By Dr. Chaudhry Qasim Mahmood Buttar, Oncologist, Pakistan Institute of Medical Sciences, Islamabad
Kidney cancer, of which the most common type is Renal Cell Carcinoma, is a type of cancer that starts in the kidneys. It is among the ten most common cancers in the world, although the risk is higher in men than in women. Kidney cancer is uncommon in people under the age of 45; and occurs most often in people 55 and older.
Not all kidney cancers are the same. There is an increasing understanding among clinicians and researchers that there are different subtypes of Renal cell carcinoma (RCC) and that they behave quite differently, both with regard to how aggressive they are in the patient and how they respond to treatment. Ten or fifteen years ago, it was common for a pathology report from a patient with kidney cancer to read simply “Renal Cell Carcinoma.” This simple diagnosis is now thought to be incomplete. Identification of the specific subtype or cell type (histology) of the kidney cancer can be as important in determining patient prognosis as knowing the stage or grade of the RCC. The Doctor should inform the patient regarding the histology, grade and stage of the kidney cancer. If not, patients should feel comfortable asking for this information since it is an important part of the treatment planning.
Renal cell carcinoma (RCC) is the most common type of kidney cancer in adults, with the worldwide incidence rising by 2% annually. In adults, RCC accounts for 85% of kidney cancers and nearly 30% of patients with RCC have metastatic cancer at diagnosis and have a peak incidence at 60–70 years of age.
It is not always clear what causes renal cell carcinoma, and the doctor may not be able to give a definite answer as to why the patient has developed this condition. However, certain traits can be considered to be risk factors in the development of Renal Cell Carcinoma, such as, a history of smoking, obesity, use of diuretics—medications that help the body eliminate excess water, certain genetic conditions such as von Hippel-Lindau (VHL) syndrome, gender—men are at a higher risk for kidney cancer than women, exposure to certain chemicals in the workplace.
Signs and symptoms of RCC include blood in the urine (haematuria), fatigue, weight loss, anemia, and pain or a mass on the side or lower back. Doctors may use a combination of the following tests to look for renal cell carcinoma and to establish its extent. Not all tests may be necessary or indicated for all patients. The doctor will decide what is appropriate for the patient. Tests for diagnosis may include a combination of the following: physical examination and medical history review, urine testing, blood testing, biopsy, and imaging techniques such as CT, MRI and ultrasound. Many renal cancers may not be easily detectable on physical examination until later stages of the disease. More than 50% of RCC tumours are now detected incidentally by imaging techniques, such as routine ultrasound scanning and CT.
Treatment options for Kidney cancer include surgery, embolization, radiation therapy, biological therapy, or chemotherapy. The particular treatment for depends on the type and stage of the disease. Usually treatment doesn’t involve chemotherapy and radiotherapy, as kidney cancers often do not respond to these treatments. If the cancer has not spread, it may be removed by surgery. Sometimes this involves removing the whole kidney, which is called Radical nephrectomy. Localised, non-metastatic RCC is frequently treated with surgical removal of the whole affected kidney, and is the only curative approach for treatment of RCC in some cases. Unless all the tumour deposits can be removed by surgery, the cancer is unlikely to be cured and other systemic treatments will be necessary. However, surgery is not always possible – for example, the patient may have other medical conditions that do not permit it, or the cancer may have spread around the body, making it surgically impossible to remove.
Many therapies are used in the treatment of advanced or metastatic RCC, and recently approved targeted therapies have improved the outcome for RCC patients. These therapies have been changing patient management approaches, and allow patients to have a better quality of life.
Depending on the patient’s condition and certain aspects of their lifestyle, an oral, intravenous, or subcutaneous injection therapy might be right for the patient. Some factors that the doctor may consider when selecting a treatment include: ease of access to a treatment center, how confident the patient is that they will remember to take pills or tablets each day, whether or not the patient prefers to have extra opportunities for face-to-face support from the doctor, side effects of treatment options and how they may impact the patient, and cost of therapy.
The more the patient knows, the more effective their decisions will be, and ultimately they will feel more in control of their illness. Knowledge about the disease can help in communication with the doctor and nurse, and increase confidence in the treatment being received. Gaining knowledge about kidney cancer is an important step in effectively fighting the disease. It is important for the patient to ask questions related to every step of the treatment, such as side effects caused by the treatment, ways to manage side effects and the response of the treatment.
Renal cell carcinoma and the potential side effects of treatment can be taxing on the body. Leading a healthy lifestyle may help ensure that the body has enough resources to cope. Eating healthy, quitting smoking, and staying active while also getting reasonable rest, are all positive lifestyle changes that may be beneficial to the patient. However, the patient should always check with his/her doctor before making any changes to their routine.
It is important to keep in mind, the positive impact friends and family can have during these challenging times. Everyone who cares for the patient should contribute to the treatment plan and help them succeed in fighting Renal Cell Carcinoma.