Understanding Kidney Cancer: Risk Factors, Diagnosis, and Treatment Options
Kidney cancer is among the 10 most common cancer types. Risk factors identified for the development of kidney cancer include smoking, high blood pressure, obesity, a family history of kidney cancers or inheritable syndromes, male gender, African American race, and dialysis. Some studies have also linked certain occupational exposures or certain medications with the development of kidney cancer as well. While the majority of kidney cancers are sporadic, there are also inheritable forms of kidney cancer, and therefore some patients may be well suited for genetic counseling.
Symptoms and Diagnosis: Why Screening Can Be Tricky
Unlike prostate cancer, for which we have a routine blood screening test (the PSA test), in kidney cancer, we unfortunately have no blood test or urine test for screening. Furthermore, the majority of kidney masses do not pose any symptoms to patients, and as a result, the majority of kidney cancers are diagnosed on imaging performed for other reasons.
In some instances, particularly for very large renal masses, patients may experience symptoms such as flank pain, blood in the urine, or may be able to feel a mass on examination. However, this is usually not the case.
Biopsies of kidney masses have inherent risks. In some instances, biopsies can be helpful and may affect the management of patients. In particular, biopsies can be helpful as a rule-in test—so when biopsies show evidence of cancer, we know for a fact that there is kidney cancer. However, a negative biopsy or an equivocal test does not definitively rule out kidney cancer, as it only samples a portion of the tumor. Again, there are some instances in which biopsies can be helpful, and thus it’s important to have a discussion with your urologist about whether or not a biopsy will be useful in your case. In my practice as Dr. Yusuf Saifee, we are constantly keeping up with and investigating novel biomarkers in both the urine and the blood, as well as novel imaging platforms to both diagnose kidney cancer and predict their clinical behavior.
Types of Kidney Tumors and Cysts
There are many types of kidney tumors, including both cancerous and non-cancerous tumors. The most common type of kidney cancer is called renal cell carcinoma; however, there are also other forms of kidney cancers, including upper tract urothelial carcinoma, sarcomas, and Wilms tumors among others. There are also benign or non-cancerous forms of kidney tumors; commonly we see them as oncocytomas or angiomyolipomas.
Even among renal cell carcinoma, there are also several subtypes. Most commonly we see an entity called clear cell renal cell carcinoma. However, there are also several other histologic subtypes which we broadly classify as non-clear cell renal cell carcinoma. Kidney cancers exhibit a wide spectrum of clinical behavior, ranging from less aggressive or what we call indolent forms of kidney cancer to more highly aggressive forms of kidney cancer.
Kidney cysts are more or less a sack of fluid that develop from within the kidney, and while the majority of kidney cysts are not cancerous, there are some forms of kidney cysts that can be associated with an often low-grade form of malignancy. In particular, we assess the complexity of kidney cysts to understand how likely they are to be associated with cancer. We make a determination based on the complexity of a cyst as to whether or not these cysts need to be followed, typically with surveillance imaging at predefined intervals, or whether it’s necessary to intervene on these cysts often surgically.
Exploring Treatment Options
There are a number of treatment options available for the management of kidney cancers, and understandably this can be very overwhelming for patients seeking kidney cancer treatment at Mumbai or kidney cancer treatment at Indore. Broadly, we like to look at both tumor factors as well as patient-related factors in making this determination. Kidney cancers can be broadly classified into small renal tumors, non-metastatic locally advanced cancers, and metastatic kidney cancer.
Approximately one in five, or 20 percent, of small renal masses are non-cancerous or benign, while the remaining 80 percent are often cancerous. That being said, among cancerous small renal masses, most tend to be relatively indolent or of low aggressivity, and as a result, active surveillance is often an appropriate strategy for these patients. We closely catalogue the clinical information, pathologic data, and outcomes of numerous patients with small renal masses who are undergoing either active surveillance or delayed definitive treatment.
We also offer the latest minimally invasive technologies to remove tumors surgically. For patients seeking robotic kidney cancer surgery at Indore or robotic kidney cancer surgery at Mumbai, we integrate the newest technological platforms, and whenever safe and feasible, we make every effort possible to preserve kidney function, such as performing a robotic partial nephrectomy at Indore.
For non-metastatic locally advanced kidney cancer, the current standard of care is to perform surgery or nephrectomy alone with curative intent, which can include options like a robotic nephrectomy at Mumbai. Unfortunately, however, approximately thirty percent or one out of three patients who undergo curative intent nephrectomy still develop recurrence within a three to five-year time frame after undergoing surgery. This is likely attributable to advanced disease biology. We are exploring novel ways in which we can help a) predict those patients who are going to develop recurrence, and b) understand ways in which we can lower those rates of recurrence, either by combining multimodal approaches to therapy or including neoadjuvant strategies such as immunotherapy prior to surgery.
Can You Live With Just One Kidney?
Many patients ask if it’s possible to live with just one kidney. As it turns out, many patients can live a normal healthy life with just one kidney if they have a normally functioning kidney and no underlying risk factors predisposing them to global kidney injury. Miraculously, the single kidney is able to accommodate the function of both kidneys. That being said, it’s really important to continue to monitor the kidney function, and in some instances, it may be necessary to consult with a nephrologist to ensure that the kidney function remains normal or appropriately controlled.
Managing Metastatic Kidney Cancer
In the setting of metastatic kidney cancer, it’s important to involve a multidisciplinary team including a medical oncologist, radiation oncologist, and urologic surgeon in your treatment discussion. In the setting of low volume or oligometastatic disease, in some cases, simply an active surveillance approach may be appropriate. However, in other cases, it may be suitable to perform local regional control of metastatic sites, which may include stereotactic radiation or other ablative approaches to those sites, or even potentially surgery to remove those other metastatic sites.
In patients with more burdensome metastatic disease, typically upfront treatment with a systemic therapy such as an immunotherapy and/or targeted therapy may be appropriate. Recent approval of novel immunotherapy combinations has dramatically revolutionized the field of metastatic kidney cancer. We are indeed in an exciting unprecedented time, and we look forward to developing novel immunotherapy combination drugs and newer agents to help treat metastatic disease. In some instances, surgery to remove the tumor may even be helpful in the setting of metastatic kidney cancer; therefore, it’s important to consult with your urologic surgeon to assess whether you may be in this category of benefit.
A Multidisciplinary Approach to Care
As Dr. Yusuf Saifee, I ensure we present all high-risk cases at a multidisciplinary tumor board attended by leading experts in medical oncology, radiation oncology, urologic surgery, pathology, and radiology to ensure that each and every patient is stratified to an appropriate personalized treatment plan. We run a high-volume practice for kidney cancer and perform numerous nephrectomies each year, including open, laparoscopic, and robotic approaches, integrating the newest technological platforms into our care.
Given our volume, we also have experience managing rare forms of kidney cancer as well. We stay engaged with the complete spectrum of kidney cancer, including both localized and metastatic disease, through innovative imaging platforms, novel therapeutics, and multimodal approaches to treatment. Most importantly, we provide personalized and compassionate care to help you navigate all of your treatment options and facilitate access to patient advocacy groups and programs in kidney cancer.
Frequently Asked Questions (FAQs)
1. What are the early warning signs of kidney cancer?
Early kidney cancer often has no symptoms. Blood in the urine, persistent back or flank pain, and occasionally an abdominal lump may be warning signs.
2. Who is at higher risk of developing kidney cancer?
Smoking, obesity, high blood pressure, older age, family history, and long-term dialysis can increase the risk of kidney cancer.
3. Is kidney cancer hereditary?
Most kidney cancers are not hereditary. However, some are linked to inherited genetic conditions, particularly when multiple family members are affected.
4. Can kidney cancer be detected through blood or urine tests?
There is no reliable routine blood or urine screening test for kidney cancer. Ultrasound, CT scans, and MRI are commonly used to detect and evaluate kidney tumours.
5. Does every kidney tumour or cyst mean cancer?
No. Many kidney cysts and some solid tumours are benign. Imaging helps determine whether further investigation or treatment is required.
6. Is a biopsy always necessary to diagnose kidney cancer?
No. Imaging is often sufficient to guide treatment decisions. A biopsy may be recommended when its results could change the treatment plan.
7. Does every kidney cancer patient need immediate surgery?
No. Some small, slow-growing kidney tumours can be monitored through active surveillance. Others require surgery depending on their characteristics and the patient’s health.
8. Can kidney cancer be treated without removing the entire kidney?
Yes. Partial nephrectomy removes the tumour while preserving healthy kidney tissue. It may be performed through open, laparoscopic, or robotic surgery.
9. Can someone live normally with only one kidney?
Yes. Most people with one healthy kidney can live normal, active lives. Regular monitoring of kidney function and blood pressure remains important.
10. Can advanced or metastatic kidney cancer be treated?
Yes. Immunotherapy, targeted therapy, and selected surgical or radiation treatments can help control advanced kidney cancer. Treatment depends on the individual patient’s condition.
