Niki Ridge had been taking hormone replacement therapy (HRT) in the form of patches for four years when she started experiencing hot flashes again. She asked her GP if she could increase the dose.
‘I had been suffering from hot flushes in the run-up to the menopause, but hormone replacement had sorted that out,’ says Niki, 58, a former IT manager at a bank, who lives with her husband Steve, 57, and their sons Jamie, 21, and Ewan, 18, in Swindon, Wiltshire. ‘But this time I also started getting night sweats. I would wake up soaking wet every night. It was unbearable.
“At first I thought it was my new pajamas, which had polyester in the fabric, but the sweating continued even after I changed them. The sheets were soaked every night — I had to lie on a towel, I was so sweaty.”
Niki Ridge, 58, had been taking hormone replacement therapy (HRT) in the form of patches for four years when she started experiencing hot flashes again
After three months, Niki thought her menopausal symptoms were returning. In January 2022, she went to her GP, who agreed to increase her hormone therapy dosage.
But just as she was about to leave the practice, she told me that she had been suffering from a persistent cough and lower back pain for three months.
‘They were just throwaway comments — neither of which really bothered me and I hadn’t gone to her for them at all,’ says Niki. ‘But my GP had booked an emergency chest x-ray because I had been coughing for over three weeks.
‘I wasn’t too worried because it wasn’t too bad and I didn’t feel unwell.’
However, her doctor called the day after the X-ray to report that something had been found in her lung and that she had to be rushed to the hospital two weeks later.
Curious, Niki logged into her details on the NHS app and was shocked by what she saw: the X-ray showed a large nodule and several smaller nodules in her lung.
“It was a huge shock,” she says. “I couldn’t believe what I was seeing. I didn’t feel unwell, but I was quickly treated for suspected lung cancer.”
Even worse news came a few days later, after her GP ordered a CT scan to investigate the pain in her lower back.
When her doctor called, Niki was walking the family dog Luna (an English Cocker Spaniel/English Springer mix). She told Niki that there was something suspicious about one of her kidneys.
“It was another two-week referral, so I knew it was for a cancer screening,” Niki says. “I walked back to my car crying.”
Niki’s cancer had actually started in her kidneys and then spread to her lungs. Doctors warned her it was incurable. “I thought my time was up,” she says. “Like most people, if cancer had spread to multiple places, I thought there was no hope.”
In fact, a revolution in cancer therapy over the past decade has dramatically changed the prognosis for many patients like Niki.
This is largely due to the advent of immunotherapy drugs that use the body’s own immune system to attack the disease. These drugs can help and in some cases turn cancer into a chronic, but still serious, condition that patients live with.
Because these treatments are relatively new, many experts are reluctant to call them a cure. But that could soon change, says Professor Paul Nathan, a medical oncologist at the NHS Mount Vernon Cancer Centre in Middlesex and the private clinic HCA Leaders in Oncology in London.
“Most cancers cannot be cured once they have metastasized and spread throughout the body. However, many cancers can be controlled for a period of time,” he says.
‘But some of the recent developments may now indeed cure some patients, particularly those with advanced kidney cancer. However, we will not know for sure until we have long-term data.
‘Of course they don’t work for everyone, but I know a number of patients with advanced kidney cancer who we first treated with immunotherapy more than ten years ago.
‘That would never have happened without the new treatments; back then, patients lived an average of 12 to 18 months.’
More than 13,000 cases of kidney cancer are diagnosed each year in the UK. According to Cancer Research UK, that could rise to almost 22,000 a year by 2040. Professor Grant Stewart, honorary urological surgeon at Addenbrooke’s Hospital in Cambridge, said: ‘The incidence of many cancers has either stagnated or is falling, but kidney cancer is increasing. We don’t fully understand why, but it’s probably a combination of rising obesity and greater use of scanning, which often accidentally detect kidney tumours when they’re done for an unrelated problem.’
Kidney cancer symptoms can be vague. One of the main signs is blood in the urine, but this also occurs with urinary tract infections, kidney stones, and bladder cancer.
Other symptoms include a lump or swelling in the back below the ribs, constant pain between the ribs and waist, night sweats, loss of appetite, weight loss, and fatigue.
But these often only become noticeable when the cancer is in an advanced stage. ‘About 90 percent of people with small, curable kidney cancers [4cm or less in diameter] will have no symptoms at all and are usually only noticed when they are scanned for other things,’ says Professor Stewart. ‘These types of kidney cancer are curable with surgery or thermal ablation [where a probe is used to destroy the cancer cells with heat] which can be repeated if necessary.’
The charity Kidney Cancer UK is advocating that current NHS screening programmes for lung cancer (offered to 55- to 74-year-olds at risk of lung cancer) and aortic aneurysms (a dangerous bulge in the main artery; screening is offered to men in the year they turn 65) should also include a rapid scan of the kidneys.
Niki was diagnosed with kidney cancer after a biopsy in February 2022. Although the disease had spread to her lungs, doctors assured her that the disease could be treated with immunotherapy.
“I cried when they said it was incurable,” Niki says. “I was doing research on the survival rates of people with stage 4 [cancer that has spread] kidney cancer and the statistics were frightening: only 15 percent survived five years.
‘I had already imagined a disaster scenario based on these figures, because I didn’t realise that these figures didn’t take into account some of the newer treatments and that they were just averages.’
Niki and Steve initially didn’t tell their sons, then 16 and 19, about her diagnosis: “We wanted to know what the plan was before we had to answer everyone’s questions,” Niki says.
“The boys were both very brave, but it was clear they were worried. But we stayed positive and said I was being treated and was fine.”
First, Niki received infusions of two immunotherapy drugs — nivolumab and ipilimumab — every three weeks for three months. Both drugs work by turning on the immune system so that immune cells called T cells can attack the cancer cells.
Since then, she has received a monthly infusion of nivolumab.
“I had some minor side effects, like itchy skin, but by my first scan after three months, my kidney tumor had shrunk significantly, as had the smaller tumors in my lungs,” Niki says. “By December 2022, the main tumor was half the size of the original tumor and the tumors in my lungs had disappeared.”
However, in April 2022, new tumors appeared on her spine, followed by a 5 cm tumor in her chest. But both disappeared with immunotherapy and radiation therapy.
And in January 2023, a 3cm tumor in her brain was removed during a five-hour operation, followed by five consecutive days of radiation therapy.
Since then, all of Niki’s scans have shown that the tumors in her kidneys and lungs are stable and that no new cancers have developed elsewhere.
“I feel very good and hope I can continue this for a long time,” she says.
It’s worth remembering that the situation looked so bleak two and a half years ago.
‘I have just returned from a wonderful holiday in Iceland and am enjoying my early retirement watching my boys grow up. I didn’t know patients like me existed.’
For more information go to kcuk.org.uk
Time Will Tell: How Body Parts Change Over Time
This week: Prostate and penis
The prostate, a walnut-shaped organ beneath the bladder, can grow larger with age, while the penis shrinks. In both cases, this can be due to changes in testosterone levels, explains Professor Chris Eden, a urologist at the Royal Surrey County Hospital.
An enlarged prostate can cause a range of problems, he says, primarily resulting in trouble going to the bathroom, including having to wait to start (hesitancy), a reduced urine stream and incomplete bladder emptying. Lifestyle changes, such as cutting back on alcohol or caffeine — which irritate the bladder and worsen urinary symptoms — can help. Medications that relax the muscles in the prostate and bladder can also make a difference.
Meanwhile, the penis shrinks with age, mainly due to underuse, says Professor Vijay Sangar, a consultant urological surgeon at The Christie NHS Foundation Trust in Manchester. ‘But there are no health problems associated with it.’
He also points out that weight gain can make the penis appear smaller (‘although this is an optical illusion’).
