“There is an increasing prevalence of kidney cancer within Pakistan due to lifestyle choices and genetic factors. The most prevalent type of kidney cancer is renal cell carcinoma, accounting for 90 per cent of cases. Renal cell carcinoma (RCC) can have intense implications for patients who withdraw from society as renal cell cancers can reduce their ability to perform daily activities.”
These facts were shared by Dr Abdul Qayyum, consultant clinical oncologist and assistant professor at Dr Ziauddin University Hospital, Karachi, at a virtual meeting organised by Neurospinal and Cancer Care Institute, Karachi, with the title of ‘Kidney Cancers-A Silent Killer’ held on Saturday.
The causes of kidney cancer are mainly unknown but appear to be multifactorial in nature. A number of different risk factors have been studied, some of which are modifiable, thus creating an opportunity for primary prevention.
“Notable risk factors are tobacco smoking including cigar and Sheesha, excess body weight, alcohol consumption, physical inactivity, hypertension, chronic kidney diseases, kidney stones, and diabetes mellitus. Environmental and occupational exposures including trichloroethylene, aflatoxins, hormones, lead compound, radiations, certain viruses and aristolochic acid (Aristolochic acids are a group of acids found naturally in many types of plants known as Aristolochia and in wild ginger) and genetic risk factors. Acquired cystic disease, a frequent occurrence in the end-stage renal disease, is also associated with a high incidence of RCC,” Dr Qayyum further explained.
“Middle-aged adults who ate the most red meat were 19 per cent more likely to be diagnosed with kidney cancer than those who ate the least. A higher intake of chemicals found in grilled or barbecued meat was also linked to increased risk of the disease; people should limit the intake of red and processed meats and prepare meat by cooking methods such as baking and broiling, ” he advised.
“Kidney cancer is about as twice as common in men as it is in women. The lifetime risk for developing kidney cancer in men is one in 46 and in women, it’s one in 80. This is more common in African Americans and American Indians. Approximately 5-8 per cent of kidney cancer cases are linked to family genetics,” said Dr Qayyum.
“Most people with kidney cancer are older, with 55 as the average age of diagnosis. Kidney cancer is becoming increasingly prevalent with recent statistics citing it as the 10th most common cancer worldwide and account for more than 131,000 deaths and 413,000 new cases each year. Approximately, 30-40 per cent of patients present with metastatic disease, an additional 30-40 per cent of patients who present with localised or locally advanced disease subsequently develop metastasis.”
The expert’s projections show kidney cancer cases climbing by a further 26 per cent by 2035, which would make it one of the fastest growing types of cancer.
Dr Iqbal Shehzad, consultant urologist and assistant professor at Liaquat National Hospital, gave an urologist’s perspective on kidney cancer and shared his experience in dealing with such patients.
According to the health professional, kidney cancer is one cancer that is hard to detect because the organs are deep inside the body, and most cases of kidney cancer are picked up incidentally by common imaging such as ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) for unrelated reasons.
Renal or kidney cancer shows off symptoms similar to a urinary tract infection (UTI), so it’s important to test even the smallest symptoms for early detection. “Blood in the urine, loss of appetite and rapid, unexplained weight loss, low back pain not caused by an injury, swelling of ankles and legs, mass or lump on the side or lower back, fatigue, recurrent fever not caused by a cold or the flu,” Dr Shehzad said, highlighting the signs and symptoms.
“Often, people with kidney cancer have blood in their urine only one time. That’s why the cause of any blood in your urine needs to be investigated right away by your primary care doctor. Early detection of kidney cancer is the key to successful treatment, so paying close attention to symptoms and having them evaluated by a medical professional is essential.”
Usually, kidney cancers do not respond to radiation or chemotherapy,” Dr Shehzad explained. “The only way to deal with it is complete or radical nephrectomy (resecting the entire kidney). RN is still performed in about 35 per cent of cases of renal tumors.”
“The most widely popularised surgical treatment option is nephron-sparing surgery (NSS) by partial nephrectomy (PN). This procedure has been investigated extensively and is the standard of care for smaller renal tumors,” said Dr Shehzad.
“PN was reserved for patients with solitary functioning kidney, bilateral renal tumors, hereditary renal tumors (e.g., Von Hippel-Lindau disease), patients with renal impairment, and those with comorbidities predisposing them to renal compromise in future. PN is now performed routinely and electively for patients with small tumors and healthy contralateral kidneys.”
Dr Shehzad added that kidney tumors excised at an early stage rarely reappeared and the patient had an excellent prognosis post-surgery. “People detected with malignant tumours growing outside the kidney, who underwent surgery at Stage I, had a survival rate of 93 per cent for the next five years.”
“There are several novel and exciting therapies on the horizon, which have the potential for treatment of metastatic RCC and may eventually lead to improvement in the current dreary survival statistics,” said Dr Lubna Saleem, consultant medical oncologist at the Cancer Foundation Hospital, Karachi.
“Kidney cancer is not a single disease, but rather a heterogeneous group of at least five different histologic types. This malignancy occurs in a sporadic noninherited form as well as a hereditary form, the latter associated with distinct, known genetic mutations and thus identifiable diseases or syndromes.”
Treatment options and recommendations depend on several factors, including the cell type and stage of cancer, possible side effects, and the patient’s preferences and overall health.
Kidney cancer is most often treated with surgery, targeted therapy, immunotherapy, or a combination of these treatments. Radiation therapy and chemotherapy are occasionally used. People with kidney cancer that has spread, called metastatic cancer, often receive multiple lines of therapy.
Sometimes the doctor may recommend closely monitoring the tumor with regular diagnostic tests and clinic appointments. This is called “active surveillance”. Active surveillance is effective in older adults and people who have a small renal tumor and another serious medical condition, such as heart disease, chronic kidney disease, or severe lung disease.
Today, immunotherapy is becoming the new standard approach based on clinical trials that show it has greater benefits than targeted therapy. “Immunotherapy works by stimulating your immune system to fight the cancer. This approach can cure some people and allow others to control their disease for many years. More information is needed from clinical trials about how patients are doing after treatment, but over the next few years, it is likely that most to all patients with advanced kidney cancer will receive immunotherapy as part of their first treatment plan,” said Dr Lubna.
Targeted therapy is still important because it is now being combined with immunotherapy, and it can be useful if immunotherapy does not work. Compared to traditional forms of cancer medicine like chemotherapy and radiotherapy, immunotherapy produces much fewer side effects. In addition, it can be targeted to attack only cancer cells, without damaging other healthy tissue as often happens with chemotherapy.
Patients who respond to these drugs go into remissions measured not in extra weeks or months of life, but lifetimes,
“Such transformative, durable responses are the unique value proposition of the cancer immunotherapeutic approach,” Dr Lubna further explained.
Adeel Ahmed, manager marketing at the NCCI, thanked and appreciated the speakers and medical community.
At the NCCI, he said, “we are committed to helping patients get the information they need about kidney cancer and qualified resources for their conditions”.
“We’re also focused on local research and advocacy programs, not only to develop treatments to address unmet medical needs but also to expand awareness of disease prevention, cancer screening and treatment options on community levels,” Ahmed said and called upon NGOs and industrial sector to help and coordinate with cancer caring institutions for more and in-depth support for such patients.