists at Memorial Sloan-Kettering are leaders in the use of these studies. Ultrasound may be used to determine if a kidney mass is a fluid-filled cyst or a solid tumor.

If you doctor suspects that you have cancer of the renal pelvis, or transitional cell carcinoma, he or she may perform a cytoscopy -- in which small tube with a lens is inserted into the urethra so the bladder and urethra can be seen; a pyelogram; or a ureteroscopy, in which a narrow lighted tube is passed through your urethra, into your bladder, into a ureter, and into the renal pelvis to look for signs of cancer.

Your doctor may remove a small piece of tissue to examine (biopsy) for cancer cells.

It is now understood that kidney tumors are a family of tumors with varying degrees of aggressiveness. About 90 percent of all kidney tumors are classified as renal-cortical tumors. These tumors are actually a family of different tumor types. About 65 percent of renal-cortical tumors are the conventional, or clear-cell type, which have the most malignant potential. The remaining 35 percent are oncocytomas (which are virtually benign) and two types of indolent (slow-growing) tumors -- papillary carcinoma and chromophobe carcinoma.

After surgery to remove a renal-cortical tumor, doctors will examine the tumor cells to determine which of the cell types mentioned above is present. Our doctors can then use this information, along with the size of the tumor, and other aspects of the tumor's growth, to more accurately predict the patient's prognosis and determine whether further treatment is necessary.

In addition to these tests, your doctor will take your medical history into account, perform a physical examination, and order laboratory studies such as blood and urine tests.

Treatment

For those diagnosed with a kidney tumor, Memorial Sloan-Kettering offers the most comprehensive and advanced treatment options to both eradicate the disease and preserve the patient's ability to function normally.

Our physicians help to determine the choice of treatment for a kidney tumor depending on the specific tumor size, location, and stage of the disease -- that is, how large the tumor has grown, how deeply it has invaded the kidney, and whether it has spread to nearby organs, lymph nodes, or another part of the body. Treatment may include surgery, chemotherapy, radiation therapy, or immunological therapy, alone or in combination.

Our doctors are experts in the management of both localized and advanced kidney tumors.

Surgery

Surgery is the most common form of treatment for kidney tumors, and it is often the only treatment necessary. Memorial Sloan-Kettering's urologic surgeons have expertise in all surgical approaches to kidney tumors, including kidney-sparing and laparoscopic surgery.

If an operation is necessary, our team of specialists will evaluate the patient and, based on the size and location of the tumor, recommend either the removal of the tumor (partial nephrectomy) or removal of the entire tumor-bearing kidney (complete or radical nephrectomy).

Partial Nephrectomy: Kidney-Sparing Surgery

Kidney-sparing (or nephron-sparing) surgery is the term used for the removal of a kidney tumor, leaving a margin of normal kidney tissue, in order to preserve the function of the remaining kidney. Studies from Memorial Sloan-Kettering and other institutions have demonstrated equal results between partial and complete nephrectomy in patients with small tumors (less than 4 centimeters), while maintaining functioning kidney tissue. Our surgeons are among the most experienced world-wide in these technically demanding operations. In appropriate situations, our team can offer laparoscopic partial nephrectomy.

Complete (Radical) Nephrectomy

In some situations, the entire kidney needs to be removed. These tend to be larger tumors that have advanced locally, and sometimes they have advanced to another part of the body. Our team can help determine whether patients with such tumors may be best served by laparoscopic or open nephrectomy. Because we are able to offer all possible modes of treatment, we can tailor the approach to each individual patient.

For transitional cell carcinoma of the kidneys and ureters, surgical approaches include nephroureterectomy (removal of the kidney and ureter) and segmental resection (partial removal of the ureter). These procedures can also be performed laparoscopically. When transitional cell carcinoma is found on the surface of the renal pelvis or ureter, it may be treated by laser surgery, which uses a narrow beam of light to remove cancer cells.

During the surgery, the doctor may remove nearby lymph nodes to examine them for cancer cells. Doctors will examine the cells of the tumor to determine which type of cancer is present.

Systemic (Whole-Body) Therapy

Chemotherapy -- treatment with anticancer drugs -- is sometimes used in addition to surgery to treat kidney cancer. Conventional, or clear-cell, renal cancer does not respond to chemotherapy, so any drugs that are used are being evaluated as part of a clinical trial, in an effort to find more effective treatments. Transitional cell carcinoma is sensitive to chemotherapy, so it is used to treat patients with advanced cancer of this type. Sometimes it is helpful to apply such chemotherapy directly to the tumor by feeding teh drug into the renal pelvis. This so-called intrapelvic chemotherapy is sometimes done in addition to surgery.

For kidney tumors that have spread widely to other parts of the body, Memorial Sloan-Kettering's medical oncologists have access to the latest systemic immunotherapies available. Two such drugs that stimulate the immune system -- interleukin 2 and interferon -- have shown promise in treating renal cancer.

Another type of immunotherapy being investigated by our doctors involves the donation of stem cells (blood-forming cells) to the patient from a relative who has compatible stem cells -- this is an allogeneic stem cell transplant. T lymphocytes -- certain white blood cells in the donated stem cells -- frequently see an organ of the patient (host) as foreign, and attack the organ. This is called graft versus host disease (GvHD). The hope is that the cells from the donor will see the tumor as "foreign" and attack it as well. Before the stem cell transplantation, the patient will receive chemotherapy drugs to suppress the immune system and to destroy some of their own bone marrow cells, so the new stem cells from the donor will grow.

Radiation Therapy

Radiation therapy is sometimes given as the primary form of treatment for patients who are not well enough to undergo surgery. It can also be used to relieve the symptoms of kidney cancer, such as pain.

Rehabilitation Therapy

For patients with kidney cancer, rehabilitation therapy provides a means to improve function and mobility after surgery or chemotherapy. Memorial Sloan Kettering's physical therapists evaluate patients' functional needs shortly after surgery or hospitalization and design an individualized treatment and exercise plan to increase each patient's strength, endurance, and balance and thereby improve their mobility and function. After chemotherapy, radiation, or abdominal surgery for cancer, a patient may notice changes in his or her range of motion, strength, flexibility, balance, and endurance. Occupational therapists educate patients about these changes and about adaptive equipment and compensatory techniques that can increase their independence during their daily routines. They also evaluate and treat patients' ability to perform basic daily activities such as bathing, dressing, and moving around their environment.

http://www.mskcc.org/mskcc/html/362.cfm

Information from Memorial Sloan-Kettering Cancer Center

http://www.mskcc.org/mskcc/html/44.cfm

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Arm and Leg Swelling After Cancer

With the advent of better and more effective cancer treatments, the survival rate for all cancers has risen dramatically. With this progress, a new and often misunderstood and misdiagnosed complication has arisen.

Many cancer survivors , having overcome cancer, find themselves with sudden and often unexplained swelling, usually of the arms or of the legs.

This swelling occurs because of one of several factors.

First, the swelling begins after lymph nodes have been removed for cancer biopsies.

Second, the swelling may start as a result of radiation damage to either the lymph nodes and/or the lymph system.

Due to either the removal of lymph nodes or damage to the lymph system, your body is no longer able to rid itself of excess fluids. The fluids collect in the limbs effected and swelling beings.

This swelling is called lymphedema. The swelling that occurs is permanent, and while it is not curable it is treatable.

Permanent Leg Swelling

****In the situation of any permanent leg swelling whether the cause is known or unknown, the diagnoses of lymphedema must be considered****

There are several groups of people who experience leg swelling from known causes, but it doesn't go away or unknown causes where the swelling can actually get worse as time goes by.

Group One

This group includes those who have had the injuries, infections, insect bites, trauma to the leg, surgeries or reaction to a medication. When this swelling does not go away, and becomes permanent it is called secondary lymphedema.

Group Two

Another extremely large group that experiences permanent leg swelling are cancer patients, people who are morbidly obese, or those with the condition called lepedema. What causes the swelling to remain permanent is that the lymph system has been so damaged that it can no longer operate normally in removing the body's waste fluid.

In cancer patients this is the result of either removal of the lymph nodes for cancer biopsy, radiation damage to the lymph system, or damage from tumor/cancer surgeries.

This is also referred to as secondary lymphedema.

Group Three

Group three consists of people who have leg swelling from seemingly unknown reasons. There may be no injury, no cancer, no trauma, but for some reason the leg simply is swollen all the time.

The swelling may start at birth, it may begin at puberty, or may begin in the 3rd, 4th or even 5th decade of life or sometimes later.

This type of leg swelling is called primary lymphedema. It can be caused by a genetic defect, malformation or damage to the lymph system while in the womb or at birth or be part of another birth condition that also effects the lymph system.

This is an extremely serious medical condition that must be diagnosed early, and treated quickly so as to avoid painful, debilitating and even life threatening complications. Treatment should NOT include the use of diuretics.

What is Lymphedema?

Lymphedema is defined simply as an accumulation of excessive protein rich fluid in the tissues of the leg. The accumulation of fluid causes the permanent swelling caused by a defective lymph system.

A conservative estimate is that there may be 1-2 million people in the United States with some form of primary lymphedema and two to three million with secondary lymphedema.

What are the symptoms of Lymphedema?

If you are an at risk person for leg lymphedema there are early warning signs you should be aware of. If you experience any or several of these symptoms, you should immediately make your physician aware of them.

1.) Unexplained aching, hurting or pain in the leg.

2.) Experiencing "fleeting lymphedema." This is where the limb may swell, even slightly, then return to normal. This may be a precursor to full blown leg lymphedema.

3.) Localized swelling of any area. Sometimes lymphedema may start as swelling in one area, for example the foot, or between the ankle and knee. This is an indication of early lymphatic malfunction.

4.) Any arm inflammation, redness or infection.

5.) You may experience a feeling of tightness, heaviness or weakness of the leg.

How is Lymphedema Treated?

The preferred treatment today is decongestive therapy. The forms of therapy are complete decongestive therapy (CDT) or manual decongestive therapy (MDT), there are variances, but most involve these two type of treatment.

It is a form of massage therapy where the leg is very gently massaged to actually move the fluid out of the leg and into an area where the lymph system still functions normally.

With these massage treatments, swelling is reduced and then the patient is fitted with a pre-measured custom pressure garment to keep the swelling down and/or is taught to use compression wraps to maintain the leg size.

What are some of the complications of lymphedema?

1. Infections such as cellulitis, lymphangitis, erysipelas. This is due not only to the large accumulation of fluid, but it is well documented that lymphodemous limbs are localized immuno-deficient.

2. Draining wounds that leak lymphorrea which is very caustic to surrounding skin tissue and acts as a port of entry for infections.

3. Increased pain as a result of the compression of nerves usually caused by the development of fibrosis and increased build up of fluids.

4. Loss of Function due to the swelling and limb changes.

5. Depression - Psychological coping as a result of the disfigurement and debilitating effect of lymphedema.

6. Deep venous thrombosis again as a result of the pressure of the swelling and fibrosis against the vascular system. Also, can happen as a result of cellulitis, lymphangitis and infections.

7. Sepsis, Gangrene are possibilities as a result of the infections.

8. Possible amputation of the limb.

9. Pleural effusions may result if the lymphatics in the abdomen or chest are to overwhelmed to clear the lung cavity of fluids.

10. Skin complications such as splitting, plaques, susceptibility to fungus and bacterial infections.

11. Chronic localized inflammations.

Can lymphedema be cured?

No, at the present time there is no cure for lymphedema. But it can be treated and managed and most of the complications can be avoided. Life with lymphedema can still be active and full, with proper treatment, patient education, and patient life style adaptation.

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Information and Resources for Kidney/Renal Cancer

National Kidney Cancer Association

http://www.nkca.org/

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Kidney Cancer - Medline Plus

Links and Information Page

http://www.nlm.nih.gov/medlineplus/kidneycancer.html

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Kidney cancer information centre

CancerBacup - UK

http://www.cancerbacup.org.uk/Cancertype/Kidney

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Kidney Cancer UK

http://www.kcuk.org/

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Kidney Cancer Treatment and Research

National Cancer Institute

http://web.ncifcrf.gov/research/kidney/

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What Is Kidney Cancer (Renal Cell Carcinoma)?

http://www.cancer.org/docroot/cri/conte ... cer_22.asp

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Kidney Cancer

MedicineNet

http://www.medicinenet.com/kidney_cancer/article.htm

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Kidney Cancer

Cancer Information Network

http://www.cancerlinksusa.com/kidney/index.asp

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American Cancer Society

http://www.cancer.org/docroot/home/index.asp

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Cancer Information on the Internet

http://www.hackley.org/medical_services ... _links.htm

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Cancer Resource Center

http://patient.cancerconsultants.com/li ... x?id=32333

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Cancer Lynx

http://www.cancerlynx.com/

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Cancer Information & Support International

http://www.cancer-info.com/

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Lymphedema

WHAT IS IT?

Lymphedema is a buildup of a fluid called lymph and protein in the tissues under the skin. Lymph accumulates when there is an obstruction to normal flow causing swelling, usually in an arm or leg. The lymph system is similar to the blood system in its network of vessels that carry lymph fluid throughout the body.

Trauma to lymphatic tissue by surgery or radiotherapy is the main cause of lymphedema in the context of cancer. It can result from surgery and/or radiation therapy during treatment for cancers of the breast, abdomen, melanoma, connective tissues (sarcomas) and the pelvic area, as well as lymphomas, in both men and women. Lymphedema may also be the result of infection, such as dermatophytosis in the foot.

Cancer tumors also can block the lymph vessels, especially in people with prostate cancer or lymphoma.

IF I HAVE CANCER WILL I DEVELOP LYMPHEDEMA?

Not necessarily. The most frequent cases occur in women with breast cancer; 10% to 25% of breast cancer patients will develop lymphedema. While most cases are mild, approximately 400,000 women cope daily with some degree of disfigurement, discomfort, and sometimes disability because of arm and hand swelling.

Because of improvements in radiation and surgical techniques (such as removing smaller samples of lymph nodes), lymphedema is less common today than it use to be. Lymphedema develops in about one in four breast cancer patients who have a mastectomy with lymph-node dissection. The risk doubles for those who also receive radiation treatments to the underarm area.

Radical prostatectomy, a procedure that removes the prostate gland, seminal vesicles and sometimes the nearby pelvic lymph nodes, can lead to lymphedema .One type of Kaposi’s sarcoma is called the lymphadenopathic form that can spread throughout the body and may aggressively involve lymph nodes, viscera, and occasionally the GI tract – resulting in a kind of lymphedema.

SENTINEL LYMPH NODE BIOPSY

If breast cancer spreads, it first goes to the lymph nodes under the arm. That's why women with breast cancer have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible, but this greatly increased the risk of lymphedema. More recently, a growing number of physicians have begun focusing on finding the sentinel nodes — the first nodes to receive the drainage from breast tumors and therefore the first to show evidence of cancer’s spread. Experts believe that if a sentinel node is removed and found to be healthy, then the chance of finding cancer in any of the remaining nodes is very small and no other nodes need to be removed. This spares as many as 75% of women who have no evidence of tumor spread to the axillary nodes the risk of complications, especially lymphedema.

WHEN DOES IT DEVELOP?

Lymphedema can appear any time after surgery or radiation treatment including many years later.

When the condition develops very soon after surgery, it is usually mild, and goes away within one to two weeks. It can also develop six to eight weeks after surgery or radiation. Again, this type of lymphedema usually goes away in a few weeks.

Unfortunately, the more common form of lymphedema in cancer survivors develops slowly over time. It may show up many months or even years after treatment ends and swelling can range from mild to severe. In most cases however, lymphedema appears between six and 12 months after treatment. While people who have many lymph nodes removed and radiation therapy have the highest risk of developing lymphedema, some high-risk patients won’t develop the condition.

WHEN TO CALL A PROFESSIONAL

Patients should contact a physician if they had a mastectomy, lower abdominal surgery or radiation treatments in the past, and the affected limb becomes red, painful or hot, or if it develops open sores or areas of broken skin. Doctors should be consulted especially if there is a fever in addition to swelling.

Diagnostic Tests

Usually, no specific testing is necessary to diagnose lymphedema, but tests may be done such as a blood count that can identify signs of infection. Ultrasound may be ordered to look for blood clots, which can cause swelling. Computed tomography (CT) may be used to find a tumor that could be blocking lymph vessels. In addition, there are more specialized tests that can identify lymph flow and lymph vessel abnormalities.

Symptoms

The first signs of lymphedema can be a change in a patient’s arms or legs or other affected area such as the groin. Initially, skin will remain soft, but if the problem continues, the limb may become hot and red and the skin hard and stiff. The lymph fluid that collects in the tissues can be very uncomfortable, but pain is not always present. Early symptoms of lymphedema may include:

A feeling of tightness around the arm on the area that was treated for cancer,

Decreased flexibility in a hand, elbow, wrist, fingers, or leg,

Difficulty fitting into clothing,

Tight fit of a ring, wristwatch, bracelet, or shoe,

Weakness, pain, aching or heaviness in the arm, legs, or feet,

Skin that looks shiny, has fewer folds, and feels stiff or taut,

A dull ache in the affected limb,

A feeling of tightness in the skin of the affected limb,
Difficulty moving a limb or bending at a joint because of swelling and skin tightness,

Pitting (small indentations left on the skin after pressing on the swollen area)

In most cases, only one arm or leg is affected. If the leg is involved, swelling usually begins at the foot, then progresses upward toward the ankle, calf and knee.

Severity

The severity is directly related to the extent of surgery and radiation treatment to the lymph nodes. Severity and general risk of developing lymphedema seems to increase with obesity, weight gain and infection in the affected area.

TREATMENTS

Lymphedema has no cure so treatment focuses on reducing the symptoms. Treatment has varied from virtually no treatment to surgery, but there are various practical methods to deal with the condition, including elevation of the limb (in the first year only), compression garments (no greater than 20-30 mm Hg), certain types of massage and exercises, pneumatic compression devices (controversial), and other types of physical therapy. Experts also recommend keeping the affected limb clean, dry and lubricated.

The National Lymphedema Network (www. Lymphnet.org) encourages massage by an specially certified expert in lymphedema massage.. In many cases, patients can also be trained to massage themselves to improve the flow of lymph fluids.

Medications

There are no medications to treat lymphedema. Diuretics have been found to be ineffective and may actually exacerbate the condition. Other medicines have been tried, but there is no clear evidence of significant effectiveness with any particular drug.

MILD LYMPHEDEMA:

Elevating the arm or leg above the level of the heart(during the first year) and flexing it frequently are basic methods to manage the condition. Since elevation is impractical except for short periods, patients should be fitted with an elastic sleeve, covering the arm or leg.

A significant reduction in edema (swelling) has been reported after wearing elastic sleeves for 6 consecutive hours per day. Using these garments during exercise, physical activity, and especially air travel is recommended, since air travel seems to exacerbate the condition.

If the legs are affected, avoid periods of prolonged standing. If working or standing a lot, a doctor may prescribe special graduated compression stockings to wear throughout the day. A doctor may also suggest a protein-rich, low-salt diet for those who are over-weight or obese.

MODERATE TO SEVERE:

For people with moderate to severe lymphedema in the legs, doctors prescribe pneumatic compression devices to be used at home to help reduce limb swelling. The “pneumatic stockings” are worn every day for an hour or two to reduce the swelling. Once the swelling has been reduced, a person may still need to wear elastic stockings up to the knee every day from the moment of rising until bedtime.

For lymphedema in the arm, pneumatic sleeves--like pneumatic stockings--can be used every day to reduce the swelling; elastic sleeves may also be needed.

Others recommend a special type of massage therapy called manual lymph drainage. Antibiotics also may be prescribed to prevent or treat infection in the affected limb. Since skin infections can be more serious in people with lymphedema, a person may need to have antibiotics administered intravenously in the hospital during an infection.

Complex Decongestive Therapy

More serious cases of lymphedema can be treated with Complex Decongestive Therapy by a physical therapist or other health care professional, who has special training. Complex Decongestive Therapy consists of skin care, massage, special bandaging, exercise, and fitting for a compression sleeve. Seeking and getting treatment early should lead to a shorter course of treatment to get the lymphedema under control. While most insurance companies will pay for this treatment, some do not.

Someone certified in the procedure should perform Manual Lymph Drainage (MLD).

In the case of lymphedema of the arm, the procedure involves a type of massage that moves built up fluid around the blocked vessels and across the chest to the other side of the body where the lymphatic system is still in tact. Usually the healthy area will be “worked” first. After each treatment, the effected area is carefully bandaged with a special layered wrap that looks like an ace bandage but is made of a different fabric. The wrap is important for keeping the effected limb de-congested. An average course is 15 daily treatments of 60 to 90 minutes each. After a MLD course of treatments, the patients will wear a compression garment every day. The patient should be measured for a new compression sleeve every six months or so. Sometimes a yearly MLD treatment course is recommended as a kind of “tune up.”

PREVENTING COMPLICATIONS

Because lymphedema development may occur even after several decades, patients should monitor themselves for signs of lymphedema and report any changes to their physicians.

Prevention is important and can require daily attention to manage the symptoms of swelling in particular. Arm and hand precautions are based on two key ideas: (1) Do not increase lymph production, which is directly proportional to blood flow, and (2) do not increase blockage to lymph system. Therefore, patients should avoid excessive heat, infections, and overly-strenuous arm exercises which would increase blood flow in the arm and thereby increase lymph production.

MANAGING LYMPHEDEMA

Patients should follow these suggestions to manage their lymphedema:

Avoid puncturing or injuring the skin in any way. Use first aid care if there is a break in the skin.

Avoid vaccinations, injections, blood pressure monitoring, blood drawing, and intravenous administration in the arm affected.

Avoid tight-fitting clothing or jewelry.

Avoid heat, such as with sunburns or tanning, baths, and saunas.

Avoid strenuous exertion, but do exercise while wearing compression garments.

Exercise, But Avoid Muscle Strain
It is important to use your affected limb for normal everyday activities, yet overuse can cause lymphedema to occur in some people. Follow these suggestions whenever possible:

Use affected arm or leg as normally as possible until fully healed, about 4 to 6 weeks after surgery or radiation treatment.

Exercise regularly but do not strain the arm or leg. Before any strenuous exercise, such as weightlifting or tennis, talk with a doctor, nurse, or physical therapist about specific goals and limitations to decide what level of activity is right. Ask if a fitted sleeve or stocking should be worn during strenuous activities or while flying.

If an arm or leg starts to ache, lie down and elevate it.

Avoid vigorous, repeated activities, heavy lifting, or pulling.

Watch for early signs of infection: rash, red blotches, swelling, increased heat, tenderness, or fever. Call a doctor right away if there are signs of infection.

Experts also recommend that those with lymphedema avoid any trauma to the area affected.

Trauma includes extreme temperature changes, repetitive movements against resistance (pushing or pulling), heavy lifting, and excessive exercise.

For More Information

American Cancer Society

The American Cancer Society held an international conference on lymphedema in 1998 in New York City. It involved 60 of the world’s leading experts and included a forum of more than 250 breast cancer survivors, leaders of breast cancer advocacy groups, and others. The conference report plus a lymphedema resource guide are available as a book from the ACS at cancer.org. (See below for title.)

National Lymphedema Network

The National Lymphedema Network is a charitable organization with an international scope. Founded in 1988, the Network’s mission is to provide education and guidance to patients and health care professionals. The Network promotes standardizing quality treatment for lymphedema patients. In addition, the organization supports research into the causes and possible alternative treatments for this “often incapacitating, often-neglected condition.”

Sources:

Current Trends in Lymphedema Management, Esther Muscari Lin, RN, MSN, CS, ACNP, AOCN, November 7, 2002.
American Cancer Society, Cancer (Vol. 92, No. 4: 748-752). http://www.cancer.org/

Cancer Principles and Practices of Oncology, Lippincott Williams &
Wilkins, 6th Edition, 2001. http://www.lww.com/productdetailresults ... 60,00.html

Harvard Medical School, Intelihealth.com, http://www.intelihealth.com/IH/ihtIH?t= ... SIHW000|~b, |

Lymphatic Research Foundation, http://www.lymphaticresearch.org/

Lymphedema Online Support Group, http://www.acor.org/.

Lymphology Association of North America, offers professional certification. http://www.clt-lana.org/main.html

Merck Manual, 17th Edition, 1999. http://www.merck.com/pubs/mmanual_home/contents.htm

National Lymphedema Network,

http://www.lymphnet.org/

https://www.cancerpage.com/centers/Side ... hedema.asp
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General Information About Renal Cell Cancer

Postby patoco » Fri Jul 06, 2007 10:27 pm

General Information About Renal Cell Cancer

National Cancer Institute / US National Institutes of Health

Renal cell cancer is a disease in which malignant (cancer) cells form in tubules of the kidney.

Renal cell cancer (also called kidney cancer or renal adenocarcinoma) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. The tiny tubules in the kidneys filter and clean the blood, taking out waste products and making urine. The urine passes from each kidney into the bladder through a long tube called a ureter. The bladder stores the urine until it is passed from the body.

Cancer that starts in the ureters or the renal pelvis (the part of the kidney that collects urine and drains it to the ureters) is different from renal cell cancer. Refer to the PDQ summary on Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment for more information).

Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer.

Risk factors include the following:

Smoking.

Misusing certain pain medicines, including over-the-counter pain medicines, for a long time.

Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.

Possible signs of renal cell cancer include blood in the urine and a lump in the abdomen.

These and other symptoms may be caused by renal cell cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows.

A doctor should be consulted if any of the following problems occur:

Blood in the urine.
A lump in the abdomen.
A pain in the side that doesn't go away.
Loss of appetite.
Weight loss for no known reason.
Anemia.

Tests that examine the abdomen and kidneys are used to detect (find) and diagnose renal cell cancer.

The following tests and procedures may be used:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.

Blood chemistry studies: A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.

Urinalysis: A test to check the color of urine and its contents, such as sugar, protein, red blood cells, and white blood cells.

Liver function test: A procedure in which a sample of blood is checked to measure the amounts of enzymes released into it by the liver.

An abnormal amount of an enzyme can be a sign that cancer has spread to the liver. Certain conditions that are not cancer may also increase liver enzyme levels.

Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.

Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram.

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography,
computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. To do a biopsy for renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is withdrawn.

Certain factors affect prognosis (chance of recovery) and treatment options.

The prognosis (chance of recovery) and treatment options depend on the following:

The stage of the disease.
The patient's age and general health.

After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body.

The process used to find out if cancer has spread within the kidney or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.

The following tests and procedures may be used in the staging process:

CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).

Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner.

The following stages are used for renal cell cancer:

Stage I

In stage I, the tumor is 7 centimeters or smaller and is found only in the kidney.

Stage II

In stage II, the tumor is larger than 7 centimeters and is found only in the kidney.

Stage III

In stage III, cancer is found:

in the kidney and in 1 nearby lymph node; or
in an adrenal gland or in the layer of fatty tissue around the kidney, and may be found in 1 nearby lymph node; or
in the main blood vessels of the kidney and may be found in 1 nearby lymph node.

Stage IV

In stage IV, cancer has spread:

beyond the layer of fatty tissue around the kidney and may be found in 1 nearby lymph node; or
to 2 or more nearby lymph nodes; or
to other organs, such as the bowel, pancreas, or lungs, and may be found in nearby lymph nodes.

Recurrent Renal Cell Cancer

Recurrent renal cell cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back many years after initial treatment, in the kidney or in other parts of the body.

There are different types of treatment for patients with renal cell cancer.

Different types of treatments are available for patients with renal cell cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Five types of standard treatment are used:

Surgery

Surgery to remove part or all of the kidney is often used to treat renal cell cancer. The following types of surgery may be used:

Partial nephrectomy: A surgical procedure to remove the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed.

Simple nephrectomy: A surgical procedure to remove the kidney only.

Radical nephrectomy: A surgical procedure to remove the kidney, the adrenal gland, surrounding tissue, and, usually, nearby lymph nodes.

A person can live with part of 1 working kidney, but if both kidneys are removed or not working, the person will need dialysis (a procedure to clean the blood using a machine outside of the body) or a kidney transplant (replacement with a healthy donated kidney). A kidney transplant may be done when the disease is in the kidney only and a donated kidney can be found. If the patient has to wait for a donated kidney, other treatment is given as needed.

When surgery to remove the cancer is not possible, a treatment called arterial embolization may be used to shrink the tumor. A small incision is made and a catheter (thin tube) is inserted into the main blood vessel that flows to the kidney. Small pieces of a special gelatin sponge are injected through the catheter into the blood vessel. The sponges block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow.

Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Targeted therapy

Targeted therapy uses drugs or other substances that can find and attack specific cancer cells without harming normal cells. Antiangiogenic agents are a type of targeted therapy that may be used to treat advanced renal cell cancer. They keep blood vessels from forming in a tumor, causing the tumor to starve and stop growing or to shrink.

New types of treatment are being tested in clinical trials. These include the following:

Stem cell transplant

Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and given to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI

Treatment Options for Renal Cell Cancer

Stage I Renal Cell Cancer

Treatment of stage I renal cell cancer may include the following:

Surgery (radical nephrectomy, simple nephrectomy, or partial nephrectomy).
Radiation therapy as palliative therapy to relieve symptoms in patients who cannot have surgery.
Arterial embolization as palliative therapy.
A clinical trial of a new treatment.

Information about ongoing clinical trials is available from the NCI Web site.

http://www.cancer.gov/clinicaltrials

Stage II Renal Cell Cancer

Treatment of stage II renal cell cancer may include the following:

Surgery (radical nephrectomy or partial nephrectomy).
Surgery (nephrectomy), before or after radiation therapy.
Radiation therapy as palliative therapy to relieve symptoms in patients who cannot have surgery.
Arterial embolization as palliative therapy.
A clinical trial of a new treatment.

Information about ongoing clinical trials is available from the NCI Web site.

Stage III Renal Cell Cancer

Treatment of stage III renal cell cancer may include the following:

Surgery (radical nephrectomy). Blood vessels of the kidney and some lymph nodes may also be removed.

Arterial embolization followed by surgery (radical nephrectomy).
Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.

Arterial embolization as palliative therapy.
Surgery (nephrectomy) as palliative therapy.
Radiation therapy before or after surgery (radical nephrectomy).
A clinical trial of biologic therapy following surgery.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Stage IV and Recurrent Renal Cell Cancer

Treatment of stage IV and recurrent renal cell cancer may include the following:

Targeted therapy alone or after biologic therapy.
Biologic therapy alone or after surgery (nephrectomy) to reduce the size of the tumor.
Arterial embolization as palliative therapy to relieve symptoms and improve the quality of life
Radiation therapy as palliative therapy to relieve symptoms and improve the quality of life.
Surgery (nephrectomy) as palliative therapy.
Surgery (radical nephrectomy, with or without removal of cancer from other areas where it has spread).
A clinical trial of chemotherapy.

This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.

Changes to This Summary (01/11/2007)

The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.

Changes were made to this summary to match those made to the health professional version.

http://www.cancer.gov/cancertopics/pdq/ ... ient/page1
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Postby patoco » Fri Jul 06, 2007 10:36 pm

Additional sources of information and support:

Renal Cell Carcinoma
eMedicine

http://www.emedicine.com/med/topic2002.htm

............

What Is Kidney Cancer (Renal Cell Carcinoma)?

American Cancer Society

http://www.cancer.org/docroot/cri/conte ... cer_22.asp

............

Dean R. O'Neill Renal Cell Cancer Rsearch Foundation

http://www.renalcellcancer.org/

............

Renal Cell Cancer

National Cancer Institute

http://www.meb.uni-bonn.de/cancer.gov/C ... 62894.html

............
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