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On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about the long-term care of MPNs.

Expert Emphasizes Importance of Integrative Care, Well-Being in Long-Term Care of MPNs

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about MPN resources and support groups available to patients and loved ones.

Improving Overall Care of MPNs with Support Groups and Advocacy Research

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Shireen Sirhan, from the Jewish General Hospital-McGIll University, about patients being their own best advocate in their MPN care.

Taking an Active Voice in MPN Treatment to Improve Communication About Care

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Shireen Sirhan, from the Jewish General Hospital-McGIll University, about finding a care team that specializes in MPNs.

Expert Emphasizes Importance of Finding Specialized Multidisciplinary Team to Treat MPNs

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about the role of caregivers after an MPN diagnosis.

Caring for the Caregiver: Expert Emphasizes Loved Ones of Patients with MPNs Shouldn’t Take This Role on Alone

MPNs

Bladder Cancer: Overview

Bladder cancer is also known as urothelial carcinoma. Urothelial cells line the urinary tract, including the urethra, bladder, and ureters and renal pelvis in the kidneys. These urothelial or transitional cells are in contact with urine. Bladder cancer happens when those cells in the bladder start to grow out of control.

Smoking and being exposed to secondhand smoke increases the risk of developing bladder cancer. In addition, people exposed to occupational or environmental chemicals may have a higher risk of developing bladder cancer. White people are twice as likely to develop bladder cancer as are Black people or Hispanic people, and older age is another risk factor. Health history also matters, with chronic bladder inflammation, such as urinary tract infections or kidney stones, as well as a personal or family history of bladder cancer, associated with risk of the disease.

Many people are unaware of the common signs of bladder cancer, such as blood in the urine, known as hematuria. If blood in the urine can be seen, this is called gross hematuria. When a physician runs a urinalysis test as part of a routine checkup, tiny amounts of blood may be detected. This is microscopic hematuria. Any blood seen in the urine should be checked by a physician. Irritation when urinating, urgency and frequency are other warning signs. These signs may also be from other causes, such as a urinary tract infection, kidney stones or aging.

Bladder Cancer: Living with Cancer

Bladder cancer has a high rate of recurrence, which implies the need for regular surveillance with cystoscopy over the course of a patient’s lifetime. For some patients, the new normal after bladder removal surgery is adjusting to life with a urinary diversion. A patient should always feel comfortable talking with their health care team about any issues or questions. If the team can’t help, they can usually find someone who can.

Bladder Cancer: Types of Disease

Doctors usually describe and treat bladder cancer by how far it has grown into the bladder wall.

NMIBC (non-muscle invasive bladder cancer) is cancer that remains in the urothelial cells that line the bladder.

MIBC (muscle-invasive bladder cancer) is cancer that has grown into the deeper layers of bladder muscle.

If bladder cancer has spread to other parts of the body outside the urinary tract, it is advanced disease, or metastatic.

Types of bladder cancer include urothelial carcinoma, squamous cell carcinoma, adenocarcinoma, small cell carcinoma and sarcoma.

Urothelial carcinoma, the most common type of bladder cancer, is also known as transitional cell carcinoma. Transitional cell carcinoma begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder.

Squamous cell carcinoma comprises 1% to 2% of bladder cancers, according to the American Cancer Society. Most squamous cell carcinomas of the bladder are invasive.

Adenocarcinoma, which are also mostly invasive, occur in only 1% of bladder cancers.

Small cell carcinoma, which occurs in less than 1% of bladder cancers, start in the neuroendocrine cells. This subtype of the disease can grow quickly.

Sarcoma of the bladder is rare, and start in the muscle cells of the organ.

Bladder Cancer: Diagnosis

A urologist will make a bladder cancer diagnosis. Urologists use a cystoscope to examine the lining of the bladder and the tube that carries urine out of the body (urethra).

If bladder cancer is diagnosed, the doctor needs to know the stage, or extent, of the disease to plan the best treatment. Staging is a careful attempt to find out whether the cancer has invaded the bladder wall or spread beyond that, and, if so, to what parts of the body. Grade refers to how abnormal the cancer cells look and how many cells are multiplying. A higher grade means the cells are more uneven and are multiplying more. Knowing the grade can help your doctor predict how quickly the cancer will grow and spread.

Bladder Cancer: Treatment

When bladder cancer is classified as NMIBC, surgery to remove the tumor is often the first step. A transurethral resection of the bladder tumor uses a special instrument inserted through the urethra to remove the tumor. If the tumor is low risk/grade and has not invaded the muscle wall of the bladder, it may not require more treatment. Unfortunately, bladder cancer has a high rate of recurrence so most of those who receive diagnoses must return to their urologist at regular intervals for surveillance using cystoscopy to see if the tumors return.

If the tumor cells appear aggressive under the microscope and the pathologist determines that the cancer is high risk/grade, it is more likely to return or worsen. In these cases, further treatment to keep the cancer from returning or worsening is required. Most often, patients with high-grade NMIBC receive intravesical (inside the bladder) treatments. Bacillus Calmette-Guérin (BCG) is an early form of immunotherapy that uses a weakened form of bacteria. When these bacteria are put into the bladder, the immune system goes on alert. It responds by killing cancer cells on the bladder lining. Though BCG is very effective, it doesn’t work for all tumors. If BCG doesn’t work, there are other options such as mitomycin C, an antibiotic that helps fight tumors.

When bladder cancer grows into the deeper layers of the bladder (MIBC), it is more difficult to treat. In many cases, a urologist may suggest radial cystectomy, which is surgery to remove your bladder. Removing the bladder also involves removing lymph nodes around the organ. As part of the surgery, it will be necessary to create a urinary diversion, a new way for urine to leave your body.

Systemic chemotherapy is medicine that treats cancer throughout the whole body. Neoadjuvant chemotherapy is chemotherapy patients get before bladder removal surgery. Clinical trials have shown that cisplatin chemotherapy before bladder removal improves survival for patients with MIBC because it helps kill bladder cancer cells that may be outside the bladder. Adjuvant chemotherapy is the chemotherapy patients get after surgery.

Recently approved targeted therapies can block the growth and spread of cancer. They focus on stopping the cancer-driving activity caused by specific genetic mutations that are found in some bladder cancers.

Some patients may benefit from combined modality therapy, which uses surgery to remove the tumor, plus chemotherapy and radiation to help kill the cancer while keeping the bladder intact. This option can be used for some patients who are ineligible for bladder removal surgery. Those with advanced or metastatic disease may benefit from chemotherapy and a variety of immunotherapies that can help the body fight off the cancer.

There are many talented researchers and clinicians working to improve the diagnosis and treatment of the disease. Clinical trials are an essential part of bladder cancer research. They may provide treatment alternatives to patients who have not had success with standard and approved therapies.

Breast Cancer: Living with Cancer

Similar to other cancers, there is often a fear breast cancer will return, and in some individuals, the cancer will never go away completely. Therefore, it is key to maintain follow-up appointments for physicians to watch closely. These include consistent doctor appointments, mammograms, pelvic exams, bone density tests, as well as we blood and imaging tests.

Survivorship care plans, comprised of a suggested schedule for follow-ups, a list of long-term effects, lifestyle modification suggestions and a summary of ones diagnosis, may be very helpful for long-term care and to aid individuals in transitioning back to a primary care provider.

Breast Cancer: Types of Disease

The type of breast cancer that is diagnosed is determined by specific cells.

Ductal carcinoma in situ, or DCIS, also known as intraductal carcinoma, is when the abnormal cells have not spread through the ducts into surrounding breast tissue. It is a non-invasive breast cancer that has not spread outside of the breast; however, it can become invasive.

Lobular carcinoma in situ, also called lobular neoplasia, is when the abnormal cell growth starts in the lobules of the breast and has likely not spread to surrounding tissues. This subtype can be an indicator for the likeliness of developing invasive cancer in either breast.

Invasive ductal carcinoma, also known as infiltrating ductal carcinoma, is the most common type of breast cancer that occurs when the cancer starts in the ducts of the breast, then grows into fatty breast tissue. This type of breast cancer may spread to other parts of the body.

Invasive lobular carcinoma, also known as infiltrating lobular carcinoma, starts in the lobules of the breast. As one of the less common types, invasive lobular carcinoma may be difficult to detect via mammogram.

Inflammatory breast cancer, an uncommon type of invasive breast cancer, occurs when the cancer cells block the lymph vessels in the skin, causing inflammation, redness, pitted appearance, itchiness or tenderness. In this instance, a lump may not be detected

Paget disease, also rare, starts in the ducts and spreads to the skin of the nipple. Symptoms include crusted, scaly, red, bleeding, oozing, burning or itchy nipples.

Lastly, there are subtypes of breast cancer driven by hormones that will drive treatment decisions: hormone receptor-positive, HER2-positive and triple-negative breast cancer.

Breast Cancer: Diagnosis

After a biopsy or surgery to remove the breast cancer, a pathologist examines the tissue and may run additional tests to create a pathology report to help create an appropriate treatment plan for the patient. In addition, the use of an Oncotype Dx® Recurrence Score results may also be considered and used to determine certain treatment.

Stage 0, carcinoma in situ, is the earliest stage of breast cancer, followed by:

Stage 1: The tumor is 2 centimeters or smaller; the cancer has not spread outside of the organ; or small clusters of cancer cells are found in the lymph nodes.

Stage 2: There is no tumor, or the tumor is smaller than 2 centimeters, but the cancer is also found in the lymph nodes or the breast; or the tumor is larger than 2 to 5 centimeters, but the cancer has not spread to lymph nodes.

Stage 3: There is no tumor, or the tumor can be any size, but the cancer has spread to the lymph nodes; the tumor is larger than 5 centimeters and small clusters of cancer cells are found in the lymph nodes or the breast; or the tumor is larger than 5 centimeters and the cancer has spread to the lymph nodes.

Stage 4: The cancer has spread to other parts of the body, often in the bones, lungs, brain or liver.

When determining the stage of breast cancer, key pieces of information include the size of the tumor, its spread to nearby lymph nodes, metastasis to other parts of the body, grade of the cancer, as well as estrogen receptor, progesterone receptor and HER2 status.

Breast Cancer: Overview

Breast cancer, which occurs when cells grow out of control, can start in one or both breasts, in different parts of the organ – lobules, ducts, nipple, fat and connective tissue, blood vessels and lymph vessels.

Although most common in women, men can get breast cancer, too

Signs of breast cancer can include a lump in the breast or arm pit, a change in shape or size of the breast, nipple changes or discharge, and skin changes to the breast.

Risk factors for breast cancer include binge drinking, being overweight, especially after menopause, living a sedentary lifestyle and an unhealthy diet, which are all changeable lifestyle factors. In addition, unchangeable risk factors include female gender, older age, genetics, family history of the disease, personal history of the disease, race and ethnicity, dense breasts, benign breast conditions, exposure to diethylstilbestrol, menstruation, menopause, previous chest radiation and recurrent breast cancer.

Screening for breast cancer includes breast self-exams, clinical breast exams by health care providers and mammograms.

Although breast cancer can be confined to the breasts, it is possible for the cancer cells to invade the bloodstream or lymph system, traveling to other parts of the body, causing spread, or metastasis.

Breast Cancer: Treatment

Each breast cancer subtype has a unique set of features that drive cancer growth, division and multiplication. Therefore, each type of breast cancer is not treated the same. Common treatment options include surgery, chemotherapy radiation or systemic therapies.

Surgeries to remove breast cancer include breast-conserving surgery, which removes the cancer as well as some surrounding normal tissue, or a mastectomy, in which the entire breast, including tissue, is removed. On the other hand, surgery to remove nearby lymph nodes includes sentinel lymph node biopsy, where a dye is injected in order to remove only the lymph nodes under the arm that have taken the dye, or an axillary lymph node dissection, where many lymph nodes are removed from the underarm.

Depending on the stage of the disease, radiation can be used after breast-conserving surgery, after a mastectomy or if the cancer has spread to other parts of the body. Similarly, chemotherapy may be recommended before or after surgery, and to treat metastatic disease.

Because some types of breast cancer are affected by hormones, treatment to stop such hormones from attaching to proteins that helps the cancer grow, hormone therapy may be used. This type of therapy is typically administered after surgery; however, sometimes it is started prior to the procedure. It can also be used to treat breast cancer that has recurred or metastasized.

Targeted therapy is used for certain types and/or stages of breast cancer. For those with HER2-positive breast cancer, targeted therapies include antibody-drug conjugates, kinase inhibitors and monoclonal antibodies. For those with hormone receptor-positive breast cancer, the use of CDK4/6 inhibitors, mTOR inhibitors and PI3K inhibitors are all considered. For those with triple-negative breast cancer, antibody-drug conjugates in combination with chemotherapy would be considered. Individuals who test positive for the BRCA mutation can also be treated with PARP inhibitors.

In addition, immunotherapy, such as immune checkpoint inhibitors, maty be used. For example, it can be used in combination with chemotherapy to treat those with triple-negative breast cancer, either before or after surgery, to treat breast cancer recurrence or disease that has spread to other parts of the body.

Gastrointestinal Cancer: Types of Disease

Gastrointestinal cancers can develop in a variety of organs, and include:

The most common types of gastrointestinal cancer are esophageal, stomach, colorectal, pancreatic and liver.

Gastrointestinal Cancer: Living with Cancer

Similar to other cancer types, a gastrointestinal cancer diagnosis, treatment and survivorship can come with a variety of emotions. Staying diligent with one’s care and follow-up appointments is key.

Moreover, to lower one’s risk for cancer recurrence or to negate any long-term effects, exercising, eating a certain type of diet or taking nutritional supplements may help.

Lastly, the GI Cancers Alliance, or GICA, have a number of advocacy groups to aid in living with a gastrointestinal cancer diagnosis.

Gastrointestinal Cancer: Treatment

Among the most common gastrointestinal cancers, treatment options vary. However, what is consistent across the different cancer types is the utilization of a multidisciplinary approach to care, which can include a medical oncologist, surgeon, gastroenterologists, radiation oncologists, and more.

Treatment options for colorectal cancer include surgery – including laparoscopic surgery, colostomy, radiofrequency ablation or cryoablation – as well as radiation, chemotherapy, immunotherapy and targeted therapies.

Similarly, esophageal cancer can be treated with surgery, radiation, chemotherapy, immunotherapy and targeted therapy, as well as endoscopic treatments like endoscopic mucosal resection, photodynamic therapy, radiofrequency ablation, laser ablation, argon plasma coagulation, electrocoagulation and esophageal stent.

For pancreatic cancer, the best option may include more than one type of treatment, comprised of surgery, ablation or embolization, radiation, chemotherapy, targeted therapy and immunotherapy.

Treatment for stomach cancer is dependent on stage, age, overall health and personal preferences. Typically two or more treatment options – including surgery, chemotherapy, targeted therapy, immunotherapy and radiation – will be used.

Gastrointestinal Cancer: Overview

A tumor can form in the gastrointestinal tract, a 25-foot pathway starting from the mouth to the anus, after a change in DNA causes abnormal cells to grow.

According to Yale Medicine, gastrointestinal cancers are more likely to develop in men, and risk for the diseases increases with age. Other risk factors include smoking, alcohol consumption and an unhealthy diet, as well as underlying conditions like gastroesophageal reflux disease in the esophagus, Helicobacter pylori infection in the stomach, diabetes in the pancreas, inflammatory bowel disease in the large intestine, and hepatitis B or C virus infection or cirrhosis in the liver. Meanwhile, a small percentage of these cancers can be associated with family history or genetics.

Symptoms of gastrointestinal cancers depend on the type of cancer, and often may not occur until the disease has become more advanced.

Gastrointestinal Cancer: Diagnosis

If gastrointestinal cancers are suspected, the following may be conducted:

Endoscopy or esophagogastroduodenoscopy: evaluates the lining of the esophagus, stomach and small intestine for tumors.

Colonoscopy: checks the colon and rectum for polyps.

Lab tests: searches for changes I the blood.

Imaging: including MRI, X-Ray, ultrasound, CT or PET scans, looks for abnormal tissue in the digestive system.

Biopsy: evaluates sample obtained for cancer cells.

Gynecologic Cancer: Diagnosis

Unfortunately, only cervical cancer has routine screening tests using Pap smear and HPV testing. If medical history or a physical exam require further testing, diagnostic tests for gynecologic cancers include blood tests, a pap test and imaging tests, and a biopsy would be necessary to confirm.

Gynecologic Cancer: Overview

Gynecologic cancers begin in the female reproductive organs: the uterus, which includes the cervix; ovaries, which attach to the top of the uterus; the vagina, which connects the uterus to the outside of the body; and the vulva, which are the external genitals.

According to Yale Medicine, gynecologic cancers are less common compared with breast or colorectal cancer. However, despite this, all women are at risk, which increases with age.

Risk factors for gynecologic cancers include human papillomavirus (HPV), a common sexually transmitted infection, age, genetics and diethylstilbestrol exposure.

Symptoms of gynecologic cancers vary, but abnormal vaginal bleeding and discharge can occur, as well as pelvic pain, bloating, constipation, or an increased need to urinate.

Gynecologic Cancer: Living with Cancer

Like other cancers, gynecologic cancers are treatable if found early.

The time after initial treatment ends has become recognized as its own, distinct phase of the cancer experience, and those who study cancer survivors have suggested a strategy for the ongoing clinical care of cancer survivors. At the heart of this strategy is a survivorship care plan (SCP), a document that includes details not only about the patient’s diagnosis and treatment, but also essential information needed for long-term follow-up care.

The SCP should officially switch a patient to a general physician who will provide primary care and routine disease screenings. Designed for discussion at the end of treatment, the SCP should include summaries of key diagnostic and staging results, treatments and dosages received and the potential late effects of those treatments. It should prompt discussion about recurrent and new cancers; genetic implications; possible long-term and late effects; explanations of legal rights affecting employment and insurance; recommendations for nutrition, exercise, lifestyle changes and rehabilitation; and referrals for psychological and support assessments.

Gynecologic Cancer: Treatment

Gynecologic cancers are often treatable, especially when found early. Treatment decisions depend on the type of disease and the stage; however, gynecologic cancers are treated using one or more of the following:

Surgery: a traditional open incision in the abdomen or a minimally-invasive technique, such as laparoscopy or robotic technology.

Radiation therapy: for cancers that have invaded deeply into the uterine wall, cervix or vagina or have spread to the lymph nodes.

Hormone therapy: may be recommended when considering future fertility.

Targeted therapy: may be combined with chemotherapy.

In addition, complementary and alternative medicine may aid in long-term effects from a gynecologic cancer diagnosis and its treatments.

Gynecologic Cancer: Types of Disease

Gynecologic cancers are comprised of five cancer types: cervical, endometrial, ovarian, vaginal and vulvar.

Cervical cancer is caused by abnormal changes in squamous cells, which protect the outside of the cervix, and glandular cells, which are mostly inside the cervix and produce the fluid and mucus commonly seen during ovulation. This is the only gynecologic cancer that can be prevented by regular screening with a gynecologist and preventive vaccination (HPV).

Endometrial, or uterine, cancer occurs in the lining of the uterus, called the endometrium.

Ovarian cancer, the seventh most common cancer among women, according to the Foundation for Women’s Cancer, occurs from abnormal cell growth in the ovaries.

Vaginal cancer, which begins in the vagina and is one of the rarest gynecologic cancers, occurs most often in the lining of the vagina. It can also be prevented by vaccinations.

Vulvar cancer, also a rare gynecologic cancer, occurs in the inner and outer lips of the vagina, the clitoris, the opening of the vagina and its glands.

Head & Neck: Living with Cancer

While treatment for cancer can often come with long-term side effects, there is also concern of preserving the function of affected areas by the head and neck cancer. Therefore, rehabilitation has been a larger effort over the years to ensure patients can return to normal activities, such as speaking, eating and more.

Rehabilitation can include physical therapy, dietary counseling, speech therapy, and/or learning how to care for a stoma – an opening into the windpipe after a laryngectomy, through which a patient breathes.

Moreover, these types of cancers may result in reconstructive and plastic surgery, or if those are not options, use of a prosthesis.

However, resources are available to help patients return to their new normal, and to deal with the psychosocial effects related to head and neck cancer.

Head & Neck: Types of Disease

Head and neck cancers have different names and vary by its site of origin. Head and neck cancer types include:

Laryngeal cancer: starts in the larynix, or the voice box.

Hypopharyngeal cancer: starts in the hypopharynx, or the lower part of the throat behind the voice box.

Oral cavity cancer: starts in the oral cavity, or the mouth.

Oropharyngeal cancer: starts in the oropharynx, or the middle part of the throat behind the mouth.

Nasopharyngeal cancer: starts in the nasopharynx, or the upper part of the throat behind the nose.

Nasal cavity cancer: starts in the nasal cavity, or the opening behind the nose.

Paranasal sinus cancer: starts in the sinuses, or the air-filled spaces in the bones around the nose.

Salivary gland cancer: starts in the glands that make saliva, and can include parotid gland cancer or submandibular gland cancer.

Head & Neck: Diagnosis

Most often, head and neck cancers are discovered after a patient has sought treatment for symptoms that may have become problematic. However, they may be found during routine exams by a doctor or dentist.

If further evaluation is required, patients will be referred to an ear, nose and throat specialist or a head and neck surgeon.

Additional tests by an ear, nose and throat specialist could include a panendoscopy, biopsy, HPV testing or imaging.

Staging of head and neck cancer includes the location of the primary tumor, the size or extent of the tumor, whether the cancer has spread to the lymph nodes and whether the cancer has spread to other parts of the body, also known as TNM staging. TNM classifications are then combined to determine the stage, ranging from stage 1 through 4, with stage 4 being the most advanced.

Head & Neck: Overview

Head and neck cancer is a number of cancers that develop in or around the throat, larynx, nose, sinuses and mouth.

According to the Head and Neck Cancer Alliance, head and neck cancers occur twice as often in men than women, and are more often diagnosed in people over the age of 50.

Common symptoms may include a lump or a sore that does not heal, a sore throat that does not go away, difficulty in swallowing or a change or hoarseness in the voice.

Risk factors for head and neck cancers include alcohol and tobacco use, including smokeless tobacco; human papillomavirus (HPV) infections; paan, or betel quid, use among immigrants of Southeast Asia; mate consumption, a tea-like beverage in South America; preserved or salted food consumption; poor oral health; occupational exposure; radiation exposure; Epstein-Barr virus infection; and Asian ancestry.

Head & Neck: Treatment

Treatment for head and neck cancers can include surgery, radiation therapy, chemotherapy, targeted therapy or a combination of treatments. However, treatment options will depend on the exact location of the tumor, the stage of the cancer and the person’s age and general health. Moreover, those with HPV-related cancers may also be treated differently than those who test negative for the infection.

Kidney Cancer: Treatment

Various factors, like disease subtype, genetics and stage can all play into the treatment of kidney cancer. Types of treatment for kidney cancer consist of surgery, ablation and other local therapy, active surveillance, radiation, targeted therapy, immunotherapy, and chemotherapy. As a result, it is important to be treated by a multidisciplinary team, including a urologist, urologic oncologist, medical oncologist, radiation oncologist and surgeon.

Active surveillance consists of close monitoring with regular diagnostic tests and appointments with an individual’s care team. This approach may be used for older adults, those who have a small renal tumor and a comorbidity, and those who are otherwise well and have few or no symptoms.

In those undergoing active surveillance, if symptoms suggest that action is needed, then a new treatment plan would be considered.

Part or all of the kidney tumor as well as some surrounding tissue and lymph nodes can be removed during surgery, in particular, for cancer that has not spread beyond the kidneys.

Types of surgery include radical nephrectomy (surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy), partial nephrectomy (surgical removal of the tumor) and minimally invasive surgery, such as laparoscopic and robotic surgery.

Non-surgical procedures may be utilized if surgery is not recommended because of characteristics of the tumor or the patient’s overall health. Non-surgical procedures include radiofrequency ablation (the use of a needle inserted into the tumor to destroy the cancer with an electrical current) or cryoablation (freezing of cancer cells with a metal probe inserted through a small incision).

Targeted therapies aim to treat specific genes, proteins or tissue environment that blocks the growth and spread of kidney cancer cells and limits damage to healthy cells. Targeted therapies for kidney cancer include anti-angiogenesis therapies, which stops the process of making new blood vessels; mTOR inhibitors, that target mTOR to slow kidney cancer growth; and HIF2a inhibitors, which target hypoxia-inducible factor-2 alpha.

More recently, the combination use of two targeted treatments and/or immunotherapies to treat various lines of relapsed/refractory kidney cancer.

Immunotherapy boosts the body’s immune system to treat cancer. Immunotherapies for kidney cancer treatment include interleukin-2, or IL-2, a cytokine (a protein produced by white blood cells) to destroy tumor cells; alpha-interferon, which changes the proteins on the surface of cancer cells and slows their growth; and immune checkpoint inhibitors.

Chemotherapy keeps kidney cancer cells from growing, dividing and making more cells. Regimens, that could be comprised of one or combined drugs, consist of a specific number of cycles over a set period of time.

Unfortunately, most kidney cancers are resistant to chemotherapy, but for some patients it will temporarily shrink a tumor.

Radiation, which is the use of high-energy x-rays or other particles to destroy cancer cells, is not effective as a primary treatment for kidney cancer. Therefore, it is rarely used alone and only used in those who have disease that has spread to ease symptoms.

Kidney Cancer: Types of Diseases

There are several types of kidney cancer:

Renal cell carcinoma, or RCC, is the most common type of kidney cancer in adult patients, occurring in about 9 of 10 kidney cancers, according to the American Cancer Society. Renal cell carcinoma can typically be just one tumor in the kidney; however, there can be two or more tumors in one kidney or tumors found in both kidneys at the same time

There are two subtypes of renal cell carcinoma: clear cell and non-clear cell.

Among renal cell carcinomas, the clear cell subtype is the most common, occurring in about 7 out of 10 people with this kind of cancer, according to the American Cancer Society.

On the other hand, non-clear clear cell renal cell carcinoma is comprised of papillary (type 1 and 2) and chromophobe subtypes. Papillary non-clear cell is the second most common type of renal cell carcinoma, of which type 1 tumors are considered slower growing and type 2 tumors are faster growing. Chromophobe non-clear cell accounts for just 5 out of every 100 cases of renal cell carcinoma.

Further, other rare subtypes of non-clear clear cell disease, comprising less than 1% of cases, are collecting duct renal cell carcinoma, multilocular cystic renal cell carcinoma, medullary carcinoma, mucinous tubular and spindle cell carcinoma, neuroblastoma-associated renal cell carcinoma and unclassified renal cell carcinoma.

Transitional cell carcinoma is also known as urothelial carcinoma, which begins in the part of the kidney, called the renal pelvis, where urine collects before moving to the bladder. This type of kidney cancer is treated like bladder cancer because both types begin in the same cells, called transitional cells, that line the renal pelvis and bladder, according to the American Society of Clinical Oncology.

Wilms tumor, also known as nephroblastoma, typically occurs in children, but can be very rare among adults. This type of disease makes up only about 1% of kidney cancers, according to the American Society of Clinical Oncology.

Also a rare subtype, renal sarcoma begins in the blood vessels or connective tissue of the kidney, making up less than 1% of kidney cancers.

Kidney Cancer: Living with Cancer

In addition to side effects from treatment, there can be long-term effects associated with the kidney cancer itself, as well as psychosocial effects. It is key for individuals to also focus on their relationships, body, finance, mind and soul.

It is common for patients to feel stress, anxiety or depression; however, support is available through support groups, advocacy groups and more.

Similarly, staying healthy is key through balanced diet and exercise.

If a patient has completed treatment, follow-up care is important in assessing long-term effects or to look for kidney cancer recurring. Patients can ask their physicians about a survivorship care plan, which could include a suggested schedule for follow-up exams and tests;a list of possible long-term side effects; suggestions for improving health to address side effects or to lower chances of the kidney cancer coming back; and appointment reminders to visit primary care providers after a patient no longer sees their oncology team.

Kidney Cancer: Overview

Kidney cancer, which is among the 10 most common cancers in both men and women, starts in the kidneys when cells in the body begin to grow out of control.

The kidneys are a part of the urinary system, attached to the upper back wall of the abdomen and protected by the lower rib cage. As a part of the group of organs that remove waste from the body through urine, the kidneys filter and clean one’s blood to remove waste and extract water from the body, also making hormones that help to control blood pressure and to aid the body in making more red blood cells.

According to the American Cancer Society, the average age of those diagnosed with kidney cancer is 64 years. Moreover, the disease is twice as common among men than women, and is more common in Black and American Indian/Alaskan Native individuals.

Risk factors, such as smoking, obesity, high blood pressure and workplace exposures, may increase an individual’s chance of receiving a diagnosis of kidney cancer. Additionally, a family history and genetic or hereditary risks, such as von Hippel-Lindau (VHL) disease, Birt-Hogg-Dube (BHD) syndrome and Cowden syndrome, as well as mutations or defects in MET, FH, SDHB, SDHD, TSC1 and TSC2, may also increase someone’s risk for the disease.

Kidney Cancer: Diagnosis

Kidney cancer may be found because of signs or symptoms, like blood in the urine, low back pain on one side that has not been caused by injury, a lump on the side or lower back, fatigue, loss of appetite, weight loss not caused by dieting, fever that is not caused by an infection and that doesn’t go away or anemia.

Kidney cancer can also be diagnosed through lab tests of the blood or urine, or imaging tests using x-rays, magnetic fields, sound waves or radioactive substances.

Staging of kidney cancer is based on the acronym TNM, which stands for:

T – the size and extent of the primary tumor

M – spread, or metastasis, to distant sites in the body

Numbers or letters may also follow TNM, with higher numbers meaning the kidney cancer is more advanced, to further detail each factor:

Stage 1 disease means the tumor is 7 centimeters across or smaller and is only located in the kidney (T1), and there is no spread to the lymph nodes (N0) or distant organs (M0).

Stage 2 disease means the tumor is larger than 7 cm across but is still only located in the kidney (T2), and there is no spread to the lymph nodes (N0) or distant organs (M0); or the tumor is growing into a major or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3), and there is no spread to lymph nodes (N0) or distant organs (M0).

Stage 3 disease means the primary tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia (a fibrous envelope of tissue that surrounds the kidney), and the cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0).

Stage 4 disease means the primary tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney (T4), it may or may not have spread to nearby lymph nodes (any N), and it has not spread to distant lymph nodes or other organs (M0); or the primary tumor can be any size and may have grown outside of the kidney (any T), it may or may not have spread to nearby lymph nodes (any N), and it has spread to distant lymph nodes and/or other organs (M1)

Metastatic kidney cancer means the cancer has spread from the place it formed (the kidneys) to another part of the body. In kidney cancer, the most common places that the disease spreads to is the lungs, lymph nodes and bones, according to the Kidney Cancer Association.

MPNs

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Expert Emphasizes Importance of Integrative Care, Well-Being in Long-Term Care of MPNs

February 24th, 2022

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about the long-term care of MPNs.

Improving Overall Care of MPNs with Support Groups and Advocacy Research

February 24th, 2022

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about MPN resources and support groups available to patients and loved ones.

Taking an Active Voice in MPN Treatment to Improve Communication About Care

February 24th, 2022

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Shireen Sirhan, from the Jewish General Hospital-McGIll University, about patients being their own best advocate in their MPN care.

Expert Emphasizes Importance of Finding Specialized Multidisciplinary Team to Treat MPNs

February 24th, 2022

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Shireen Sirhan, from the Jewish General Hospital-McGIll University, about finding a care team that specializes in MPNs.

Caring for the Caregiver: Expert Emphasizes Loved Ones of Patients with MPNs Shouldn’t Take This Role on Alone

February 24th, 2022

On behalf of the Canadian MPN Research Foundation, CURE spoke with Dr. Pierre Villeneuve, from the University of Ottawa, about the role of caregivers after an MPN diagnosis.