The American Cancer Society estimates nearly 500 Idahoans will be diagnosed with kidney and renal pelvis cancer this year, some of the approximately 78,000 Americans the National Cancer Institute says will be diagnosed with renal cancer in 2023. Renal cancer is the eighth-most common cancer in the United States. During March, Kidney Cancer Awareness Month, it’s important to raise the visibility of this condition and highlight treatment options.
It’s important to note that while the number of new renal cancer cases increased by about 1% between 2015 and 2019, the death rate from kidney cancer has decreased by the same amount. Increased awareness, improved diagnostic tools and new treatments have helped raise the five-year survival rate to 93% (for those with cancer only in the kidneys. If the cancer spreads to surrounding tissues or organs, the five-year survival rate is 71%).
The most common type of renal cancer in the United States is “clear cell carcinoma” because of the appearance of the tumor cells under the microscope. Risk factors include smoking, misusing certain pain medicines, including over-the-counter pain medicines for a long time, being overweight, having high blood pressure, hepatitis C infection, exposure to certain chemicals (asbestos, cadmium, or benzene) or polycystic kidney disease (an inherited disorder). If there’s a history of kidney cancer in your family, especially if you have a relative who had tumors in both kidneys, it’s a good idea to ask your doctor to refer you to a genetic counselor. He or she can do a more in-depth review of your family history and determine if you need formal genetic testing.
Classic symptoms of kidney cancer include pain in the mid-back (flank) and blood in the urine. If the tumor becomes large enough, it can sometimes be felt as a mass during a physical examination. Often, the cancer is found incidentally on a CT scan while investigating another problem, such as bone pain or unexplained fracture, high blood calcium, or high red blood cell count. A renal ultrasound can be helpful as well, but a CT scan with contrast will give the best resolution. Once detected, it’s important to get treatment, because a tumor can block drainage from the kidney, leading to urinary tract infection and the cancer can also spread to other areas of the body.
If the tumor has characteristic features of renal cell carcinoma on the scan, there are multiple treatment options. Patients can be taken directly to surgery to remove all or part of the involved kidney. If there is high risk for recurrence, one year of immunotherapy can be given after surgery. Radiofrequency or cryoablation, which involve passing an instrument through the skin and burning or freezing the tumor, can be used for small tumors in patients not healthy enough for surgery.
If renal cell carcinoma has spread outside of the kidney, such as to the bones or lungs, diagnosis is made with a biopsy of the involved area. Treatment then focuses on using medication to shrink the tumors and prevent them from growing. Immune checkpoint inhibitors are intravenous drugs that stimulate your own immune system to attack the cancer cells. There are also oral medications called tyrosine kinase inhibitors that block certain steps in the growth and development of the cancer cells. These two therapies are often used together for maximum effect.
It’s important to talk with your doctor if you notice any new or concerning symptoms. If you or a loved one are diagnosed with kidney cancer, the Saint Alphonsus Cancer Institute has locations in Boise, Nampa, Caldwell, Emmett and Baker City, Oregon, where we can provide complete care, from genetic counseling to minimally invasive robotic surgery.
Lauren Midthun, MD is a Medical Oncologist at the Saint Alphonsus Cancer Institute
