In July 2021, Niki Ridge started to experience terrible night sweats. She was 55 and already on HRT, so figured it was nothing to worry about. “We were on holiday and I’d just bought new pyjamas for the occasion, so I assumed that was the cause,” she says.
But as the sweats worsened into the autumn, she also developed a low-grade cough. “Again, nothing dramatic, it was just annoying and wouldn’t go away.” By January, these symptoms combined prompted her to go to the GP and ask to have her HRT changed. “When I mentioned the cough, my GP, who was brilliant, said that as it’s been more than three weeks we will refer you for an X-ray. That was it really.”
The X-ray found something abnormal in Niki’s lungs – then, later that week a CT scan found a 10cm mass in her right kidney. A biopsy then confirmed she had advanced kidney cancer, with multiple metastases in her lungs and bones.
Niki is one of an increasing number of mid-life women who have been diagnosed with kidney cancer. It is the sixth most common cancer in the UK, with about 14,000 cases diagnosed a year in England. But Maxine Tran, a professor of urology at University College London and an honorary consultant urological surgeon at Addenbrookes Hospital in Cambridge, explains that this only accounts for the recorded data.
“It’s one of those cancers that doesn’t really give rise to many symptoms, which is why it’s so hard to diagnose, meaning that data we have is at best an indication – rates are likely to be higher,” she says.
What we do know is that the demographics of those diagnosed are skewing younger and younger. “It used to be in the seventh and eighth decades,” says Tran. “There has been a shift and we are seeing people in their fifties and earlier. We even see people in their twenties and thirties with kidney cancer.”
Roughly twice as many men get it as women, “but that may be slowly turning too”, she says. “The proportions are tipping and women are getting diagnosed more, but we don’t know why.”
This is reflected in recent research. Last year, a study from the Brighton and Sussex Medical School found an unexpected rise in early-onset kidney cancer. The findings show a 157 per cent increase in incidence among males under 50, and a 133 per cent increase among females in the same age group – a trend that starkly contrasts with the relatively modest rise in older (50+) age groups.
Niki being diagnosed with kidney cancer as a 55-year-old woman may have once been an outlier, but Tran says that now “it’s not uncommon, unfortunately”.
Niki says she had none of the typical high-risk factors: she is not obese and has not smoked in 35 years. “But I have met an awful lot of women who talk about being diagnosed with advanced kidney cancer who don’t fit that profile at all.”
Part of the problem with kidney cancer is that it is largely asymptomatic until it reaches advanced stages, at which point it can present with blood in the urine, fatigue, pain around your middle that doesn’t go away, or unexplained weight loss. Niki puts it simply: “the kidney is an absolute bugger – it can cause so many problems without any symptoms because we’ve got two. And once you get the symptoms the cancer is usually advanced.”
This week, new research by Cancer Research UK showed that cancer death rates overall have fallen by 11 per cent in the past decade in the UK, thanks to huge advances in prevention, diagnosis and treatment. But for kidney cancer, the numbers dying from it are up by 5 per cent.
The tumour in Niki’s kidney was 10cm when it was found, meaning she had had it for years without any symptoms. While there has been research into finding biomarkers for kidney cancer, the only way to diagnose at present is with scans, meaning patients have to be referred – often for an unrelated reason.
On top of that, the symptoms that do occur can be very non-specific. Kidneys, for example, are one of the body’s organs that produce referred pain – where the pain is felt elsewhere from the actual infection or injury – meaning it can be written off as a back ache. Night sweats are common to kidney cancer, too, but these are a common symptom of the menopause.
“For any 55-year-old woman going to the GP with night sweats, there’s only one conversation that you’re really going to have,” Niki points out, “and that’s not the doctor’s fault.”
An unexplained cough, which Niki had because her cancer had metastasised to her lungs, is currently being researched as an indicative symptom. “A lot of patients on kidney cancer patient forums seem to have a cough throughout the stages, even with smaller tumours,” says Tran. “It’s too early to say that there’s a definite, causal link, but it’s certainly something to keep an eye out for.”
Only about 5 to 10 per cent of cases are due to genetics. “We don’t actually know the cause of kidney cancer,” she says simply. “We know it’s associated with the Western lifestyle in terms of obesity, smoking, high blood pressure, but these are quite general associations. I’ve had lots of patients who don’t smoke, who aren’t obese, who don’t have high blood pressure, so I don’t think it’s a very strong link.”
Even with the rates of diagnosis steadily increasing (thanks to scanning more patients) she says that the prognosis for kidney cancer hasn’t improved as much as hoped. “We know that we’re detecting it earlier and if you remove kidney cancer at a very early stage, then most of these patients are cured (95 per cent) and their cancers will never recur.” However, for patients with more advanced tumours the prognosis remains much poorer. “The death rate is still quite high – around 45 per cent will still succumb to kidney cancer.”
The good news is that you can live a full life with advanced kidney cancer, as Niki herself attests. She started immunotherapy and responded to it well – she says that within six weeks her cough and her night sweats stopped, and by Christmas of 2022 “my kidney tumour had shrunk to less than half its size, and my lungs had pretty much cleared”. She has very regular scans, and has had tumours found and treated in her breast, brain and bowel. The breast lump disappeared with immunotherapy, while the other tumours were operable and removed with little impact on her.
Other than scans every three months on her torso, every six months on the head, and an hour and a half of treatment at the hospital once a month, she continues to live life as fully as she can.
“A friend of mine has also got advanced kidney cancer and she can’t bring herself to eat processed meat because it can raise the risk. But I say to her that we’ve already got it – it’s already as bad as it can be. There are so many other restrictions in my life and I still have to live.”
She’s keen to emphasise that her kidney cancer may be advanced but it’s not terminal. “I never say that it’s incurable. At the moment, I am trying to live well with the hand I’ve been dealt. And I don’t think on any planet any other woman with my symptoms would have got answers quicker than I did. None of us thought it was going to be cancer.”
Tran agrees. “No one wants cancer, and it’s not one of those that automatically means your life is going to be shortened, especially if it is detected early. There’s lots of management options out there, including active surveillance for very small tumours.”
However, both caution that it’s key to get things checked if you have changes that persist. Changes in night sweats, pain in the flank, torso or back, and a persistent cough can all be warning signs that warrant investigation.
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