By Kenar D. Jhaveri, MD
Kidney cancer is when cells of the kidney change into cancerous or abnormal cells. Kidney cancer comes in two types–renal cell cancer or transitional cell cancer. Renal cell is the most common type. Decades ago, when imaging was not available, kidney cancer was a difficult diagnosis to make. Now, most cases of kidney cancer are diagnosed incidentally via imaging CT scans or MRIs done for other reasons. 30% of patients that are diagnosed with kidney cancer get metastatic disease which means that it spreads to other organs.
If you are concerned about kidney cancer, here are 6 important questions to ask your doctor.
1. What are the symptoms of kidney cancer?
As suggested above, in many cases, no symptoms can be noted or you can have blood in the urine, pain in the back, weight loss, night sweats or unexplained fevers.
2. Why did I get kidney cancer? What are the risk factors?
Smoking is a well known risk factor. Other smaller risk factors include presences of cystic kidney diseases (if you have polycystic kidney disease) or if you have been on dialysis and have chronic kidney disease. Exposure to carcinogenic chemicals and radiation are also other risk factors.
3. What type of doctors do I need to see if I am diagnosed with kidney cancer?
The two most important physician specialists you should seek care with when diagnosed are urologists and oncologists.
4. What are the treatment options for kidney cancer?
If one of your kidneys is affected by cancer, the surgeon can remove the cancerous kidney (completely or partially) and cure you of the cancer. A lot of the decision regarding how much of the kidney is to be removed depends on your overall kidney function, if you have chronic kidney disease or how far the kidney cancer has spread.
The medical treatment for cancer includes chemotherapy agents that the oncologist can prescribe in addition to the surgery or instead of surgery. These medications are most commonly used in the malignant, or spreading, form of kidney cancer.
5. How do I decide whether to undergo complete or partial removal of my cancerous kidney?
If the cancer-free kidney is in good working condition, then the surgeon might decide to remove the entire cancerous kidney (radical nephrectomy). But if the cancer-free kidney is not healthy (for example, because it has been damaged by diabetes or hypertension or other kidney disease), the surgeon might decide to do a partial removal of the kidney with the cancer and leave the non-tumor part behind (partial nephrectomy).
6. Can kidney cancer surgery lead to chronic kidney damage of the other kidney?
The kidneys remove metabolic waste, water and salt from your body. When one kidney is completely removed from your body, the other kidney works harder and compensates for the work. Eventually, it can get tired and you can develop chronic kidney disease and/or proteinuria (loss of protein in the urine). The risk is even higher if you have co-morbid conditions such as diabetes or hypertension that have already damaged that non cancerous kidney. Therefore, it’s very important that kidney sparing surgery of the cancerous kidney is discussed with your doctor earlier in your cancer course to prevent chronic kidney damage long term.
It is important to have this conversation with your urologist and oncologist regarding the choice of surgery. Dr Paul Russo and colleagues did a recent study to investigate the awareness of patients on their choices of surgery and treatment for kidney cancer. The researchers found that there was lack of patient awareness that kidney cancer and radical nephrectomy are risk factors for worsening chronic kidney disease. A minority of patients underwent partial nephrectomy or were given that as an option for their cancer. This suggests a knowledge gap between physicians and patients and caregivers. It is important to have a dialogue with your cancer specialist about appropriate treatment.
Kenar D. Jhaveri, MD
Associate Professor of Medicine
Hofstra North Shore LIJ School of Medicine, NY
Blog editor, http://www.eajkd.org