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UNDERSTANDING RCC RENAL CELL CARCINOMA the most common form of kidney cancer RENAL CELL CARCINOMA ABOUT THIS GUIDE ❑ Help you understand renal cell carcinoma (RCC) ❑ This guide will: Provide information on its causes and treatment CONTENTS What is RCC? .....................................................................................................4 Who is at increased risk for RCC? .......................................................................4 How does RCC start? .........................................................................................4 How does RCC spread? ......................................................................................4 What tests are used to detect RCC? .....................................................................6 What are the stages of RCC? ...............................................................................8 What are the treatments for RCC? ....................................................................10 What should I ask my doctors or nurses about my condition?.............................13 What’s next? ......................................................................................................14 Cancer resources ................................................................................................18 Patient support resources....................................................................................19 2 RCC RENAL CELL CARCINOMA ❑ RCC is a cancer that begins in the kidneys ❑ WHAT IS RCC? It is the most common kind of kidney cancer – About 46,000 people in the United States were diagnosed with RCC in 2007 ❑ People who smoke ❑ People who are obese ❑ People who overuse certain pain medicines, including over-thecounter medicines, for a long time ❑ WHO IS AT INCREASED RISK FOR RCC? People who have certain genetic conditions, such as von HippelLindau (VHL) disease ❑ RCC starts as a single cancer cell in the kidney. The cell then grows, divides, and multiplies when it shouldn’t ❑ HOW DOES RCC START? A tumor forms once enough cancer cells are made 4 ❑ As the tumor gets larger, some of the cancer cells may get into the blood and spread to other parts of the body ❑ RCC often grows as a single tumor in one kidney – Sometimes more than one tumor grows in one kidney – Less often, tumors grow in both kidneys at the same time ❑ HOW DOES RCC SPREAD? New tumors may then develop in other organs – These new tumors are called metastases – This condition is called metastatic RCC (mRCC) – For example, cancer from the kidney can spread to the lungs. If this happens, it is still called RCC. It is not called lung cancer. This is because the cancer started in the kidney, not in the lungs RCC KIDNEY CROSS-SECTION Example of renal cell carcinoma Terms to Know kidney—One of a pair of organs that remove waste products from the blood. In the process, they make urine to help carry waste out of the body. One is on the left side of the abdomen. The other is on the right side. metastases—Tumors that result from the spread of the primary tumor. von Hippel-Lindau (VHL) disease—The VHL gene helps to prevent tumor growth. If the gene is not working the way it should, RCC can develop. 5 RENAL CELL CARCINOMA WHAT TESTS ARE USED TO DETECT RCC? Your doctor may use any or all of the following tests and procedures: Biopsy 6 ❑ MRI or NMRI ❑ CT scan (or CAT scan) ❑ Ultrasound ❑ Urine test (or urinalysis) This measures the amount of enzymes the liver releases into the blood to make sure that cancer has not spread to the liver ❑ Liver function test These measure the amounts of certain substances released into the blood by organs and tissues This test checks the color and contents of the urine ❑ Blood tests Patients are asked if they have any unusual symptoms or about their health history to find out if they are at risk for cancer Produces a picture, called a sonogram, of internal tissues or organs ❑ Health history This helps to check a person’s body for signs of cancer, like lumps or anything else unusual This is a series of detailed pictures of areas inside the body taken from different angles ❑ Physical exam DEFINITION Uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body ❑ TEST A tissue sample is taken and studied by a pathologist to check for signs of cancer RCC Terms to Know enzymes—Proteins that direct the flow and speed of a specific chemical reaction. pathologist—A doctor who identifies diseases by studying cells and tissues under a microscope. 7 RENAL CELL CARCINOMA WHAT ARE THE STAGES OF RCC? There are 4 stages of RCC: ❑ ❑ Tumor is 7 centimeters or smaller ❑ Tumor is found only in the kidney ❑ Tumor is larger than 7 centimeters ❑ Stage II Tumor is found only in the kidney Cancer may be found in: – The kidney – 1 nearby lymph node – An adrenal gland – The tissue around the kidney – The main blood vessels of the kidney ❑ Stage I DEFINITION Cancer has spread beyond the layer of fatty tissue around the kidney and may be found in: – Nearby lymph nodes – Other organs, such as the intestines, pancreas, or lungs ❑ STAGE Recurrent RCC is cancer that has returned after it has been treated – The cancer may come back in the kidney. Or it may come back in other parts of the body many years after the first treatment Stage III Stage IV and recurrent RCC 8 RCC Tumor size is an important factor for determining the stage of RCC Doctors determine tumor size by measuring its largest area. The images below help to give you an idea of tumor size. The size of a golf ball (5 cm) The size of a tennis ball (7 cm) The size of a baseball (8 cm) Scale Images are not actual size. 0 1 2 3 4 5 Centimeters (cm) Terms to Know lymph node—Located throughout the body, lymph nodes filter lymph fluid. They store special cells that can trap cancer cells or bacteria that are traveling through the body in the lymph. adrenal gland—One of a pair of small glands; one sits on top of each kidney. The adrenal glands produce hormones that help control heart rate, blood pressure, the way the body uses food, and other vital functions. pancreas—A 6-inch-long organ that stretches across the back of the abdomen. It makes pancreatic juices, which help digest food in the small intestine. The pancreas also makes insulin, which controls the amount of sugar in the blood. 9 RENAL CELL CARCINOMA WHAT ARE THE TREATMENTS FOR RCC? Any of the following treatments may be used: ❑ Surgery This is used to remove the tumor and/or kidney. It is referred to as a nephrectomy – It can be simple, partial, or radical – Blood vessels of the kidney and some lymph nodes may also be removed – It is sometimes used as palliative therapy to relieve symptoms Note: palliative therapy may make a patient feel better, but it cannot cure the cancer ■ ❑ Intravenous (IV) or oral drug therapies These are used to shrink or stabilize the cancer When making treatment decisions, it may help to discuss what kind of treatment may be best for you. You should talk with your cancer care team, including your doctor and nurse. Also, make sure your primary care physician is aware of your cancer treatment. You can talk with family and friends as well. Do what helps. 10 ❑ Side effects that your treatment may cause ❑ Ways to avoid or treat side effects ❑ You should also talk with your cancer care team at every step of your therapy about: How they think you are responding to your treatment RCC Terms to Know simple nephrectomy—Surgery to remove the kidney. palliative therapy—Treatment to help control or reduce symptoms caused by the cancer. partial nephrectomy—Surgery to remove a tumor from the kidney while sparing the rest of the organ. intravenous therapy (IV)—Treatment given directly into a vein. radical nephrectomy—Surgery to remove the kidney, adrenal gland, lymph nodes, and surrounding tissue. 11 RENAL CELL CARCINOMA RCC WHAT SHOULD I ASK MY DOCTORS OR NURSES ABOUT MY CONDITION? ❑ During your treatment: Have honest conversations with your doctors and nurses – They are eager to answer all your questions, no matter how unimportant they may seem – Getting answers will help you feel less anxious ❑ What type of kidney cancer do I have? ❑ Do you think my cancer has spread beyond the kidney? ❑ What is the stage of my cancer? And what does that mean in my case? ❑ What treatment choices do I have? ❑ What do you recommend and why? ❑ What risks or side effects are there to the treatments you suggest? ❑ Some sample questions: What are the chances of recurrence of my cancer with these treatment plans? ❑ Also, be sure to write down questions of your own. For example, you may want to find out more about things you can do to better manage your treatment 13 RENAL CELL CARCINOMA WHAT’S NEXT? Follow-up tests ❑ X-rays, CT scans of the abdomen and chest, and other imaging studies may be taken to see if the cancer has returned ❑ Your doctor will decide which tests you should have and how often they should be done based on the original stage of your cancer and your response to treatment. Your doctor will also check for metastases, or for a new tumor. Blood tests to check kidney and liver function may also be requested Keep track of your treatment 14 ❑ At each visit, talk to your doctor about how you are responding to treatment ❑ Note any side effects you may have ❑ Your body is unique. Doctors can determine certain facts about tumors and drugs. They can use many types of treatments to help fight the cancer. But no one can say for sure how your body will respond to cancer or its treatment. Tell your doctor about any drugs, treatments, or herbal supplements you are taking RCC 15 RENAL CELL CARCINOMA WHAT’S NEXT? (CONT’D) Lifestyle ❑ Stop smoking – If you smoke, quitting now will improve your overall health – The return of your sense of smell from quitting may also help you enjoy a healthy diet during recovery ❑ Drink less alcohol – Have no more than 1 to 2 drinks per day ❑ Eat a well-balanced diet and maintain a healthy weight – Eat more fruits, vegetables, whole grains, and high-fiber foods – Eat less fatty meats – Discuss your diet with your health care provider ❑ Exercise when you are ready – Consult with your doctor or nurse regarding any exercise limitations you may have ❑ Give your body the rest it needs to recover from treatment – Cancer treatment can add to the fatigue caused by the disease itself ❑ Making changes in your lifestyle can help your recovery. These may help: Make an extra effort to talk with loved ones – Talk about how you are doing. Talk about your feelings This will help people understand what you are going through. It will give them a chance to help you – Talk about treatment choices. If you can, work together to make treatment decisions When you can, attend doctors’ appointments together so you have the same information ■ ■ 16 ❑ RCC If you have children, talk with them about your condition – Take their feelings seriously Children have many different reactions when they learn a parent is ill – Tell them that it’s okay to have lots of different feelings and that you have them as well – Try to offer a balanced outlook It’s usually best to give a realistic but hopeful summary of the situation. Try to focus on the efforts directed toward your recovery – Prepare your children for the effects of treatment Cancer and cancer treatment can often change the way a person looks It’s best to prepare children in advance so they know what is happening ■ ■ ■ ❑ ■ Consider going to a meeting of a local support group – Cancer diagnosis and treatment represent major challenges that affect patients and their loved ones – Support groups can reduce anxiety associated with isolation 17 RENAL CELL CARCINOMA CANCER RESOURCES 18 ❑ Treatment guidelines for patients ❑ Cancer treatment information for patients Open clinical trials for new treatments ❑ ❑ National Comprehensive Cancer Network (NCCN) (888) 909-6226 www.nccn.org/patients/ Physician directory ❑ ❑ ❑ ❑ Links to support groups Information on choosing hospice and home care Finding support groups People Living With Cancer (703) 519-2927 www.plwc.org ❑ ❑ Helpful advice about RCC How to pay for cancer treatment Information about cancer studies ❑ ❑ Stories about cancer survivors Facts about cancer, treatments, and clinical trials Helpful cancer advice ❑ ❑ Facts about treatments National Cancer Institute (NCI) (800) 422-6237 www.cancer.gov Treatment facts ❑ ❑ News about cancer studies ❑ The American Cancer Society (ACS) (800) 227-2345 www.cancer.org Useful cancer glossary RCC PATIENT SUPPORT RESOURCES ❑ ❑ Simple ways to make living with kidney cancer easier The toll-free help line provides information and short-term counseling to patients and their families How to find and meet other kidney cancer patients and survivors ❑ Information and advice also provided by e-mail Free financial services ❑ Support services for people living with cancer ❑ Cancer Hope Network (877) HOPENET (467-3638) www.cancerhopenetwork.org Matches patients one on one with cancer survivors ❑ ❑ Facts about cancer The Wellness Community (TWC) (888) 793-WELL (9355) www.thewellnesscommunity.org Community-based support groups for people living with cancer, guided by trained professionals ❑ ❑ Helpful cancer advice and counseling ❑ CancerCare® (800) 813-HOPE (4673) www.cancercare.org 24 Wellness Community centers in the United States ❑ ❑ A service of the AMC Cancer Research Center ❑ A group of patients, families, doctors, and health care providers who are all involved with kidney cancer and treatments Cancer Information and Counseling Line (CICL) (800) 525-3777 ❑ Kidney Cancer Association (KCA) (800) 850-9132 www.curekidneycancer.org Web-based support groups 19 SUU00181 © 2008 Pfizer Inc. All rights reserved. Printed in USA/January 2008