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1 The TV Series Produced By: INFORMATION TELEVISION NETWORK ONE PARK PLACE 621 NW 53RD ST BOCA RATON, FL INFO-ITV Information Television Network. All Rights Reserved.

2 UNDERSTANDING KIDNEY CANCER: THE SILENT DESTROYER Our kidneys are bean-shaped organs about the size of a small fist. They are located above the waist on either side of the spine. Shielded and protected by the lower rib cage, they play a key role in the body s waste disposal system. Each day, our kidneys filter some 200 quarts of blood which generates about two quarts of urine. There are several types of cancer that can develop in the kidney, but the most common form is known as renal cell carcinoma (RCC). In renal cell carcinoma, malignant cells grow into a mass, or tumor. In most cases, a single tumor develops, although more than one tumor can form in one or both kidneys. Renal cell carcinoma is divided into four major types. Clear renal carcinoma, granular renal cell carcinoma, mixed granular renal cell carcinoma, and spindle renal cell carcinoma. The majority of patients develop clear or mixed type renal cell carcinoma. Renal cell carcinoma occurs more commonly in men than in women, and as with most forms of cancer, the risk of getting renal cell carcinoma increases with age. However, renal cell carcinoma can affect any age group. Today, more than 30,000 new cases of kidney cancer are diagnosed annually, claiming nearly 13,000 lives each year; renal cell carcinoma accounts for about 85 percent of all cases. Like most cancers, patients with renal cell carcinoma have a far better prognosis if the disease is found in its early stages before the cancer cells can spread. Tumors discovered at an early stage often respond well to treatment. Survival rates in such cases are high. Tumors that have grown large or spread (metastasized) through the bloodstream or lymphatic system to other parts of the body are more difficult to treat and present an increased risk for mortality. Symptoms The most common symptom of renal cell carcinoma is blood in the urine. Other possible symptoms of RCC include back and abdominal pain, swelling of the abdomen, fever, weight loss, and a general malnourished look. These warning signs are not always the result of renal cell carcinoma and can often times be attributed to many other ailments. Diagnosis If a doctor suspects renal cell carcinoma, a series of examinations, procedures, and laboratory tests are performed to confirm the diagnosis. First, a thorough physical examination is performed to assess the patient's health, information is obtained about symptoms, and a medical history is taken to determine if there are any risk factors for RCC. Next, one or more imaging procedures may be needed to obtain pictures of the kidney(s) and locate abnormalities. Some imaging tests include: CT scans, MRI scan, and ultrasound. Lastly, laboratory tests are performed to confirm the presence of RCC. These tests include: urinalysis and blood tests. Staging Renal Cell Carcinoma Once a diagnosis of renal cell carcinoma is made, it is then staged. Staging is the process of gathering information from exams and diagnostic tests to determine how widespread the cancer is. The stage (extent) of a cancer is one of the most important factors in selecting treatment options for the patient. The grade of a cancer cell is an assessment of its appearance compared to that of a normal, healthy cell. Grading is done on a scale of 1 to 4: Grade 1 RCC cells differ little from normal kidney cells, typically spread slowly, and have a good prognosis for treatment. Grade 4 RCC cells look extremely different and indicate an aggressive cancer with poor prognosis.

3 TREATMENTS and OPTIONS Staging factors that influence a patient's prognosis are: Spread to tissues surrounding the kidney Spread to contiguous organs Spread to nearby lymph nodes Distant metastasis There are two staging systems for RCC, Robson and TNM. The Robson system classifies tumors as stages: Stage I The tumor is confined to the kidney and does not involve the capsule that surrounds the kidney Stage II- The tumor extends through the capsule of the kidney Stage III- The tumor involves lymph node(s) Stage IV- The tumor has invaded organs adjacent to the kidney or shows evidence of distant spread to organs such as the lungs The TNM (tumor-node-metastasis) system uses stages generally similar to those of the Robson system but provides a more detailed description of the tumor(s). Stage I - Small tumors (less than 1 inch) without evidence of local invasion; no lymph node involvement and absence of distant disease Stage II- Tumors larger than 1 inch without evidence of local invasion; no lymph node involvement and absence of distant disease Stage III- Tumors of any size that involve one lymph node (less than 1 inch); tumors that invade the adrenal gland or surrounding renal tissues; tumors that invade the renal vein or the inferior vena cava Stage IV - A mixed group including tumors that invade adjacent structures; any tumor that has evidence of distant spread; any tumor in which more than one lymph node is involved Treatment Finding effective treatments for advanced kidney cancer has proven to be difficult. Because renal cell carcinoma appears to resist conventional cancer treatments such as chemotherapy and radiation therapy, surgery has been, and remains, an ideal option when kidney tumors are detected early. Selected renal cell carcinoma patients also respond well to immunotherapy. Immune therapy, which shows modest activity against renal cell carcinoma, has been the standard approach for metastatic kidney cancer. Immunotherapy drugs used against RCC include interleukin-2, interferon-alpha, and interferon-gamma. Clinical Trials Participating in clinical trials is a crucial step for renal cell carcinoma patients to consider because it helps doctors find new and better treatment options that may prove effective now and for future patients. Today, the main goal of the latest therapies is to attack kidney cancer on a molecular level. This is done by new agents designed to break the basic biological code that allows tumors to grow and spread. Once these agents are developed, carefully screened groups of volunteers help researchers determine how effective the agents are, and what potential side effects they might create.

4 FREQUENTLY ASKED QUESTIONS Can a person live with just one kidney? Yes, most people can live with only one kidney if need be. If there is some sort of damage or if one kidney is removed, then generally the other kidney is adequate to maintain good kidney function. Do all cancers in the kidneys arise primarily from the kidneys themselves? No. The kidney is a frequent site of metastatic cancers from other sites. The most common sources of metastatic cancer to the kidney occur from primary lung and breast cancers. Who is at greatest risk for renal cell carcinoma, (or RCC)? Men are twice as likely as women to develop renal cell carcinoma. In fact, for men, kidney cancer is the seventh most common cause of cancer and the 10th most common cause of cancer death. In addition, smokers face a three-fold greater risk than non-smokers to get renal cell carcinoma. What is the survival rate for renal cell carcinoma patients? If the tumor is removed and has not spread beyond the kidney, the survival rates are quite good; five-year survival rates will be over 80 percent for most of those patients. If tumors are large and have spread more locally into the lymph nodes, the five-year survival rates come down accordingly and would be in the range of 30 to 40 percent. Does renal cell carcinoma spread quickly or slowly? Renal cell carcinoma, once it has spread, can grow slowly or rapidly. Is there a cure for renal cell carcinoma? More than 50% of patients with renal cell carcinoma are cured in early stages. The treatment for Stage 1, 2 and 3 is simply surgery, but unfortunately the outcome for stage IV is poor. Are there any drawbacks associated with immunotherapy? There is one significant drawback associated with immunotherapy and that is the unpleasant side effects associated with the medication. Do all cases of renal cell carcinoma have signs and symptoms? No, some RCC patients will notice blood in the urine which is an early warning sign of kidney cancer. But most of the time, the problem will be discovered during a routine urinalysis test or during an imaging exam for an unrelated medical procedure. Kidney cancer is usually found incidentally, not as the primary search. As of now, how many treatments are approved for advanced-stage kidney cancer? Currently, there is only one approved form of treatment for advanced-stage kidney cancer. But judging from the success of new trial medications, as well as their lack of known side effects, that could be about to change.

5 DATA, RESOURCES, HOTLINES, PUBLICATIONS and MEDIA CONTACTS Kidney Cancer Association 1234 Sherman Avenue Evanston, IL (P) National Institutes of Health (NIH) 9000 Rockville Pike Bethesda, Maryland (p) Cleveland Clinic 9500 Euclid Avenue Cleveland, OH (P) National Kidney Foundation 30 East 33 Street Suite 1100 New York, NY (P) American Association of Kidney Patients 3505 East Frontage Road, Suite 315 Tampa, FL (P) Centers for Disease Control and Prevention 1600 Clifton Rd Atlanta, GA (P) 800) For a DVD copy of a 30 minute documentary style program on Kidney Cancer call or visit. To watch on television, consult your local public television station for air-times in your area. American Kidney Fund 6110 Executive Boulevard, Suite 1010 Rockville, MD (P) or American Society of Nephrology 1725 I Street, NW Suite 510 Washington, DC (P) The U.S. Department of Health and Human Services 200 Independence Avenue, S.W. Washington, D.C (P)

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