10 Questions to Ask Your Doc About Kidney Cancerby Jeanine Barone Health Writer
Nothing like a kidney cancer diagnosis to turn your whole world upside down. Likely, your mind is swirling with a million questions: How will life change? What are the treatment options? What will the future look like? One way of coping with news nobody wants is to become more knowledgeable about the disease and its implications. We’re here to help you do that, by taking some of the most common questions people have about kidney cancer straight to the docs that treat it. Here’s what they told us.
What Type of Kidney Cancer Do I Have?
“There are over a dozen subtypes of kidney cancer,” says Brian Shuch, M.D., director of the Kidney Cancer Program at UCLA Health in Los Angeles. The most common is called “clear cell,” which accounts for about 80% of kidney cancers, says Randy F. Sweis, M.D., assistant professor of medicine and a hematologist at University of Chicago Medicine. The subtype reflects which kidney cells the cancer started in, which helps determine the best treatment. “One kidney cancer subtype may be treated very differently than another,” says Dr. Sweis.
What Does Kidney Cancer Stage Mean?
“Staging is the extent of the disease, meaning how large and how far it has advanced,” says Dr. Shuch. There are four stages, ranging from stage I where the tumor is small (7 centimeters or less) and is only in the kidney, to stage IV where cancer may have spread to other parts of the body. “Knowing the stage of kidney cancer is a major determinant of how patients are treated and how closely they must be monitored since it reflects the risk of recurrence,” he adds.
How Fast Will My Cancer Spread?
“Various kidney cancers spread at different rates,” says Joseph Zabell, M.D., assistant professor of urology at the University of Minnesota Medical School in Minneapolis. A lot depends on the size of the cancer, its grade (an indicator of how fast or slow the cells grow), and stage at diagnosis. While some kidney cancers spread within a few months, many are found when they’re small and grow slowly with minimal spread for several years, adds Dr. Zabell. When kidney cancer spreads, it most commonly moves to the bones, lungs, or brain.
What Is My Prognosis?
“It depends on many factors, but stage and subtype are among the most important features that determine prognosis,” says Dr. Sweis. For instance, Stage 1 clear cell kidney cancer may be cured with surgery alone and has an expected five-year survival rate of more than 90%. However, Stage IV (metastatic) kidney cancer cannot be cured and has a worse prognosis. “On the positive side, survival—even for metastatic kidney cancer—has been improving significantly every year for the last decade due to much more effective treatments,” adds Dr. Sweis.
What Kind of Tests Will I Need?
To determine staging, a simple X-ray may be done if the tumor is small; for more aggressive tumors, advanced imaging may be done, says Dr. Shuch. “While a biopsy—where tissue from the tumor is examined under the microscope—is frequently offered to patients, many elect to proceed directly to treatment (without a biopsy), depending on the extent of disease and the appearance of the tumor on imaging,” adds Dr. Zabell. The imaging is usually a CT or MRI, which is used to evaluate the kidney as well as other parts of the abdomen to determine if the tumor has spread.
What Is the First Line of Treatment?
Depending on the cancer subtype and stage, treatment may involve surgery, targeted therapy (sometimes called anti-angiogenic or VEGF therapy), immunotherapy, or a combination. “For localized cancer, surgery is the standard first-line treatment,” says Christopher Weight, M.D., director of urologic oncology at the Glickman Urological & Kidney Institute at the Cleveland Clinic in Ohio. Immunotherapies activate your immune system to attack the cancer, while anti-angiogenic therapy inhibits the tumor’s blood supply.
Does Treatment Have Side Effects?
The two main ways to treat advanced kidney cancer are targeted therapy (oral pills) and immunotherapy (IV treatments). “For targeted therapy, the most common side effects are high blood pressure, gastrointestinal symptoms (nausea, diarrhea), skin rashes including redness and peeling of the skin on the palms and soles, mouth sores, and fatigue,” says Dr. Sweis. For immunotherapy, some common reactions are skin rashes, cough or shortness of breath due to inflammation in the lungs, and diarrhea due to inflammation in the colon.
Is There a Way to Alleviate Side Effects?
There are many ways to manage treatment side effects. “Sometimes, your doctor may recommend taking a break from therapy, reducing the dose, or using other medications to stop the side effects,” says Dr. Sweis. In all cases, it is critical to tell your doctor about any new symptoms that seem unusual, even if they don't seem bothersome to you. “With good communication, most side effects can be controlled, so the drugs can be continued for as long as they are working,” adds Dr. Sweis.
Can Lifestyle Changes Improve My Outcome?
Regular exercise is important for everyone, but especially for people with cancer. “It keeps the body strong and mitigates some of the side effects from treatments,” says Dr. Sweis, who suggests a goal of 30 to 45 minutes of exercise, five days a week, vigorous enough that casual conversation during the workout is hard. A vegetable- and lean protein-based diet is also important, he says. But while these lifestyle factors can improve your outcome, they are not a substitute for clinical care.
Should I Sign Up for a Clinical Trial?
Clinical trials offer patients a chance to try a new treatment that one day may become the standard of care, says Dr. Shuch. It’s possible to find trials for all stages of disease. “These often try to provide the patient with a new approach when we are not satisfied with the existing one,” he adds. The safety of clinical trials is carefully monitored to minimize risks. In addition, enrolling in a trial gives you an opportunity to advance the field so that other patients may also benefit.