Kidney Cancer

Kidney Cancer in India

Research from SGPGI, Lucknow, suggests that early-onset kidney cancer in India may be linked to poor nutrition. The clinical presentation of diseases in developing countries often differs from that in the West. In India, nearly 20% of kidney cancer cases are diagnosed at an advanced stage due to financial constraints and lack of awareness, delaying timely medical consultation.

Risk Factors

Our studies indicate lower survival rates among younger kidney cancer patients, with an increasing number of cases in younger age groups compared to Western populations. Common risk factors include smoking, hypertension, obesity, and dietary habits, though the exact causes remain unclear. One possible explanation for early-onset cases in India is malnutrition, which may compromise immunity and increase susceptibility to cancer.

Early Symptoms

It is crucial to seek medical advice if any of the following warning signs appear:

• Blood in urine (hematuria) – an alarming symptom that should never be ignored
• Persistent dull pain or heaviness in the flank or lower back
• Family history of kidney cancer
• Unexplained fever
• Unexplained weight loss

(Reference: Jain P et al., Indian J Urol. 2009 Oct-Dec; 25(4):479-82.)

What to Do if You Notice Symptoms

Consult a primary physician or a urologist and request an abdominal ultrasound as an initial screening test for kidney cancer.

Imaging for Diagnosis

A contrast-enhanced CT (CECT) scan is the gold standard for diagnosing kidney cancer. An MRI may be used if the patient is allergic to contrast media or has impaired kidney function.

Is a Biopsy Necessary?

In most cases, a CECT scan is sufficient for diagnosis, making routine biopsies unnecessary. A biopsy may sometimes be required if there is uncertainty regarding the nature of the mass, in which case a core needle biopsy can be performed under ultrasound or CT guidance.

Does Surgery or Biopsy Increase Cancer Spread?

A common misconception is that biopsy or surgery can cause cancer to spread. However, biopsy does not increase the risk of metastasis, and surgery is often the only viable treatment for kidney cancer, as chemotherapy and radiation therapy are largely ineffective against this disease.

Determining the Stage of Kidney Cancer

Staging is determined using CECT scans, along with chest X-rays or CT scans.

Role of PET Scan

A PET scan is not typically used for initial diagnosis or staging but can be valuable in detecting recurrent or metastatic disease after primary treatment. It also helps assess the response to targeted therapy and immunotherapy.

Treatment Options

Surgical removal of the affected kidney (radical nephrectomy) or a portion of the kidney (partial nephrectomy) is the preferred treatment. A single healthy kidney is generally sufficient for a normal lifespan.

If the tumor is small (less than 4 cm, and in some cases up to 7 cm), a partial nephrectomy is recommended to preserve kidney function, especially for patients with diabetes or hypertension.

Partial Nephrectomy

Partial nephrectomy involves removing only the tumor while preserving the rest of the kidney. This procedure can be performed using open surgery, laparoscopy, or robot-assisted surgery. Robot-assisted partial nephrectomy provides advantages such as enhanced magnification, 3D visualization, and improved precision, particularly in obese patients. However, a skilled laparoscopic surgeon can achieve comparable results, and open surgery remains a cost-effective alternative.

Is Robot-Assisted Surgery Beneficial?

Robot-assisted surgery is particularly helpful for partial nephrectomy, offering the benefits of minimally invasive surgery, including smaller incisions, reduced pain, and quicker recovery. It is especially useful in cases where the tumor extends into the inferior vena cava, as robotic techniques can avoid large muscle-cutting incisions.

What If Cancer Has Spread Beyond the Kidney?

If kidney cancer has metastasized to lymph nodes, lungs, liver, or bones, survival prospects decline significantly. As chemotherapy and radiation therapy are ineffective against kidney cancer, the primary goal remains surgical removal of as much tumor as possible while preserving bodily function. Newer treatments such as targeted therapy and immunotherapy have shown promise in improving survival rates.

Targeted Therapy for Kidney Cancer

Cancer cells require a blood supply to grow and spread. They achieve this by releasing growth factors that stimulate blood vessel formation. Targeted therapy involves drugs called Tyrosine Kinase Inhibitors (TKIs), which block these growth factors, preventing new blood vessels from supplying nutrients to cancer cells. While TKIs do not directly kill cancer cells, they help slow tumor progression. Commonly used TKIs include:

• Sunitinib
• Sorafenib
• Pazopanib
• Axitinib
• Everolimus

Can Targeted Therapy Reduce Tumor-Associated thrombus?

In some cases, kidney cancer extends into the inferior vena cava and reaches the heart. Targeted therapy can sometimes shrink the thrombus (cancer-associated blood clot) before surgery. Studies indicate that 40-50% of patients respond to this approach, allowing for safer surgical removal without the need for cardiopulmonary bypass.

With advancements in diagnostics and treatment, early detection and intervention remain key to improving kidney cancer outcomes. Regular health check-ups, lifestyle modifications, and awareness can significantly enhance survival rates.