Kidney Cancer

Early Detection

It is always better to detect kidney cancer in the earlier stages namely in stage 1 or 2, when cure can be achievable.

In the early stages, kidney cancer may not have any symptoms. Most cases are discovered while doing a medical screening on an ultrasound.

Blood in the urine (hematuria) – either gross or microscopic detected in a urine test, may be detected in the earlier stages of kidney cancer. Hence a proper evaluation and investigation need to be conducted for anyone who presents with blood in the urine.

Other symptoms in the later stages may include:

Pain in the loin which is usually persistent.
Other symptoms include weight loss, appetite loss, recurrent fever and tiredness.

The main treatment of kidney cancers are:

• • Surgery to remove part or all of the affected kidney – this is the main treatment for most people. This may be done laparoscopically (through a key-hole incision) or by open surgery, based on the evaluation by the urologist. This is either by radical nephrectomy (removal of the whole kidney) or partial nephrectomy (removal of part of the kidney).
  • There are times when targeted agents are given to reduce the bulk of the kidney before operation (known as cytoreductive nephrectomy), a strategy usually used when there is advanced disease with spread of the cancer outside the kidney but the patient still has a very good performance status.
  • Cryotherapy or radiofrequency ablation – where the cancerous cells are destroyed by freezing or heating. These are only reserved for very specific small tumors without any symptoms.

There are other treatments available for very specific conditions which include:

• • Biological or targeted therapies – medicines that help stop the cancer growing or spreading. These are specifically only used for advanced disease when the cancer is already metastatic (spread outside the kidney). They include anti-angiogenesis therapy, tyrosine kinase inhibitors, mTOR inhibitors, immune checkpoint inhibitors and various other new targeted agents.
  • Embolization – a procedure to cut off the blood supply to the cancer, only done in specific situations when the cancer is too large or has invaded the main veins and need to reduce their size prior to surgical removal
  • Radiotherapy– using high-energy radiation to target cancer cells and relieve symptoms. This is not curative, and done only for cancers which has already spread outside the kidney and which are not suitable for surgical removal

Chemotherapy is not the mainstay of treatment unless for very specific histological variants of the kidney cancer.

Take Home Message

Hematuria (blood in the urine) is a very important symptom. As per current guidelines, if you have blood in the urine, you will have to see a urologist preferably within 2 weeks of onset of the symptoms.

Anyone with hematuria need to be properly evaluated and important causes of hematuria ruled out early.

The evaluation consists of upper tract imaging (CT Urography with contrast) AND cystoscopy (endoscopy of your bladder).

Practice-pattern assessments have demonstrated significant deficiencies in the evaluation of patients presenting with hematuria.

One study found that less than 50% of patients with hematuria diagnosed in a primary care setting were subsequently referred for urologic evaluation.