Finding Out You Have Kidney Cancer
You probably don't know the ribbon color for kidney cancer (it's orange). With about 62,000 new U.S. cases each year, mostly in middle-aged and older adults, there's less awareness of kidney cancer than other, higher-profile diseases. But kidney cancer is one of the top 10 cancers, and rates are rising. According to the American Cancer Society, about 14,000 people die from kidney cancer yearly.
Early detection makes all the difference and is as simple as providing a urine specimen. But about half of cases are found by "accident" when a patient is having a CT scan for a different medical issue, and kidney cancer is revealed. Read on for more about this condition -- from prevention and early signs to the latest treatments to boost survival.
'We Found Something'
Michael Lawing, now 67, wasn't much for going to the doctor. Born and raised in Spindale, North Carolina, he always felt so healthy that he didn't see a need. But in 1997, a few days before Thanksgiving, he woke in the middle of the night with sharp abdominal pain. "I was sick and throwing up and sweating profusely," he recalls. "It was just intense pain all over."
At first, doctors at the local hospital assumed kidney stones were the culprit. They took some X-rays and sent Lawing home with a strainer to catch stones in his urine. But that wasn't the problem. A couple of days later, he got the call: "We found something."
Lawing had kidney cancer. Back then, he says, with his type of tumor, his five-year survival odds were about 65 percent. But nearly 19 years later, he's still here. And he's in treatment for recurring disease.
When Lawing was first diagnosed, the cancer had not spread beyond his right kidney, and he had surgery to have that kidney removed.
Risking Risk
The kidneys, a pair of bean-shaped organs, filter excess water, salt and waste in the blood and turn this waste into urine. Kidneys also play a role in controlling blood pressure and ensuring the body produces enough red blood cells.
Older adults are most likely to get kidney cancer. According to the American Cancer Society, the average age at diagnosis is 64, and the condition is "very uncommon" in people younger than 45. Men are at higher risk than women. African-Americans have a higher incidence of kidney cancer -- and worse outcomes -- than whites. Obesity, smoking and some workplace exposures are also risk factors.
Kidney cancer is one of the few types of cancer that's increasing in incidence, says Dr. Robert Weiss, a professor with the University of California--Davis Health System and chief of nephrology at Sacramento VA Medical Center. Metabolic syndrome, which is tied to obesity, diabetes and high blood pressure, is also a factor in kidney cancer, research suggests.
Genetic conditions like hereditary papillary renal cell carcinoma can lead to kidney cancer. Kidney failure and having had a kidney transplant may increase a person's risk, according to a study published online Nov. 12 in the Journal of the American Society of Nephrology.
Kidney-Sparing Surgery
Renal cell carcinoma is the most common type of kidney cancer. In early stages, it's very treatable with surgery alone. Surgery can involve a part of the kidney or the entire organ. Even if a whole kidney is removed, otherwise healthy people can go about their lives as usual after surgery.
With people getting far more imaging studies like CT scans than before, more kidney tumors are being discovered "incidentally," says Dr. Susie Hu, an associate professor in the kidney disease and hypertension division at the Alpert Medical School at Brown University, and a member of the ASN Onco-Nephrology Forum. "We're finding these renal cell carcinomas early on," she says. "And over 60 percent of these tumors are very small."
A tumor size of less than 7 centimeters (about 2.8 inches) is considered a small renal cell carcinoma, Hu says. A tumor of less than 4 cm (about 1.6 inches) is the earliest stage.
"For those patients, the good news is, if the tumor is small, those have a good prognosis," Hu says. "If you resect the tumor, the likelihood that you'll survive is very high. Five years: nearly 100 percent survival. It's very unlikely that you will have recurrence."
With smaller tumors, partial nephrectomy -- surgery in which only the diseased kidney tissue is removed -- spares healthy tissue. Complete nephrectomy, sometimes called "radical nephrectomy" is when the entire kidney is removed. More and more studies are showing extremely low recurrence rates of kidney cancer in patients with partial nephrectomies, Hu says: "They do remarkably well."
On the other hand, Hu says, extensive surgery involving the entire kidney and surrounding tissue can lead to worse kidney function, particularly in patients who have chronic kidney disease. Before moving forward with radical nephrectomy, she says, patients should ask about other treatment options.
Surgical choices may include like less-invasive laparoscopic procedures with smaller incisions and quicker recovery. Some urologists also do robotic kidney surgery.
If Cancer Spreads
In 2000, three years after Lawing had surgery, a lymph node his neck was found to contain cancer, and he was referred to a specialist in Charlotte, North Carolina. A treatment called interleukin-2, or IL-2, a therapy that boosts the immune system, had recently been approved. Lawing was started on a lower-dose version of IL-2 in hopes of limiting the side effects. That treatment took about a year, including eight weeks in the hospital.
In 2007, Lawing started a newer type of treatment, a drug called Sutent, which he's been taking almost continuously since. He still has active cancer in his abdominal lymph nodes, which can't be surgically removed. But he continues to count his blessings.
What to Watch For
Blood in the urine is the most common sign of kidney cancer, but you can't always notice it on your own. "Sometimes it's microscopic blood in the urine, and you don't even see it," Weiss says. Flank pain is another telltale sign. "If you have pain on one side, it should be a prompting to have it looked at," he says.
Medical visits can reveal other red flags for cancer, such as a sudden onset of hypertension or a sharp spike in your red blood-cell count, Weiss says. "These aren't things you'll notice; those will be laboratory things," he says. "And that could be a reason to come in." Finally, family history of kidney cancer is another risk factor to look into.
Improving Treatments
While surgery is the treatment of choice, patients need other therapies if kidney cancer spreads. Targeted treatments for kidney cancer are less toxic and more effective than immunotherapy such as interferon and interleukin drugs, Weiss says. Similarly, he says, old-fashioned chemotherapy, for example with platinum-type drugs, was also extremely toxic.
A recent class of drugs called "anti-angiogenic" medications works by blocking blood vessels that grow in and around kidney tumors. These drugs include Avastin (bevacizumab) and Sutent (sunitinib).
On Nov. 24, the Food and Drug Administration approved Opdivo to treat renal cell carcinoma in advanced stages. Opdivo is part of the drug class called "checkpoint inhibitors." It targets proteins that interfere with the immune system's ability to fight cancer cells. Opdivo is meant for patients who've already been through anti-angiogenic therapy. In a recent study, participants who took Opdivo lived about six months longer than other patients who took a comparison drug.
The Cancer Research Institute lists ongoing clinical trials for patients with kidney cancer.
Empowered Patients
"I feel great, except for being old and decrepit at the age of 67," Lawing says today. "I don't have any symptoms or pain or anything. I have been extremely fortunate." Next step: He and his oncologist will consider the possibility of starting him on Opdivo if needed.
Although he's retired from his full-time career as a manager and supervisor in several industries, Lawing keeps busy as an assistant director at a local nursing home. And he serves on the board of the Kidney Cancer Association to advocate for others with his condition.
For people with kidney cancer, Lawing says, it's important to find oncologists and other specialists who have worked with many such cases and are knowledgeable about the latest drugs, approved treatment methods and side effects. That might mean traveling to a specialty medical cente r. Don't hesitate to ask your doctors questions, Lawing says -- that's what they're there for.
Personal Prevention
In recent studies, processed meat, red meat and grilled meat, red or white, have all been tied to higher cancer risk -- most recently kidney cancer. But a lot of other variables play into that, Weiss says.
Obesity and high blood pressure are known risk factors you can control, not just to reduce kidney cancer risk but to stay healthy overall. Most important to catch kidney cancer early: "Get screened," Weiss says. "Just a simple urinalysis every year is probably worth doing."
Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.
