My persistent cough was the sign my hot flushes weren't just the menopause... but something much more sinister
Niki Ridge had been taking hormone replacement therapy (HRT), in the form of patches, for four years when she began 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 IT manager for a bank, who lives with her husband Steve, 57, and their sons Jamie, 21, and Ewan, 18, in Swindon, Wiltshire. ‘But this time I was also getting night sweats. I’d wake every night drenched. It was unbearable.
‘At first, I thought it was down to my new pyjamas, which had polyester in the fabric, but the sweats carried on even when I changed them. The sheets were soaked through 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 began experiencing hot flushes again
After three months, thinking her menopause symptoms were returning, in January 2022 Niki saw her GP, who agreed to up her HRT dose.
But just as she was about to leave the surgery, she mentioned a persistent cough she’d had over the same three months, and lower back ache.
‘They were just throwaway remarks — neither was really bothering me and I hadn’t come to see her about them at all,’ says Niki. ‘But my GP booked an urgent chest X-ray as I’d had the cough for more than three weeks.
‘I wasn’t too worried as it really wasn’t bad and I hadn’t been feeling unwell.’
Yet the very next day after the X-ray, her doctor phoned to say that something had showed up on her lung and she had a two-week urgent referral to be seen at hospital.
Curious, Niki logged into her records on the NHS app and was horrified by what she saw: the X-ray had found a large nodule and several smaller ones in her lung.
‘It was a huge shock,’ she says. ‘I couldn’t believe what I was seeing. I didn’t feel unwell yet I was being fast-tracked for suspected lung cancer.’
Worse news was to come a few days later, after she underwent a CT scan arranged by her GP to investigate the lower back ache.
T his time, when her GP called, Niki was out walking the family dog, Luna (a springer and cocker spaniel cross). She told Niki there was something suspicious on one of her kidneys.
‘It was another two-week referral, so I knew it was a cancer investigation,’ Niki says. ‘I walked back to my car in tears.’
Niki’s cancer had, in fact, started in her kidneys and then spread to her lungs. Doctors warned her that it was incurable. ‘I thought my time was up,’ she says. ‘Like most people, I thought once a cancer has spread to multiple sites, there’s no hope.’
In fact, a revolution in cancer therapy over the past decade or so has transformed the outcome for many patients such as Niki.
This is largely due to the emergence of immunotherapy drugs that harness the body’s own immune system to tackle the disease. These medicines can help and, in some cases, turn cancer into a chronic if still serious condition that patients 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 HCA Leaders in Oncology clinic in London.
‘Most cancers, once they have escaped and spread around the body, can’t be cured, although many can be controlled for some time,’ he says.
‘However, some of the recent advances may now be curing some patients, particularly with advanced kidney cancer — although we will not know for sure until we get 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 the new treatments; back then, patients lived on average 12 to 18 months.’
More than 13,000 cases of kidney cancer are diagnosed each year in the UK. That could rise to nearly 22,000 a year by 2040, according to Cancer Research UK. Professor Grant Stewart, an honorary consultant urological surgeon at Addenbrooke’s Hospital in Cambridge, says: ‘The incidence of many cancers has either plateaued or is decreasing but kidney cancer is on the rise — we don’t fully understand why but it’s probably a mixture of an increase in obesity and greater use of scans, which often spot kidney tumours by chance when being done for an unrelated problem.’
K idney cancer symptoms can be vague. One of the main signs is blood in urine but this also occurs in urinary tract infections, kidney stones and bladder cancer.
Other symptoms include a lump or swelling in the back under the ribs, pain between the ribs and waist that is constant, night sweats, loss of appetite, weight loss and feeling tired.
But these often only become noticeable when the cancer is at an advanced stage. ‘Around 90 per cent of people with small, curable kidney cancers [4cm or less in diameter] will have no symptoms at all and tend only to be picked up when they are being 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 needed.’
The charity Kidney Cancer UK is now calling for the current NHS screening programmes for lung cancer (offered to 55-74 year olds at risk of lung cancer) and aortic aneurysms (a dangerous bulge in the main artery, screening is offered to men the year they turn 65) to include a quick 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,’ says Niki. ‘I’d been researching survival rates for people with stage 4 [cancer that has spread] kidney cancer and the statistics were scary — only 15 per cent survived for five years.
‘I had been catastrophising based on these figures, not realising they don’t take into account some of the newer treatments and are just averages.’
Niki and Steve didn’t tell their boys — then aged 16 and 19 — about her diagnosis initially: ‘We wanted to know what the plan was before we started having to answer everyone’s questions,’ says Niki.
‘The boys were both very brave, but it was obviously worrying for them. But we stayed positive and said I was having treatment and things were going well.’
First, Niki had infusions of two immunotherapy drugs — nivolumab and ipilimumab — every three weeks for three months. Both drugs work by turning the immune system back on so immune cells called T-cells can attack the cancer cells.
She has had monthly infusions of nivolumab ever since.
‘I had some minor side-effects, such as itchy skin — but at my first three-month scan my kidney tumour had shrunk significantly, as had the smaller tumours in my lung,’ says Niki. ‘By December 2022, the main tumour was half the original size and the ones in my lungs had disappeared.’
However, new tumours appeared on her spine in April 2022, followed by a 5cm tumour in her breast. But both disappeared with immunotherapy and radiotherapy.
And in January 2023, a 3cm tumour on her brain was removed in a five-hour operation, followed by five successive days of radiotherapy.
Since then, all Niki’s scans have shown the tumours in her kidney and lung are stable and there are no new cancers elsewhere.
‘I’m feeling really well and hoping I can carry on like this for the foreseeable future,’ she says.
‘It’s a good place to be considering two-and-a-half years ago things looked so bleak for me.
‘I’m just back from a fantastic holiday in Iceland and enjoying early retirement and seeing my boys grow up. I didn’t know patients like me existed.’
For further 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 below the bladder — can enlarge 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 issues, he says, mainly resulting in problems going to the loo, including having to wait to get started (hesitancy), a decreased urinary stream and incomplete bladder emptying. Lifestyle changes such as drinking less alcohol or caffeine — which irritate the bladder and make urinary symptoms worse — may help. Medications that relax the muscles in the prostate and bladder can also make a difference.
Meanwhile, the penis shrinks with age mainly because of under use, says Professor Vijay Sangar, a consultant urological surgeon at The Christie NHS Foundation Trust in Manchester. ‘But there aren’t any health issues associated with this.’
He also points out that weight gain can also make the penis appear smaller (‘though this is an optical illusion’).
