Dr. Brian I. Rini is a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University in Cleveland, Ohio, and a staff member of the Department of Solid Tumor Oncology of the Taussig Cancer Institute. He’s the Cancer.Net Associate Editor for Genitourinary Cancers.
Did you know that kidney cancer is the sixth most common cancer for U.S. men and the tenth most common cancer for U.S. women? Here are 4 important facts about this disease:
1. Kidney cancer may cause no symptoms or only subtle symptoms.
Every person has 2 kidneys. These fist-sized organs filter blood to remove impurities, excess minerals and salts, and extra water. They also produce hormones that help control blood pressure, red blood cell production, and other bodily functions. Because your kidneys are located in the back of your abdomen surrounded by fat, a tumor may not cause symptoms in its early stages. As it grows, common symptoms can include pain in the side or blood in the urine. Often, people with kidney cancer have blood in their urine only 1 time. That’s why the cause of any blood in your urine needs to be investigated right away by your primary care doctor or a urologist, a doctor who specializes in treating conditions of the urinary tract. Early detection of kidney cancer is key to successful treatment. There are only a few well-identified risk factors for kidney cancer aside from smoking, and most people don’t have an inherited form of the disease. So paying close attention to symptoms and having them evaluated by a medical professional is essential
2. There are many different approaches to treating kidney cancer.
There are several different types of kidney cancer and kidney cancer cells. As a result, there are many different approaches to treatment that depend on a person’s individual circumstances. Cancer that is found only in the kidney can often be cured with surgery. If the cancer has spread beyond the kidney, the decision to use surgery to remove the tumor in the kidney and, possibly, cancer that has spread to other parts of the body, isn’t always straightforward. A specialized team of medical oncologists and urologists will need to review the cancer and help develop a treatment plan. In a small number of people with advanced kidney cancer, aggressive surgery may be able to remove all of the disease. However, the risk of the cancer coming back is high. This is called a recurrence.
If kidney cancer is advanced, meaning it has spread beyond just the kidney, another consideration is when to start systemic therapy. Systemic therapy is the use of medication to destroy cancer cells throughout the body. Some people with slow-growing kidney cancer can safely wait to have systemic therapy until a later time. Other people need this type of therapy right away based on how fast the disease is worsening, the symptoms from the disease, and where in the body the cancer has spread. A kidney cancer specialist and the patient should make this decision together.
3. Immunotherapy is becoming the standard of care for advanced kidney cancer.
Therapy using medication that targets blood vessels has been the standard treatment for advanced kidney cancer for over a decade. This is often called targeted therapy. Studies show these drugs can help control the disease, but often do not cure it. Today, immunotherapy is becoming the new standard approach based on clinical trials that show it has greater benefits than targeted therapy. Immunotherapy works by stimulating your immune system to fight the cancer. This approach can cure some people and allow others to control their disease for many years. More information is needed from clinical trials about how patients are doing after treatment, but over the next few years, it is likely that most to all patients with advanced kidney cancer will receive immunotherapy as part of their first treatment plan. Targeted therapy is still important because it is now being combined with immunotherapy, and it can be useful if immunotherapy does not work.
4. You need to be comfortable with your doctor and your multidisciplinary team.
The ways that we treat kidney cancer are rapidly changing. Be sure to talk with a doctor who treats a lot of people with kidney cancer and keeps up with the latest options. Kidney cancer can be treated at many different types of medical centers. As noted above, that care often involves different types of doctors. Your health care team may include surgeons, medical oncologists, and, sometimes, radiation oncologists. This is called multidisciplinary care, and it’s vital for people with kidney cancer. Both you and your lead doctor need to be comfortable with the treatment plan and who is delivering it. Access to clinical trials is also important. Although many advances in kidney cancer treatment have been made in the last decade, people still need as many treatment options as possible.