Q. I have had a kidney removed due to kidney cancer. This was a stage I cancer. Is there any additional treatment I can receive to prevent possible spread of the cancer? Thanks. Charley
Dear Charley,
Treatment for Stage I renal cell carcinoma is radical nephrectomy (removal of the kidney).
In some instances, a partial nephrectomy may be indicated. The five-year survival rate is around 60-70 percent.
There are various treatment options to treat metastatic tumor (cancer that is spreading).
Because your cancer was stage I, however, that means that it was confined within the capsule of the kidney and had not spread.
Before your surgery, you likely had an imaging study to determine the extent of spreadthe stageof the cancer. This study was likely a CT/CAT scan. Now that the cancer is removed, a pathology report can confirm if the cancer was still confined to the kidney.
There have been studies done in which patients have received post-operative radiation therapy. The idea behind this was to sterilize any left-over microscopic/gross tumor. However, this treatment did not lead to increased survival rates.
The key aspect of your management now is follow-up for tumor recurrence. You should be seen four-six weeks after your surgery for follow-up, with subsequent surveillance for recurrence every six months for four years, and then annually.
The studies that may be obtained include serial CT scans, chest X-rays, liver function tests and renal function tests. Sometimes, renal cell carcinoma can elevate the liver function tests without evidence of spreading there.
Be aware of symptoms that may indicate cancer recurrence: anorexia, weight loss, hematuria, pain/mass in the flank or bone pain.
Therapy for metastatic disease includes chemotherapy and immuno-therapy. The side effects of these agents are too risky to be administered without documentation of tumor recurrence. At this point, you should stay positive and diligently comply with your follow-up.
Q. My mother has only one kidney one was removed about 25 years ago due to an auto accident. Earlier this year, the remaining kidney was diagnosed with cancer. My mother recently suffered kidney failure and is now on dialysis three times a week. She was supposed to go through chemo-therapy and a medication treatment plan, but now does not meet the criteria for such treatment. My mother is 50 years old and very thin; she weighs about 110 pounds. She has no other diseases.
What options do you think she may have regarding treatment?
Would she be eligible for a kidney transplant?
Does she need a kidney if she remains on dialysis?
K im
Dear Kim
I am sorry to hear about your mothers condition. Chemotherapy is usually reserved for metastatic kidney cancer.
The chemo would be contraindicated (not advised) because the kidney function is needed to clear those agents that become toxic to normal body tissue. Surgery is usually reserved for kidney cancer that has not spread. There are centers performing studies with IL2 (inter-leukin 2) and alpha interferon but these protocols have strict entrance criteria.
We would have to find a center that uses alpha interferon on a compassionate basis. With transplant organs in such short supply, a recipient candidate with a diagnosis of cancer has to wait 12 - 24 months without evidence of residual disease before they would be considered for a transplant. The immuno-suppressive medications she would have to take will make her cancer grow faster.
