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The kidneys are located above the waist on both sides of the spine. Kidneys are important organs
that filter blood and remove impurities, excess minerals and salts, and extra water. Doctors use
many tests to find or diagnose kidney cancer. They also do tests to learn if cancer has
spread to another part of the body from where it started. If this happens it is called metastasis.
For example imaging tests can show if the cancer has spread.
These tests show pictures of the inside of the body. Doctors may also do additional tests to
learn which treatments could work best. There are several types of kidney cancer
and the most common type is called renal cell carcinoma which accounts for 85% of
all kidney cancers. In addition to finding out the type of kidney cancer you've been diagnosed with,
it is important to find out the type of kidney cancer cells that make up your tumor.
The main variety is called clear cell but there are other rare subtypes,
and the treatment really differs pretty substantially in those cases.
I'd also want to figure out your stage of disease--that's also very critical--so
getting baseline CTs, MRIs, bone scans, these are all essential first initial bits of knowledge.
Doctors use diagnostic tests to find out the cancer stage, so staging may not be complete until
all the tests are finished. Knowing the stage helps the doctor decide what kind of treatment
is best, and can help predict a patient's prognosis, which is the chance of recovery.
There are 4 different stages of kidney cancer, with stage I being the earliest stage,
up to stage IV, which is the most advanced stage.
Typically stage I through III kidney cancer is gonna stay within the kidney itself,
and stage IV, which is the bulk of what I see as a medical oncologist,
will migrate outwards, to the lungs, the liver, bones, and other structures.
Surgery is a common first treatment and sometimes it is the only treatment needed.
The type of surgery varies, depending on how extensive the cancer is and other factors.
Sometimes surgery is not recommended, because of characteristics of the tumor or the patient's
overall health. Every patient should have a thorough conversation with their doctor about
their diagnosis in order to determine what course of action is best for them.
If you've got newly diagnosed kidney cancer, it's always important to consider the role
of actually taking the kidney out. I always have my patients, as a medical oncologist,
meet with the urologist to see whether or not that's a relevant option.
So deciding whether or not to take that kidney out if you already have stage IV disease is a
really tricky question. I would say that most individuals at this point in time will leave
that kidney in place, but having said that, if it's causing symptoms--pain, bleeding,
etc.--those are definitely scenarios where I think urologists should consider taking the kidney out.
Kidney cancer is usually treated with a multi-disciplinary team which can
include a urologist, a urologic oncologist, a medical oncologist, a radiation oncologist,
and other healthcare professionals who have special skills and training
to help patients with the physical and emotional effects of cancer and its treatment.
Treating kidney cancer, I tend to take a team-based approach, so my nurse plays
an equally important role, my social workers play an equally important role. It's always
difficult to figure out how to convey this news to friends and family sometimes,
and that's really a place where I think social workers can be immensely helpful.
Treatment options and recommendations depend on several factors including the kidney cancer type,
the cell type, the stage of cancer, possible side effects, and the patient's preferences
and overall health. Take time to learn about all of your treatment options,
and be sure to ask questions about things that are unclear. Talk with your doctor
about the goals of each treatment, and what you can expect while receiving treatment.
Drug therapies for later stage kidney cancer generally fall into 2 main categories.
One is targeted therapy so these are drugs, typically taken by mouth,
that really sort of get at the mechanism of action of kidney cancer and try to block it.
The other is immune therapy and this is relatively novel. These are drugs that stimulate your body's
immune system to evoke a response against the cancer. You know, we've got these 2
broad classes of therapy for kidney cancer, the targeted therapies and the immune therapy.
I think there's a lot of investment from researchers now in understanding whether or not we
can combine those 2 classes of drugs. So if I look back over the past year or 2, some of the biggest
advances have come from taking agents that we know work independently and throwing them together.
Over the past decade, there have been many new and successful treatments based on research studies,
called clinical trials. These have lengthened survival
and provided hope to those with advanced kidney cancer.
What's amazing to me is that for stage IV disease,
we typically align a prognosis of a median of 1 year. We've tripled that, and almost quadrupled
that, over the time that I've been in practice and that's a relatively short amount of time.
So I'm hoping that we can continue that trend, and triple and quadruple survival for kidney
cancer over the next 10 years as well. What's remarkable is, I vividly remember telling patients
a decade ago, look you know median survival here is just about a year or so, but thanks
to clinical trials early access to agents, I've been able to experience those patients survive for
well beyond a decade at this point and that's just incredibly rewarding. I hope that continues.
For more information about kidney cancer, visit ASCO's patient information website, Cancer.Net.
The best place to go online is Cancer.Net. It really has a number of resources related to
kidney cancer that I think will provide a fairly comprehensive overview of what
treatments should be employed, how the disease should be comprehensively diagnosed,
and it also just provides great access to experts in the field.
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