Kidney Cancer: What You Need To Know

Kidney (renal) cancer is on the rise. In Washington, D.C. alone, 100 to 150 people a year are expected to be diagnosed with this disease. That number doesn’t include potential new cases in our surrounding counties.

On a broader scale, as one of the 10 most common cancers in the U.S., it will be newly diagnosed in about 75,000 Americans each year, and claim the lives of about 15,000 people annually. Although the reasons aren’t clear, more men than women are affected by this condition.

Incidental Diagnoses

In about half the cases, people discover they have the disease when they visit their primary care doctor for a separate reason. They may have back pain, abdominal pain, gastrointestinal upset. The kidney condition only becomes apparent when a scan reveals a tumor in the kidney. This is why it’s critical to have a good relationship with a trusted primary care doctor.

When I receive a referral from a patient’s primary care doctor, I may order either a high-quality CT scan or an MRI. With those images, I am able to understand the stage of the cancer and surrounding areas with which it may be associated and can determine a path forward if surgery is a recommended option for that patient.

Symptoms to Be Aware of

I want to make it clear that many patients in our community who are diagnosed with localized kidney tumors have no symptoms. They feel 100% normal. But as the cancer progresses—and particularly once it spreads to other areas of the body—some patients will experience a change in appetite and unintentional weight loss. They may also have:

• Blood in the urine: This is a critical signal. If you see blood in your urine, make an appointment with your doctor
• Pain in the side
• Constitutional symptoms, such as fatigue and night sweats
• A general sense of not feeling well

Higher Incidence…or More Scans?

The rate of renal cancer has appeared to be rising since the 1990s. Many people speculate that this is simply due to greater awareness of the disease and increased use of more advanced imaging.

Because it’s become easier to obtain a CT scan, many patients who wouldn’t have been scanned 10 or 20 years ago are scanned today, allowing us to readily identify more cancers than in the past. It’s unclear whether the true number of cases is actually increasing.

Stages, Sizes, and Survival Rates

Once renal cancer develops, it can progress from Stage 1 to Stage 4.

• Stage 1: Small tumors (less than 7 cm) contained within the kidney. Stage 1 cancers actually have a very good five-year survival rate if treated—probably 90%–95%. If you have a small tumor and it’s completely removed by surgery, your prognosis is generally very good.
• Stage 2: The cancerous tissue is larger than in Stage 1, but still localized to the kidney.
• Stage 3: These tumors display signs that they’re invasive. For instance, they may be moving into the surrounding fat or the central part of the kidney. There may also be evidence of local lymph node involvement.
• Stage 4: When the disease has spread outside the kidney, we classify that as Stage 4. At this stage, we’re looking at a 10%–15% five-year survival rate, even with therapy. This is a deadly disease once it spreads from the kidney.

A Range of Treatment Options

Each patient receives a personalized treatment plan. We talk about their goals and create a plan that could provide the best outcome for them. There are several treatment options that we discuss:

Minimally invasive and robotic surgery
The mainstay of therapy for localized renal cancer tends to be surgery. Surgical options depend on many things, including the size of the tumor and its location within the kidney. Although complete removal of the kidney is sometimes warranted, in many cases, we can simply remove the tumor and spare the remainder of the kidney. This is known as a partial nephrectomy.

For many patients who undergo this procedure, a minimally invasive robotic approach offers several advantages:

• Improved visualization for the surgeon
• Improved surgical dexterity for complex reconstruction of the kidney
• Shorter hospital stay
• Less blood loss

Percutaneous ablation
Rather than remove tumors, we can often work with our interventional radiologists to kill the cancer cells within the tumor. The interventional radiologist guides specialized needles into the tumor and either freezes it using a technique known as cryoablation or heats it through radiofrequency or microwave ablation.

Active surveillance with appropriate interventions
In certain scenarios, observation of the tumors can be an option because some kidney cancers can actually grow very slowly and remain in the kidney. The patient follows up with the urologic oncologist or medical oncologist with periodic scans to ensure the tumors are not growing. If a tumor starts to grow or if new symptoms develop, treatment may be called for.

It’s difficult to know how a particular tumor will affect that patient. It could end up being life-threatening or relatively harmless. The choice of active surveillance is a decision made between the doctor and patient and is dependent on various factors.

Immune-boosting agents
For patients with more advanced disease, a variety of therapies can be delivered systemically. These aren’t traditional chemotherapy agents, they’re agents that work on the immune system and can be considered immune-boosting pharmaceutical agents to help attack metastatic cancers.

Clinical trials
For patients interested in a novel therapy, some clinical trials currently available for patients with locally advanced or metastatic renal cancer may be an option.

What to Expect

As the largest hospital in Washington, D.C., MedStar Washington Hospital Center is an excellent choice for kidney cancer treatment.

If you opt for minimally invasive surgery, you will have smaller incisions, less pain, and improved convalescence. Within 24 to 48 hours, you’re eating a regular diet and able to take care of yourself.

My major restriction is no heavy lifting for a period of time after surgery so the incisions can heal. Within a week or two, most of our patients feel almost 100%. And those without a lot of strenuous activity at work can return to the job within two or three weeks.

Looking Forward to Truly Personalized Medicine

Within the next decade or two, we hope to be able to characterize each patient’s tumor at a molecular level. That means we’ll be able to provide targeted, specialized therapy to each patient for his or her unique tumor.

To me, targeted therapy is really fascinating because it unites clinicians like myself with the translational science teams who work to develop drugs and other therapeutic agents. As we move forward in the 21st century, I’m excited about how we’ll become even better enabled to use personalized medicine to care for our patients with kidney cancer.