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I always did well in high school and college when it came to grades. I studied hard. I was prepared as best I could be. One of the common themes for kidney cancer patients (maybe all cancer patients) is the anxiety of an upcoming surveillance exam. Generally, about two weeks before the exam date patients tend to get more anxious. More nerves. More questions. More need for reassurance. It's the waiting for a report that you know is coming due. A report card of sorts. Hopefully not a final report card. But your mind goes there. When I first sat (laid down) for my CT scan to verify whether I had kidney stones, my report card came back with an unexpected result. I had to doublecheck the answer. I was sure my test was mixed up with someone else's. I was expecting a zero for anything but a kidney stone sitting somewhere. Turns out I had a grade 3 tumor in one of my kidneys. That's not a good report. Nowhere close to an A. I had a lot of studying to do to fix this. Maybe I could take the test over again. Study harder. Pass with flying colors next time. My doctor said the score was final. No matter how many times I retake the test, the result would be the same. Damn.

I'm not a patient person. I am a patient, but that doesn't mean I'm patient. Waiting for the follow up surveillance exam (in two weeks) is what creates anxiety. Not just for me, but for other patient's in the same boat. It's like floating along with one paddle instead of two. Hard to navigate, hard to steer your mind in the right direction. It's the unknowing. I want to be all-knowing. As my Auntie Terry will attest to, waiting for 5 to 7 days to get the pathology report is nerve wracking and unsettling. That's why I write. To put my thoughts on paper. It helps to talk about it out loud. On a keyboard. That allows you to go back and make corrections. If only I could go back and erase the cancer. If only we mere mortals had the power. The Delete Key doesn't work for that. Pretty worthless key in that regard. I'm part of the KCCure (Kidney Cancer Cure) on-line support group. The group is on a Facebook board. Access is only for confirmed patients with kidney cancer (about 80% of its over 2,700 members worldwide). The other 20% are healthcare providers / professionals who are interested in kidney cancer. The group is very supportive. We all share our status and stories, look for common practices for our particular stage and grade of tumor, and receive a lot of positive feedback and thoughts. We need that. We get that. For kidney cancer patients (renal cell carcinoma - clear cell in particular), even though you have the entire kidney that cancer invaded removed, the cancer can show up somewhere else in the body later. It's still renal cell carcinoma - clear cell even though it shows up somewhere else in your body. The cancer cells traveled elsewhere. The border isn't closed at the kidney. It's wide open. That's where the worry comes from. Will it show up somewhere else?

Illustration by D. Bicker, pixabay.com When I searched the vast internet to learn more about patients with kidney cancer, I found that most patients who are diagnosed with kidney cancer are blindsided by it because kidney cancer rarely has symptoms. That was true in my case. Like many other cases, my cancer was discovered on a CT scan that was looking primarily to see where the kidney stone(s) was located. The secondary concern (a rule-out diagnosis if you will) was to look for anything more sinister. That begs the question...should total body scans or CT scans of the abdomen and pelvis be done more frequently to screen for kidney cancer in populations where kidney cancer is more prevalent? Early detection increases the likelihood of a better prognosis. But what are the downsides of scanning your body looking for something sinister? Do you really want to know what is growing or lurking in your body? It’s kind of like learning how sausage is made. After you do, you kind of wish you hadn’t. One downside is the unnecessary worry that can be created by seeing shadows within that are nothing to be concerned about. Another is the cost. Health insurance companies don't like to cover the cost of medical services that are not based on an indication to justify it. That makes sense to a point. The counterpoint to that argument is that detecting medical issues early can reduce the total healthcare costs in general. It's a preventative approach rather than waiting for a bigger shoe to drop. Another question to be asked is who would / should be tested for kidney cancer? Kidney cancer only makes up about 4 percent of cancer diagnoses in the United States (about 82,000 new cases each year). Worldwide it is even less than 4 percent. Does it make sense to test 100 percent of the population to detect the 4 percent who have kidney cancer? It doesn't seem cost effective. Unless you are the one with cancer growing in your kidney. The American Cancer Society tells us that most people diagnosed with kidney cancer are between ages 65 and 74. That is when patients are diagnosed with cancer. How long had the cancer been present before diagnosis? Kidney cancer usually doesn’t present with symptoms. That's when a CT scan (or MRI) needs to be done - years before the cancer is detected. For the population that is at higher risk. I was age 61 when the mass was detected, and it had been there between 5 and 14 years. Would a CT scan have picked up the mass when I was age 47 to 50? I’d like to think so. Kidney cancer is very uncommon in people younger than age 45. So, scanning for kidney cancer before age 45 would seem unnecessary. Maybe starting at age 45? Kidney cancer is about twice as common in men than in women and it is more common in African Americans, American Indians, and Alaska Natives. The only category I fit of these is being male. If you are a smoker, diabetic, or like to drink more than most, you are at higher risk of getting kidney cancer. None of these fit my case. Yet, I got renal cell carcinoma-clear cell. I wouldn't be on anyone's radar as a likely candidate for a positive diagnosis. I wouldn't fit the criteria for having a body scan to search for this nemesis. Truth be told, I’m not sure I would have signed up for one had it been offered to me anyway. But other people likely would. Like many kidney cancer patients, I had no symptoms. Had it not been for a kidney stone that was setting off alarm bells, I would not have had a clue there was cancer within. It's too bad our bodies are not transparent. It would make it so much easier to see what is going on. Probably best we don't have that close a view. As the saying goes, beauty is only skin-deep. Perhaps that fits here.

Boy with Umbrella Just over a year ago, I had a radical nephrectomy.  This past summer we experienced a drought in Minnesota.  Like many others dealing with kidney cancer, at times we can lack faith in God or a positive outlook for the future.  This writing lifted me up at a low point: “There was once a small village, which was suffering from a severe drought.  The crops were dying, and the villagers and their animals had very little water to drink. One day, to try to find a solution to the drought, the village priest called the villagers to gather at the village square to pray together for rain.  He told them to bring along a token of their faith, so the prayer would be done in sincere faith. And so, the villagers gathered at the square bringing with them tokens of their faith.  Some brought the Holy Bible while others carried small crosses.  They all prayed aloud with great faith and hope. Sure enough, within a few minutes it began to rain.  The whole crowd was overjoyed and danced happily.  The priest noticed that among the joyous crowd was a nine-year-old boy, clutching an umbrella as a token of faith.  The priest admired this little boy, who had brought an umbrella in total faith that God would surely hear his prayers and send rain.” By Darla NobleIt’s No Problem for God, Daily Bible Inspirations, 2023 That’s faith.  Seeing the world through a child’s eyes.  They hear and see the obvious that adults often take for granted or walk past and don’t even notice. Go Forward in Confidence.  Like that kid with the umbrella. Illustration by TheCognitiveQuest_pixabay.com