Harish is a 57-year-old gentleman having a 9 am -5 pm desk job. He is overweight and does not exercise. For the past three months, he is noticing dull aching pain in his right flank. He managed it with intermittent pain killers but did not bother to get it further investigated. However, he was alarmed when he noticed blood while passing urine and immediately consulted a local physician, who got urine examination and ultrasound of the abdomen done. Ultrasound revealed a lump in his right kidney. He was sent to a urologist. The Urologist ordered more tests that included blood investigations, CT scan of the chest and abdomen to see the extent of the disease. His disease was found to be limited to the kidney and hence he underwent removal of his right kidney. The specimen was examined under the microscope which revealed cancer. He underwent surgery. The cancer was removed completely. He has been periodically following up with the doctor to see if there is a recurrence so that it is detected early and interventions can be planned. After 1 year of surgery, he came back with shortness of breath. CT scan of the chest showed multiple small lumps in the bilateral lungs suggestive of disease recurrence in the lungs. He is referred to a medical oncologist who decides to treat him with targeted therapy.
Cancer arising from kidneys is one of the most lethal cancer known. The predominant risk factors are obesity/overweight, smoking, history of hypertension and strong family history. As far as the symptoms are concerned- these tumors remain hidden for a very long time before presenting with blood in urine, pain or feeling of mass in the flanks. The other problems presenting similarly, are stone in the kidney and infections. Like other cancer, treatment and outcomes will depend upon the extent of spread of the disease- better known as “stage”. Stage 1, 2 and 3 are curable, though the chance of disease recurrence increases with increasing stage. Stage 4 is a disseminated form where the treatment aims to reduce symptoms, improve quality of life and prolong life. The most common sites for the spread of kidney cancer are lungs and bones, though it can go to any part of the body including the brain, liver and muscles. Any cancer has the ability to release cancer cells in the blood circulation. Due to this, they can spread to many other organs.
The main stay of the treatment in stages 1,2 and 3 is surgery. For stage four- the main option is oral drugs better called as –Targeted therapy. These are oral tablets or capsules which act selectively on pathways responsible to drive cancers. Now there is a new addition it the list-immunotherapy. Immunotherapy drugs are injections given once in 2-3 weeks. Kidney cancers are one of those cancers where body immunity plays a major role in controlling cancer growth. Hence these tumors are good targets for immunotherapy. Immunotherapy drugs act by selectively stimulating cancer specific immunity which in turn suppresses cancer growth. They have changed the treatment landscape of kidney cancer. Their side-effect profile is different from targeted drugs and in many cases they have been able to induce long-term remission. Chemotherapy and radiation therapy do not work in these tumors.
In order to prevent kidney cancer, it is important to quit smoking, exercise for a half-hour at least five days a week and maintain a healthy body weight.
Disclaimer: Name and case mentioned at the beginning are hypothetical.