Articles tagged with: Kidney

23
September
2013

Management of Localised Kidney Cancer

Management of Localised Kidney Cancer

Alexander Kutikov, MD is a Surgical Oncologist and Associate Professor of Urologic Oncology at the Fox Chase Cancer Center in Philadelphia. He is a highly published author and experienced presenter on the topic of Urological Cancer, and is very active in Social Media in Urology. In this Guest Post, Alex gives a concise account of the diagnosis and treatment options for localised kidney cancer. He explains what you need to know, and what you should ask your surgeon.

You can read more about Alex by clicking this link : Alexander Kutikov MD, and you can follow him on twitter @uretericbud.

Details of the Fox Chase Cancer Center can be found here : Fox Chase Cancer Center.

The Kidneys

"If you or your loved one has been diagnosed with a kidney tumor / mass, reliable information regarding this condition is often difficult to obtain. It is important that you have a good understanding of the diagnostic and treatment options available in order to make an educated choice on how to best proceed with your treatment.

"Generally, when patients are diagnosed with a kidney mass, it is apparent on imaging studies whether the tumor is localized to the kidney or if it has spread beyond the kidney to other parts of the body. For patients with localized disease, surgical resection remains the gold standard, and is largely superior to therapies such as cryotherapy or radiofrequency ablation.

"The following points are important to remember:

1. Understand that not All Kidney Tumors are Malignant.

2. Understand Goals of Treatment:

Surgical Oncologists
  • Primary treatment goal: Oncologic cure - cancer control must never be compromised and surgical resection is the gold standard treatment for patients with kidney tumors. Yet, for some patients "active surveillance" is often an ideal initial option of choice (Small renal masses progressing to metastases under active surveillance: a systematic review and pooled analysis).

  • Secondary treatment goal: Kidney preservation - years of experience with kidney (aka: nephron) preserving surgery (partial nephrectomy) demonstrates that this approach is oncologically safe and is associated with long-term benefits to overall health. A standardized system to classify features of kidney tumors as they relate to ability to safely perform partial nephrectomy was developed at Fox Chase Cancer Center in 2009 (The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth.) and is currently used by kidney surgeons all over the globe.

  • Tertiary treatment goal: Utilization of minimally invasive surgical approaches - . Both transperitoneal and retroperitoneal minimally-invasive (laparoscopic / robotic) surgical approaches are currently utilized by expert kidney surgeons. Finding the right surgeon may help avoid a large painful incision, albeit traditional open kidney surgery continues to play an important role in management of some patients with large / anatomically complex kidney tumors.

3. Be Prepared During Your Visit.

Here are some questions to pose to your treating physician when you or your family member is diagnosed with a renal mass:

  • Understand characteristics of your mass: size of tumor, clinical stage of tumor, RENAL nephrometry score. If your tumor has been resected, be sure to obtain information regarding pathologic stage, grade and histology. Pathology review by expert pathologists at times can make a critical difference in guiding further treatments.
  • Why or why not do a biopsy?
  • Treatment Options:
    • Active Surveillance - am I a candidate?
    • Medical Therapy (generally reserved for tumors that have spread)
    • Renal mass ablation (generally reserved for frail patients whose surgical risks are prohibitive).
    • Surgery
      • partial nephrectomy: is your surgeon familiar and experienced with kidney preservation techniques? Is he/she comfortable performing partial nephrectomy minimally-invasively, thus accelerating your recovery and minimizing pain?
      • radical nephrectomy: if radical nephrectomy is offered, be sure to establish that partial nephrectomy is not possible at a more experienced center. If kidney preservation is not possible, can radical nephrectomy be performed with minimally-invasive techniques?
  • Risks of treatment: be sure to understand risks associated with each option.

"In summary, kidney cancer is curable in the majority of cases and its treatment is rapidly evolving. Finding an expert urologic surgeon who not only understands this complex disease, but also possesses the needed surgical skills to appropriately manage this condition is critical to successful outcomes."

This post was adapted by Alex Kutikov from an original Fox Chase Cancer Center Cancer Conversations blog post which appears at: Understanding Your Kidney Cancer Treatment Options

Categories: Updates

03
June
2013

Kidney cancer – a new class of drugs to watch for the future

Kidney cancer – a new class of drugs to watch for the future

The American Society of Clinical Oncology Annual meeting is in Chicago this week, and promising data on a new class of cancer drugs for will be presented.

Drugs known as Anti-PD-1 are a type of immune-therapy. PD-1 is a receptor on the surface of T cells, the immune system's disease fighters.


A cancer cloaking device

Some cancer cells have something called a PD-1 cloaking device; the cancer cells produce a molecule that binds to PD-1 to prevent the body’s cells from recognising and killing cancer.

Anti-PD-1 drugs disable that shield so that the body’s own immune cells can recognise and attack the cancer.

In one study, one third of patients with advanced kidney cancer demonstrated tumour shrinkage. Whilst this is encouraging, it is important to recognise that:

  1. These results are preliminary
  2. There are side effects of the drugs
  3. Two thirds of patients did not respond
  4. The drugs do not offer a cure
  5. Not all investigational drugs become treatment drugs, and if they do it can take a long time for them to pass safety tests.
  6. However, these developments do hold out hope for the future treatment of advanced kidney cancer

Categories: Kidney Cancer

21
May
2013

Survival advantage for partial nephrectomy questioned by new study

Small renal tumours can be treated by either complete (radical) or partial nephrectomy. Over the past few years, there has been a trend to use partial nephrectomy where possible, despite the higher complication rate from this surgery. This trend has been driven by evidence that overall survival is better in patients treated by partial nephrectomy, perhaps because kidney function is preserved, which in turn may have beneficial effects on overall health. A study published in May from Yale School of Medicine and the National Cancer Institute questions this belief, with evidence that the survival benefit seen with partial nephrectomy may actually be due to 'selection bias'. This means that the survival benefit may be due to the fact that healthier patients were chosen for partial nephrectomy, and they would have survived longer regardless of treatment option.

In summary, our current understanding is that both treatment options are reasonable for patients with small kidney tumours. Partial nephrectomy, where possible, is favourable for those patients who have reduced renal function, or have a disease that may make them prone to kidney problems later in life, such as diabetes and high blood pressure.

The following link takes you to a summary of the study

Link
Overall survival advantage with partial nephrectomy: A bias of observational data?

Categories: Kidney Cancer

25
April
2013

Kidney Cancer-Mayo Clinic

Categories: Video, Kidney Cancer

25
April
2013

Kidney Cancer Diagnosis

Categories: Video, Kidney Cancer

25
April
2013

How Do Kidney Stones Form? How Can We Prevent Them?

Categories: Video, Kidney Stones

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