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CANCER


like you to look out for people with the following symptoms:


• Haematuria (blood in urine) • Pain in the side/lower back/flank • Mass in the side/lower back/flank • Fatigue • Night sweats • Persistent cough • High blood pressure • Nausea/vomiting • Weight loss • Anaemia • Raised liver enzymes • Other urological symptoms


(Data from a Kidney Cancer UK symptom survey conducted in 2016 (131 respondents))


Traditionally the main kidney cancer symptoms are described as a triad: blood in urine, pain in the flank/back or side and a mass in the flank/back or side. According to our survey which explored the symptoms presented to GPs, haematuria and pain in the back/side or flank are two of the most commonly presented symptoms. Of the respondents that did visit their GP prior to diagnosis, 39 per cent and 41 per cent described blood in urine and pain in the side/back/flank respectively. However, if the percentage is calculated to include the number of people who did not visit their GP, only 26 per cent and 27 per cent of respondents visited the GP with these symptoms. This is a small number of people who clearly present classic kidney cancer symptoms to their GP.


Fatigue was the next most commonly presented symptom. Fatigue is often associated with cancer but can


also be caused by many diseases. A lump or mass in the flank/back/ side was not commonly described in conversations with the GP even though it is one of the clearest symptoms to indicate kidney cancer.


Many of the other symptoms presented to the GP are quite vague and commonly associated with viral infections and other diseases, symptoms such as; night sweats, high temperatures, digestive disturbances and coughs.


Weight loss, raised liver enzymes and anaemia are often associated with cancer but they do not present a clear picture of the type of cancer. Overall, there is a complex mixture of symptoms presented to GPs which are often unspecific.


We would like you to be aware of the collection of symptoms associated with kidney cancer, however it is rare for people to present with many of these symptoms at the same time. Our surveys suggest that people only describe one or two symptoms to their GP prior to diagnosis and a very large number of people did not visit their GP at all.


Ultimately, if you have any suspicion of kidney cancer when discussing a patient’s symptoms, then please ask them to request an appointment with their GP. In order to investigate their symptoms further, rule out kidney cancer and potentially ask for an upper abdominal ultrasound referral.


BLOOD IN URINE The third national ‘blood in pee’ campaign took place from 15 February to 31 March 2016. The key message promoted was ‘If you notice blood in your pee, even if it’s ‘just the once’, tell your doctor.’


The advertising highlights that finding cancer early makes it more treatable.


Kidney Cancer UK fully support the ‘blood in pee’ campaign but would like to highlight that it has its limitations, especially in diagnosing early-stage disease. Only 50 per cent of people with kidney cancer ever see blood in their urine, according to a Kidney Cancer UK survey. A large amount of haematuria is identified by urinalysis rather than by the naked eye, especially in early stage disease. Visible haematuria increases as the stage of the disease increases. So identifying this symptom would rarely indicate very early stage disease. It is clear to us that more needs to be done to improve early diagnosis rates.


HOW CAN WE IMPROVE EARLY DIAGNOSIS OF KIDNEY CANCER? Kidney Cancer UK is actively aiming to raise awareness of kidney cancer and the problems we face in diagnosing it at an early stage. We are currently promoting and funding research into potential ultrasound screening programmes and biomarker identification. We would like to see everyone over 50 years old regularly screened for kidney cancer using ultrasound. We understand that developing a screening programme and collecting the evidence required to establish one will take time but we are in active talks with research groups about making this happen.


Identifying biomarkers to indicate kidney cancer would be of great use in the fight for early diagnosis. We are funding such research and remain hopeful that in time a scientific discovery will evolve into a routine non-invasive test that can be used to detect if a person has kidney cancer.


We have also written and hosted an educational course for nurses on our website to raise awareness and provide information on kidney cancer. We are also currently developing a course for doctors (GPs and newly- qualified registrars) in the hope that kidney cancer is further to the front of their mind when considering a potential diagnosis for someone with lower back pain or persistent night sweats, for example.


HOW CAN YOU HELP? Pharmacists have a vital role to play. You discuss a large variety of symptoms with people feeling unwell, which on the surface might


Data from a Kidney Cancer UK symptom survey conducted in 2016 (131 respondents). SCOTTISH PHARMACIST - 53


CANCER CAN BE A DIFFICULT THING TO DISCUSS AND YOU MAY WORRY THAT YOU COULD DISTRESS SOMEONE UNNECESSARILY. ALTHOUGH IF DISCUSSED CAREFULLY WE FEEL THAT IT IS BETTER TO SUGGEST PEOPLE GET THEMSELVES CHECKED, THAN IGNORE POTENTIAL CANCER SYMPTOMS.


not sound at all serious. However, if the symptoms described to you sound at all like the list of symptoms described in this article please can you suggest to that person that they talk to their GP to rule out kidney cancer. Cancer can be a difficult thing to discuss and you may worry that you could distress someone unnecessarily. Although if discussed carefully we feel that it is better to suggest people get themselves checked, than ignore potential cancer symptoms. Someone could be exceptionally grateful if their kidney cancer is discovered at an early stage and successfully treated rather than left undiscovered until it is too late. Thank you for taking your time to refresh your knowledge of kidney cancer and we hope you can play a part in our campaign to improve its early diagnosis. •


References


1. Cancer Research UK. http://www. cancerresearchuk.org/health- professional/cancer-statistics/ statistics-by-cancer-type/kidney- cancer. Accessed February 2017.


2. Cancer Research UK http://www. cancerresearchuk.org/health- professional/cancer-statistics/ statistics-by-cancer-type/kidney- cancer/incidence#heading-Three. Accessed February 2017.


3. Cancer Research UK http://www. cancerresearchuk.org/health- professional/cancer-statistics/ statistics-by-cancer-type/kidney- cancer/survival#heading-Three. Accessed February 2017.


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