DR GAGAN GAUTAM, CHAIRMAN, UROLOGY, MEDANTA HOSPITAL, GURUGRAM
The kidneys are amongst the most important organs of the body, and their primary function is to filter the blood, removing waste and excess fluids which are then expelled from the body via urine. Kidney cancer results from an abnormal and uncontrolled increase in the number of cells, resulting in a lump or mass, which can potentially spread to other parts of the body as well. There are several types of kidney cancers, and according to data from the Indian Council of Medical Research, kidney cancers account for approximately 2% of all cancer cases in India, which means that it is among the top ten cancers prevalent in India. This type of cancer is very widespread in North East India, predominantly found among male patients, with researchers linking this high occurrence to the consumption of tobacco. Two other factors that can trigger kidney cancers are obesity and hypertension. People with a family history of kidney cancer are also at a higher risk of getting the disease, as are those who are on long-term dialysis. In addition, men are twice as likely to develop kidney cancer as women. There are various stages of kidney cancer, and the type and extent of spread of the disease is crucial for determining prognosis and treatment strategy. Many early stage kidney cancers are caught incidentally, while testing for other conditions or during routine health check-ups — mostly through imaging such as ultrasound, CT scans, or MRI. This is because the symptoms usually associated with kidney cancer — blood in the urine, persistent back pain, unexplained weight loss, fatigue, and loss of appetite — usually present after the cancer has reached a more advanced stage. Early detection is vital for successful treatment outcomes.
The first two stages, commonly known as Stages 1 and 2, is when the cancer is confined to kidney, with no apparent spread in the body. For cancers at an early stage, modern technological advancements such as robotic surgery, can potentially enable the complete and precise removal of the tumor, while sparing the normal part of the kidney in a procedure called robotic partial nephrectomy. Unlike open surgical procedures, which entail a higher risk of complications with delayed recovery, robotic procedures can be performed with miniscule cuts which often result in a quicker recovery, less pain and decreased complication risk. In robotic surgery, the surgeon sits at a console, from where he controls the movements of fine instruments attached to robotic arms. This affords extremely precise and delicate movements. In addition, a high definition magnified 3D vision of the operative field enables the surgeon to see and appreciate minute structures inside the human body, thereby making the surgery safer. Minimally invasive procedures like robotic surgery or laparoscopic surgery can also be used to remove the complete kidney (nephrectomy) in case partial nephrectomy in not possible due to some tumor or patient related medical factors.
For very early stages of kidney cancers, as well as those kidney cancers where the patient is not fit for surgery, experimental treatments like cryoablation and radiofrequency ablation can also be used. These are procedures with a minimal invasive approach, although the long-term outcomes of these techniques are yet to be ascertained. At Stage 3 of kidney cancer, surgical treatment still remains the mainstay of the treatment but is more challenging since often by this point, the tumour has extended into major veins or the adrenal gland or lymph nodes. Many times surgical treatment is followed by additional medical treatment with immunotherapy to decrease the chances of recurrence of the disease. Advanced or metastatic kidney cancer, referred to as Stage 4, is when the tumor has spread beyond what can be called the broader kidney area and may even be involving adjacent organs such as the liver or pancreas. At this point, metastasis to the lungs, bones, and/or brain may have also taken place. For these stages, the doctor may suggest targeted therapies: drugs which are designed to attack cancer cells directly, sparing healthy cells and reducing side effects. Tyrosine kinase inhibitors (TKIs) such as sunitinib, pazopanib, and axitinib inhibit specific enzymes involved in tumours growth and spread, with the aim of halting disease progression and prolonging survival.
Another treatment could be through immunotherapy, which boosts the immune system to identify and destroy cancer cells, especially for advanced cases. Immune checkpoint inhibitors (ICIs) such as nivolumab and pembrolizumab enhance the body’s immune response against cancer cells, providing an innovative approach to combat kidney cancer. There are other treatments that are still at the experimental stage: For example, in the US, trials are underway to test vaccines against cancer. A separate experiment is looking at treating patients with advanced stages of kidney cancer with a combination of immunotherapy and radiolabeled antibody. In the future, these and other advancements are likely to contribute significantly to improving the outcomes of kidney cancer treatment for our patients. To conclude, while a diagnosis of kidney cancer can come as a shock for the patients and their families, modern methods of early diagnosis (which are a part of most health check-ups), advanced technology (like robotic surgery) and recent development of modern therapies (targeted therapy and immunotherapy) can go a long way in relieving the suffering of and offering hope to the patients detected with this disease.
