Tackling kidney cancer: Medical imaging helps catch this symptom-free cancer earlier, Upstate urologist explains
Doctors traditionally saw kidney cancer in people in their 60s and older, explains Upstate urologist Oleg Shapiro, MD, but the increased use of medical imaging has led to a rise in the incidence of kidney cancers that are discovered incidentally. These are typically small tumors, found in younger people. Kidney cancer is among the 10 most common cancers in both men and women.
“Most people with kidney cancer feel absolutely nothing, even if the tumor is very large,” says Shapiro. The more advanced types of kidney cancer may produce blood in the urine or lower back pain on one side, along with fatigue, loss of appetite, weight loss, fever and anemia.
Kidney cancer can develop within the organ or anywhere outside of it. The majority of the small tumors that are found incidentally are low- to intermediate-grade and do not grow quickly. The larger tumors tend to be the more aggressive.
If kidney cancer spreads, it’s most likely to appear in the nearby lymph nodes or lungs, but Shapiro has also seen it spread to the liver, bone and brain.
Someone who is found to have a mass on a kidney may undergo a special CT scan that is taken after an injection of dye. Shapiro explains that up to 80 percent of the masses that react to the dye turn out to be cancerous. Some doctors may verify with a biopsy. Others make immediate plans for treatment.
“Surgery is the mainstay of therapy for kidney cancer,” he says, “but it depends on the size of the tumor, the age of the patient and the medical comorbidities — if someone is diabetic, or obese, or if they have heart disease.”
In some cases, the tumor may be frozen, using cryoablation, or burned, using radiofrequency ablation.
“We don’t need to operate on every single patient,” Shapiro points out.
“A lot of patients can be observed. They can actually be watched safely with serial CT scans and not have any problems from their disease, ever.”
Depending on the size, location and type of tumor, the entire kidney may have to be removed.
But ideally, surgeons can do what’s known as a “partial nephrectomy,” removing only the tumor and leaving healthy kidney tissue behind. “It has nothing to do with cancer. It has to do with other things, such as diabetes and heart disease. The more normal kidney tissue one has, the better off they are in the long term,” Shapiro explains.
Most surgeries are done laparoscopically, using a small incision and robotic assistance, and patients are back to normal activities within a week.
Kidneys are not sensitive to chemotherapy. Radiation therapy is not an effective treatment, either.
However, several types of immunotherapy — designed to boost the body’s own immune system to recognize and destroy cancer cells — are available for patients with advanced kidney cancers. Shapiro says patients at Upstate also have access to a variety of clinical trials of immunotherapies in development.
Shapiro says some insurance companies suggest patients only need follow-up care for five years after treatment for kidney cancer. “I follow patients forever,” he says. “The reason is, I have seen people redevelop kidney cancer somewhere else 10, 15 or even 20 years down the road.”
This article appears in the summer 2019 issue of Cancer Care magazine.