Kidney Cancer: An Overview
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing Dr. Harry Drabkin who is Chief of Hematology-Oncology here at the Medical University of South Carolina and is Gilbreth Chair of Hematology and Oncology Research. Dr. Drabkin, I know that your own area of specialty is in kidney cancer, or renal cancer. How common is that cancer?
Dr. Harry Drabkin: Approximately, I would say, 35,000 to 38,000 cases in the U.S. every year. It tends to be a fairly silent disease. It is an internal organ. It is not something that you feel getting bigger. Most people have fairly no symptoms with early disease. The symptoms they develop are usually late, things like back pain. Blood in the urine, I would say, is one of the more common things for late disease, when the tumors are large. Many tumors today are discovered incidentally because of a CT scan that was done for some other reason. It is a great technique. It is very accurate. We are picking up more and more small tumors. Those tumors, by and large, tend to be not metastatic. So, the ones that I see, that have spread to some place else, like the lung, or bones, or liver, or some place like that, are these late tumors. It is much like ovarian cancer in terms of not producing symptoms until it is well under way.
Dr. Linda Austin: So, I guess one take-home point, then, is anytime one has visible blood in the urine, it certainly is time to call your doctor right away.
Dr. Harry Drabkin: Absolutely, absolutely. And it does not have to be kidney cancer. It could be a bladder infection. It could be a stone in the bladder. It could be a tumor somewhere in the system from the bladder to the ureters, to the kidney, whatever. But, the important thing is, it should never be left alone, always should be looked at.
Dr. Lind Austin: You mentioned that often these tumors are picked up incidentally. The doctor may have ordered a scan for something else and sees a small tumor in the kidney that has not spread. In that case, is it a pretty simple matter of just operating on it?
Dr. Harry Drabkin: It is a simple matter. The surgery these days for small tumors is pretty simple. For the most part, it can be laparoscopic-based. So, instead of having a big incision, you have a couple small holes in your belly where the surgeons go in, stick the scopes, fill the belly up with air and take these tumors out. People are out of the hospital often the next day with minimal complications. That actually can be done for more advanced tumors. But, depending on the tumor, the surgeon, the this and that, there is always a variety of factors that influence what kind of operation is done. Another way we start to pick these up, for example, in screening procedures now, say for like cancers, there are ongoing lung cancer screening programs, all of a sudden they find some individuals that have some spots on their lung. Well, they are not lung cancer, they have spread from some other tumor, and the kidney is one of those kinds of things.
Dr. Linda Austin: In another podcast, we will talk about the treatment of kidney cancer once it has spread. But, just to cover some of the basics now, who is most vulnerable to kidney cancer?
Dr. Harry Drabkin: Well, it is predominantly men more than women but we see a number of women with this disease. Like many cancers, actually tobacco plays a big role in this, I would say, in the clinic, on the order, I would say, maybe 90 percent or more of people are current or former smokers, but there is always a group of people that are not. There are some well recognized forms of hereditary kidney cancer, but there is one disease in particular that is probably, I would say, the lion’s share of hereditary kidney cancer. There are certainly multiple forms and there are still, like many diseases, seemingly hereditary forms that we do not know exactly what the cause is yet. Or, when we look for mutations in the genes we know and we do not find them, it does not mean that that is not the culprit. It may mean that we missed something that is wrong or did not look in the right place. So, it is never 100 percent.
Dr. Linda Austin: What about exposure to toxins? Can that be a cause of kidney cancer?
Dr. Harry Drabkin: There are some exposures to toxins. There is, for example, a particular factory in France that had a proprietary method actually, I think it was to making a vitamin, and there was a real outbreak of renal cancer in that situation due to a particular toxin. So, that is a factor. But, in terms of most people, most people, of course, we do not know. But, as I said, maybe the large majority of people are smokers and the carcinogens that come into the lungs, get into the blood and they are concentrated in the urine so the bladder is at risk for cancer in smokers. The kidneys certainly are at risk, and many organs are.
Dr. Linda Austin: What is the most common age of presentation?
Dr. Harry Drabkin: I would say, for most people we see in clinic, it is tumors that come on in the 50s, 60s, those sorts of things. The hereditary ones tend to be earlier age and onset.
Dr. Linda Austin: So, just to sort of wrap up, the simple, the small, kidney cancers that are easily resected, it sounds like you can remove part of kidney.
Dr. Harry Drabkin: You can remove part of a kidney.
Dr. Linda Austin: Or even an entire kidney and still have one left.
Dr. Harry Drabkin: Yeah, you can do fine with one kidney. But, the surgical techniques are that you can do a great job taking only part of the kidney, and those early lesions, for the most part, there are always exceptions, have a great prognosis.
Dr. Linda Austin: Thank you very much.
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