Niki Ridge had been taking hormone replacement therapy (HRT), in the form of patches, for four years when she started experiencing hot flushes again, so she asked her GP about increasing her dose.
“I’d had hot flushes in the run-up to the menopause but HRT had sorted them out,” says Niki, 58, a former bank IT manager, who lives with her husband Steve, 57, and sons Jamie, 21, and Ewan, 18, in Swindon, Wiltshire. “But this time I was also suffering from night sweats. I’d wake up every night soaked. It was unbearable.
“At first I thought it was because of my new pajamas, which had polyester in the fabric, but the sweat was still there even when I changed them. The sheets were soaked every night; I had to lie on a towel from sweating so much.”
Niki Ridge, 58, had been taking hormone replacement therapy (HRT), in the form of patches, for four years when she began experiencing hot flushes again.
After three months, thinking her menopausal symptoms were returning, in January 2022 Niki saw her GP, who agreed to increase her HRT dose.
But just as he was about to come out of surgery, he mentioned a persistent cough he had had for the same three months and pain in his lower back.
“They were just casual comments, neither of them bothered me and I hadn’t gone to see her about it,” says Niki. “But my GP ordered an urgent chest X-ray because I had been coughing for more than three weeks.
“I wasn’t too worried because it wasn’t really anything serious and I didn’t feel bad.”
However, the day after the X-ray, her doctor called her to tell her that something had appeared in her lung and that she needed to be urgently referred to hospital within two weeks.
Curious, Niki logged into her records on the NHS app and was horrified by what she saw: the X-ray had found one large nodule and several smaller ones on her lung.
“It was a huge shock,” she says. “I couldn’t believe what I was seeing. I didn’t feel sick, but I was being taken for an urgent procedure for suspected lung cancer.”
The worst news came a few days later, when she underwent a CT scan arranged by her GP to investigate her lower back pain.
At the time, when her GP called her, Niki was walking the family dog, Luna (a springer spaniel/cocker spaniel cross). She told Niki that there was something suspicious about one of her kidneys.
“It was two more weeks of referral, so I knew it was cancer research,” Niki says. “I went back to my car crying.”
Niki’s cancer had 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, I thought that once cancer has spread to multiple sites, there is no hope.”
In fact, a revolution in cancer therapy over the past decade or so has transformed the outcome for many patients like Niki.
This is largely due to the emergence of immunotherapy drugs that harness the body’s own immune system to fight the disease. These drugs can help and, in some cases, turn cancer into a chronic, albeit serious, disease that patients have to live with.
Because these treatments are relatively new, many experts have been reluctant to call them a cure, but that may soon change, says Professor Paul Nathan, a consultant medical oncologist at the NHS Mount Vernon Cancer Centre in Middlesex and the private clinic HCA Leaders in Oncology in London.
“Most cancers, once they have spread through the body, cannot be cured, although many can be controlled for a time,” he says.
‘However, some of the recent advances may be curing some patients, particularly those with advanced kidney cancer, although we won’t know for sure until we have long-term data.
‘Of course, they don’t work for everyone, but I have some patients with advanced kidney cancer who we first treated with immunotherapy more than ten years ago.
“That would never have happened before new treatments; back then, patients lived on average between 12 and 18 months.”
More than 13,000 cases of kidney cancer are diagnosed in the UK each year, a figure that could rise to almost 22,000 a year by 2040, according to Cancer Research UK. Professor Grant Stewart, honorary consultant urological surgeon at Addenbrooke’s Hospital in Cambridge, said: “The incidence of many cancers has plateaued or is falling, but kidney cancer is increasing. We don’t fully understand why, but it’s probably due to a combination of rising obesity and increased use of scans, which often detect kidney tumours by chance when they’re done for an unrelated problem.”
Kidney cancer symptoms can be vague. One of the main signs is the presence of blood in the urine, but this also occurs in 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 feeling tired.
But these symptoms only become apparent when the cancer is at an advanced stage. “Around 90 per cent of people with small, curable kidney cancers (4cm or less in diameter) have no symptoms at all and tend to be detected only 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 cancer cells with heat) which can be repeated if necessary.”
The charity Kidney Cancer UK is now calling for current NHS screening programmes for lung cancer (offered to people aged 55 to 74 at risk of lung cancer) and aortic aneurysms (a dangerous bulge in the main artery, screening offered to men in the year they turn 65) to include a rapid scan of the kidneys.
Niki’s kidney cancer diagnosis was confirmed after a biopsy in February 2022. Although the disease had spread to her lungs, doctors assured her it was treatable with immunotherapy.
“I cried when they said it was incurable,” Niki says. “I had been researching survival rates for people with stage 4 kidney cancer (cancer that has spread) and the statistics were terrifying: only 15 percent survived five years.
“I had been catastrophically relying on these numbers, not realizing that they don’t take into account some of the newer treatments and are just averages.”
At first, Niki and Steve didn’t tell their children — then 16 and 19 — about their diagnosis: “We wanted to know what the plan was before we had to start answering everyone’s questions,” Niki says.
“The two boys were very brave, but they were obviously worried. But we kept a positive attitude and told them that he was receiving treatment and that everything was going well.”
First, Niki received infusions of two immunotherapy drugs (nivolumab and ipilimumab) every three weeks for three months. Both drugs work by reactivating the immune system so that immune cells, called T cells, can attack cancer cells.
Since then he has received monthly infusions of nivolumab.
“I had some minor side effects, such as itchy skin, but by my first three-month scan, the tumor on my kidney had shrunk significantly, as had the smaller tumors on my lung,” says Niki. “By December 2022, the main tumor was half the original size and the ones on my lungs had disappeared.”
However, in April 2022, new tumors appeared on the spine and then a 5 cm tumor on the chest. But both disappeared with immunotherapy and radiotherapy.
And in January 2023, he had a 3cm tumour removed from his brain in a five-hour operation, followed by five successive days of radiotherapy.
Since then, all of Niki’s scans have shown that the tumors in her kidney and lung are stable and there are no new cancers elsewhere.
“I feel very good and I hope to continue like this in the near future,” he says.
‘It’s a good place to be considering two and a half years ago things were looking pretty bleak for me.
“I have just returned from a fantastic holiday in Iceland and am enjoying early retirement and watching my children grow up. I didn’t know patients like me existed.”
For more information visit kcuk.org.uk
Time will tell: How body parts change over time
This week: Prostate and penis
The prostate, a walnut-shaped organ that sits below the bladder, can increase in size 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.
According to him, an enlarged prostate can cause a number of problems, mainly problems going to the bathroom, such as having to wait to start (hesitancy), decreased urinary flow and incomplete bladder emptying. Lifestyle changes, such as drinking less alcohol or caffeine (which irritate the bladder and worsen urinary symptoms), can help. Medications that relax the muscles of the prostate and bladder can also make a difference.
Meanwhile, the penis shrinks with age mainly due to lack of use, says Professor Vijay Sangar, consultant urological surgeon at The Christie NHS Foundation Trust in Manchester. “But there are no health problems associated with this.”
He also notes that weight gain can also make the penis appear smaller (although this is an optical illusion).