Young diseases

Introduction

Each year, more than 28,000 people in the United States learn that they have kidney cancer. The National Cancer Institute (NCI) has written this booklet to help people with kidney cancer and their families and friends better understand this disease. We hope others will read it as well to learn more about kidney cancer.

Definitions of words that may be new to readers and other terms related to kidney cancer can be found in the Glossary. For some words, a "sounds-like" spelling is also given.

This booklet discusses symptoms, diagnosis, treatment, and followup care. It also has information to help patients cope with kidney cancer.

Our knowledge about kidney cancer keeps increasing. For up-to-date information or to order this publication, call the NCI-supported Cancer Information Service (CIS) toll free at 1-800-4-CANCER (1-800-422-6237).

The CIS staff uses a National Cancer Institute cancer information database called PDQ and other NCI resources to answer callers' questions. Cancer information specialists can send callers information from PDQ and other NCI materials about cancer, its treatment, and living with the disease.

The Kidneys

The kidneys are two reddish-brown, bean-shaped organs located just above the waist, one on each side of the spine. They are part of the urinary system. Their main function is to filter blood and produce urine to rid the body of waste. As blood flows through the kidneys, they remove waste products and unneeded water. The resulting liquid, urine, collects in the middle of each kidney in an area called the renal pelvis. Urine drains from each kidney through a long tube, the ureter, into the bladder, where it is stored. Urine leaves the body through another tube, called the urethra.

The kidneys also produce substances that help control blood pressure and regulate the formation of red blood cells.

What Is Cancer?

Cancer is a group of many different diseases that have some important things in common. They all affect cells, the body's basic unit of life. To understand cancer, it is helpful to know about normal cells and about what happens when cells become cancerous.

The body is made up of many types of cells. Normally, cells grow and divide to produce more cells only when the body needs them. This orderly process helps keep the body healthy. Sometimes cells keep dividing when new cells are not needed. A mass of extra tissue forms, and this mass is called a growth or tumor. Tumors can be benign or malignant.

* Benign tumors are not cancer. They often can be removed and, in most cases, they do not come back. Cells in benign tumors do not spread to other parts of the body. Most important, benign tumors are rarely a threat to life.
* Malignant tumors are cancer. Cells in malignant tumors are abnormal and divide without control or order. These cancer cells can invade and destroy the tissue around them. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. This process is how cancer spreads from the original (primary) tumor to form new tumors in other parts of the body. The spread of cancer is called metastasis.

Kidney Cancer

Several types of cancer can develop in the kidney. This booklet discusses renal cell cancer, the most common form of kidney cancer in adults. Transitional cell cancer (carcinoma), which affects the renal pelvis, is a less common form of kidney cancer. It is similar to cancer that occurs in the bladder and is often treated like bladder cancer. Wilms' tumor, the most common type of childhood kidney cancer, is different from kidney cancer in adults. The Cancer Information Service can provide information about transitional cell cancer and Wilms' tumor.

As kidney cancer grows, it may invade organs near the kidney, such as the liver, colon, or pancreas. Kidney cancer cells may also break away from the original tumor and spread (metastasize) to other parts of the body. When kidney cancer spreads, cancer cells may appear in the lymph nodes. For this reason, lymph nodes near the kidney may be removed during surgery. If the pathologist finds cancer cells in the lymph nodes, it may mean that the disease has spread to other parts of the body. Kidney cancer may spread and form new tumors, most often in the bones or lungs. The new tumors have the same kind of abnormal cells and the same name as the original (primary) tumor in the kidney. For example, if kidney cancer spreads to the lungs, the cancer cells in the lungs are kidney cancer cells. The disease is metastatic kidney cancer; it is not lung cancer.

Symptoms

In its early stages, kidney cancer usually causes no obvious signs or troublesome symptoms. However, as a kidney tumor grows, symptoms may occur. These may include:

* Blood in the urine. Blood may be present one day and not the next. In some cases, a person can actually see the blood, or traces of it may be found in urinalysis, a lab test often performed as part of a regular medical checkup.
* A lump or mass in the kidney area.

Other less common symptoms may include:

* Fatigue;
* Loss of appetite;
* Weight loss;
* Recurrent fevers;
* A pain in the side that doesn't go away; and/or
* A general feeling of poor health.

High blood pressure or a lower than normal number of red cells in the blood (anemia ) may also signal a kidney tumor; however, these symptoms occur less often.

These symptoms may be caused by cancer or by other, less serious problems such as an infection or a cyst. Only a doctor can make a diagnoses. People with any of these symptoms may see their family doctor or a urologist, a doctor who specializes in diseases of the urinary system. Usually, early cancer does not cause pain; it is important not to wait to feel pain before seeing a doctor.

In most cases, the earlier cancer is diagnosed and treated, the better a person's chance for a full recovery.

What if I don't have time to cook?

Eating healthy doesn't have to take a lot of time. You can prepare a healthy meal just as quickly as an unhealthy one. It's just a matter of planning ahead, having the right foods on hand, and learning how to cook quick, healthy meals.

Ask friends or coworkers who eat healthfully how they manage to find time. Get family members involved and ask them to help prepare meals or do other tasks. Find a cookbook or collect recipes that feature time-saving ideas.

To make preparing meals more fun, take a cooking class with a friend or loved one. Learn to prepare healthy ethnic dishes, such as Mediterranean, Indian, and Japanese foods, that you can share with your family and friends.

Try following these tips for making fast, healthy meals and snacks:

* Buy packaged, prewashed, ready-to-eat fresh vegetables, such as baby carrots, salad mixes, and chopped or shredded broccoli and cauliflower.
* Buy packaged, presliced fruits, such as melon or pineapple.
* Find recipes using foods that don't require a lot of cleaning and preparation, such as baby carrots, cherry tomatoes, or grapes.
* Drink 100% fruit or vegetable juice as a snack.
* Blend low-fat yogurt, fruit juice, and canned or frozen fruit to make a smoothie for breakfast or a snack.
* Use frozen vegetables to make a stir fry with skinless chicken. Serve on top of a quick brown rice or whole-wheat pasta.
* Add frozen vegetables to a jar of marinara spaghetti sauce and serve on whole-wheat pasta.
* Cook potatoes or other vegetables in a microwave.
* Cook vegetables and fruits over the grill. Drizzle them with olive oil and wrap in aluminum foil. Or put them on a skewer and cook directly on the grill.
* Make a fast fruit salad with sliced bananas, apples, blueberries, and a can of mandarin oranges.

How can I start eating a healthier diet?

A healthy diet includes eating a variety of foods from the basic food groups: protein, such as meat, eggs, and legumes; dairy; fruits and vegetables; grains, such as breads and pasta; and fats and sweets. As simple as this sounds, it’s not always easy to get the nutrition you need. You may eat more of your favorite foods from only one food group, and as a result, avoid others. Or perhaps you opt for convenience over quality when you are hungry.

A healthy diet requires some planning and purpose and an effort to include a variety of foods in your meals. If you look closely at how you eat, you might find you aren't getting enough nutrients because you don't get the recommended number of servings from each food groupClick here to see an illustration..

So, not only is it important to pay attention to what you eat but also to what you are missing from your diet. To accomplish this, keep a food diary of everything you eat and drink for 1 week. Pay attention to serving sizes, and check to see if you are eating a variety of foods from each of the food groups. You don't need to meet the minimum number every day, but try to get the recommended intake on average over a week. You might find that making a few small changes will ensure that you're eating a healthy, balanced diet. Or, you may find that you are missing many important nutrients.

Managing anger may be more important for younger men than older men, says Charles Spielberger, PhD, professor of psychology at the University of South Florida in Tampa. "I don't know of studies that look only at men under age 35, but a young man is dealing with a lifelong habit of anger," he tells WebMD.

He says anger involves feelings ranging from annoyance to rage and causes psychological and biological changes. Spielberger developed the widely used STAXI (State Trait Anger Expression Inventory) to assess anger and has studied the role of anger in hypertension. "Research shows it is people who are boiling inside but don't show it who are more likely to develop hypertension."

Anger can also be a personality trait. "Some people feel anger more often across a wider variety of situations. People who do this and hold it in, they're the ones in danger of hypertension."

Spielberger tells WebMD that a good anger management program can help someone lower or normalize blood pressure. It's a three-step process.

First, learn to recognize the anger and the situations that cause it. "A lot of people who feel anger frequently might not recognize it, especially low to moderate levels."

Second, analyze the situation. "If your supervisor frequently makes you and other employees angry, tell yourself 'It's not me. This person is supercritical. I'll listen to what he says, but I'm not going to blame myself for his bad disposition.'"

Third, reduce the anger. "Counting to 10 will distract you, or try muscle relaxation. If possible, avoid the situation."

What About 'White Coat Hypertension?'

If you have a physical exam that shows elevated blood pressure, your doctor might say it could be "white coat hypertension," meaning the stress of seeing the doctor caused the high reading.

White coat hypertension was once thought to be benign, but that may not be the case, says Ulrich Broeckel, who is assistant professor of medicine at the Medical College of Wisconsin in Milwaukee. He co-authored a study of 1,677 patients aged 25 to 74. The study, reported in the British Medical Journal, measured structural changes in the heart, which Broeckel says were probably related to stress and the response to stress. "We found a significant difference between people who had white coat hypertension and those who didn't. It suggests that if people have these increases in blood pressure when they see a doctor, they have them in other stressful situations," says Broeckel.

Don't Wait 5 Years

"The longer you have untreated hypertension, the more complications you get," says Broeckel. "We also know patients who had early onset hypertension and developed diabetes at an early age. It makes early diagnosis and treatment very important."

If the threat of premature death from complications of untreated high blood pressure doesn't get your attention, perhaps this will: A recent study showed that men with high blood pressure were 2.5 times as likely as men with normal pressure to develop erectile dysfunction (ED). Men with prehypertension also had a higher incidence of ED than did men with normal pressure.

Michael Doumas, MD, of the University of Athens in Greece, presented the study at the American Society of Hypertension 20th Annual Scientific Meeting and Exposition. In order to assess the link between hypertension and erectile dysfunction, researchers excluded men who had a history of diabetes, heart disease, renal failure, or liver and vascular disease, which are associated with ED.

While the study of men aged 31 to 65 didn't compare younger vs. older men, the fact that more than one-third of the participants with high blood pressure had erectile dysfunction should be seen as another very good reason to seek treatment and follow doctor's orders.

Risk Factors

Young men with hypertension often have what's called "metabolic syndrome," which is known to contribute to heart disease and diabetes. It includes a cluster of risk factors found in an individual and include excess body fat (especially around the waist and chest), high cholesterol, and insulin resistance. Studies have also shown that early vertex baldness can be associated with HBP. In addition, obstructive sleep apnea and snoring are linked to HBP in men in general.

Family history plays a role, but whether its importance varies with age of onset is unknown. "From epidemiological and twin studies, estimates range from 10% to 40%," says Ulrich Broeckel, MD, who is researching the role of genetics in hypertension. The goal of research is to subcategorize hypertension in order to improve diagnosis and treatment. "We're not ready for a diagnostic test, but ultimately we'll treat patients better based on their genetic makeup."

Younger men with high blood pressure typically have high diastolic pressure while older men have high systolic pressure. "In young men, the diastolic pressure rises because the heart is pumping harder," says Lackland. "In older men, the systolic pressure rises and stiffens arteries.

"Part of the problem with young men is increased body mass. Ten years ago we wouldn't have seen hypertension in the teens and 20s, but now it's increasing along with rising obesity rates. We're seeing the increase in particular in African-American men, but it affects men of all races."

Lackland, who is professor of epidemiology and medicine at the Medical University of South Carolina in Charleston, says that as with older men, treatment for younger men follows JNC 7 guidelines for lifestyle changes and medications.

The JNC 7 recommends the following lifestyle modifications for people with prehypertension as well as hypertension:

Weight reduction. Maintain a normal weight with a target body mass index (BMI) of 18.5 to 24.9.

This can result in an approximate reduction in systolic blood pressure of 5-20 points per 10 kilograms of weight loss, according to the JNC 7.

DASH (Dietary Approaches to Stop Hypertension) eating plan. Adopt a diet rich in fruits, vegetables, and low-fat dairy products. Reduce saturated and total fat. This can be expected to drop systolic blood pressure by 8-14 points.

Lower salt intake. Reduce dietary sodium to less than 2,400 milligrams or about 1 teaspoon a day. According to the JNC 7, a 1,600-milligram sodium DASH eating plan has effects similar to a single drug therapy. The approximate reduction in systolic blood pressure would be 2-8 points.

Aerobic physical activity. Engage in regular physical activity, such as brisk walking, at least 30 minutes per day most days of the week. This can decrease systolic blood pressure by 4-9 points.

Moderation of alcohol consumption. Men should limit alcohol to no more than two drinks per day. A standard drink is defined by the type of alcohol. For example, a standard drink, such as a 12-ounce bottle of beer, a 5-ounce glass of wine, or 1.5-ounce shot of 80-proof distilled spirits, has between 11 and 14 grams of alcohol. Limiting the amount of alcohol to this quantity is expected to result in a reduction in systolic blood pressure by 2-4 points.

When medications are indicated for younger men, one question is what will be the long-term effect? "We've had medications around since the 1970s, but with newer ARBs (angiotensin receptor blockers), we don't know," says Lackland. "But the benefit of keeping blood pressure to goal is so great. Without treatment, a man at [age] 30 could be facing end-stage renal disease, stroke, or heart attack."

High blood pressure is more common in younger men, and should be taken just as serious as in their older counterparts.

You're under 35 and feel fine, yet the doctor says your blood pressure is high and you'd better come back to have it checked again. Being a red-blooded male, you figure five years will be soon enough. After all, isn't high blood pressure an old man's disease?

"Young men are less likely than older men to believe they have hypertension and less likely to go back to the doctor," says Daniel Lackland, DrPH, spokesman for the American Society of Hypertension. "Often these are patients whose blood pressure would respond to weight management and other lifestyle changes, but they're less likely to seek treatment."

Untreated hypertension damages the heart and other organs and can lead to life-threatening conditions that include heart disease, stroke, and kidney disease. It's called "the silent killer" because symptoms generally appear only after the disease has caused damage to vital organs.

"With treatment, we can truly prolong life,"

Understanding High Blood Pressure

If your blood pressure is 120/80, 120 represents systolic pressure, or the pressure of blood against artery walls when the heart beats. Eighty represents diastolic pressure, or the pressure between beats.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) guidelines categorize hypertension as follows:

* Normal. Less than 120/80
* Prehypertension. 120-139/80-89
* Hypertension. 140/90 (130/80 for patients with diabetes or chronic kidney disease)
* Stage 2 hypertension. 160/100

Hypertension, or high blood pressure (HBP), exists when either the systolic measurement is 140 or higher or the diastolic measurement is 90 or higher. However, in the majority of people, controlling systolic hypertension is a more important heart disease risk factor than diastolic blood pressure (except in young people under the age of 50).

There are two types of hypertension: essential, which accounts for 90% to 95% of cases, and secondary. The cause of essential hypertension is unknown, although lifestyle factors such as obesity, sedentary lifestyle, and excessive alcohol or salt intake contribute to the condition. In secondary hypertension, the cause may be kidney disease; hormonal imbalance; or drugs, including cocaine or alcohol.

According to the JNC 7, half the adult population is prehypertensive or hypertensive, and because blood pressure increases with age, most people will become hypertensive if they live long enough.