Top Questions About Metastatic Kidney Cancer, Answered
If you’ve just learned you have metastatic kidney cancer, you probably feel pretty out of control over your future with this advanced disease. But if there’s one thing we know, it’s that learning more about your diagnosis, the treatment options, and how your life will be affected can give you a sense of control. Since the shock of this news can have your mind feeling like a blank slate, where you can’t even think of what to ask, we’re here to help with some common questions and answers about your future with this disease.
Where Does Metastatic Kidney Cancer Spread?
The most common type of kidney cancer, renal cell carcinoma, begins growing in the kidney and then it can spread (metastasize) to the surrounding tissues and organs. “The most common locations where kidney cancer spreads are the lymph nodes, lungs, and bones,” says, Randy F. Sweis, M.D., assistant professor of medicine at University of Chicago Medicine. In scarier cases, it can spread to the brain or liver. Where it spreads depends on the specific cancer in the individual’s body, says Dr. Sweis.
How Quickly Does Kidney Cancer Spread?
With kidney cancer, it's likely you may not experience any symptoms. Instead, your physician gives you a diagnosis of metastatic kidney cancer when you’re being examined for some other condition or when you start having symptoms, such as blood in the urine, weight loss, fever or night sweats, all indicating the cancer has already spread. Dr. Sweis says “...the speed of the spread of kidney cancer depends on the unique biology of each individual’s cancer.” Though some kinds of kidney cancer spread within a few months, most types can take years.
What Additional Tests Do I Need Before I Can Start Treatment?
A scan (either computed tomography—CT—or magnetic resonance imaging—MRI) of your body will be needed to know exactly where the tumor is located before you begin treatment, says Dr. Sweis. Then, after starting treatment, your physician will do additional scans to evaluate these spots, checking if they shrunk. Most new cancer treatments will require a few tests for safety purposes. “Blood tests that evaluate your liver function, kidney function, and blood counts are needed to ensure your body will be able to process the drug therapy,” adds Dr. Sweis.
How Will My Doctor Decide Which Treatment Is Right for Me?
Doctors will consider blood test results that show signs of a heightened immune response; whether you have other health conditions, such as an autoimmune disorder; and any medications you're taking, says Sandy T. Liu, M.D., assistant professor, hematology-oncology at the David Geffen School of Medicine at UCLA in Los Angeles. “This will help me determine if a patient is eligible to receive immunotherapy,” one of the key treatments for metastatic kidney cancer. Someone who is otherwise healthy will be a better candidate for this sort of treatment.
Will I Need Surgery?
If most of the cancer is in the kidney and if surgery would leave little, if any, cancer behind, then it’s reasonable to consider surgery, says Moshe Ornstein, M.D., a kidney cancer medical oncologist at the Cleveland Clinic. Depending on the amount of cancer left, you and your oncologist will discuss whether to start additional drug therapy. However, “...for patients who have a lot of cancer outside the kidney (like in the lungs, liver, or bone), there is not much of a role for upfront surgery…” adds Dr. Ornstein, and medications should be started right away.
What Medications Can Help?
First-line treatments fall into two categories: immunotherapy that helps the person’s own immune system knock out the cancer cells and targeted therapy drugs, which zero in on specific proteins or other molecules located inside or on the surface of cancer cells, curtailing cancer growth. According to Jorge A. Garcia, M.D., assistant professor at the Case Western Reserve University School of Medicine and chief of solid tumor oncology, in Cleveland, OH, physicians typically use a combination of two immunotherapy drugs or one immunotherapy and one targeted therapy drug.
What Side Effects Can I Expect and How Do I Manage Them?
Common side effects associated with immunotherapy include diarrhea, shortness of breath, a persistent cough, or a skin rash. Common side effects linked with targeted therapy include fatigue, high blood pressure, mouth sores or nausea. Depending on what drug you are taking, there are various ways to manage the side effects, including reducing the dose, putting the therapy on hold, or prescribing other medications that can curtail the side effects. It's important to ask your doctor what to expect so you can let them know right away if you encounter any.
Can Lifestyle Changes Help?
Eating a diet rich in fresh fruits and vegetables, whole grains, and lean meats (or plant-based proteins) is important for everyone, especially if you have metastatic kidney cancer. (These foods will give you all the vital nutrients you need for your body to battle the cancer.) According to Dr. Sweis: “Regular exercise (to the extent that it is safe according to your doctor) is important. The patient who is very active ... would have a more favorable prognosis. Exercise can also improve the tolerability of cancer treatments.” You should develop an exercise plan with your physician.
What Are the Odds of Beating Metastatic Kidney Cancer?
Some people live 10 years or more if they have fewer and slower-growing tumors, says Dr. Sweis. Unfortunately, people with aggressive forms may survive less than one year. One possible predictor of a better prognosis is if there are several years between the removal of the kidney tumor and the metastasis. “The prognosis for kidney cancer patients continues to improve each year, as new treatments are being developed rapidly. Even compared to just five years ago, the prognosis for metastatic kidney cancer has dramatically improved,” adds Dr. Sweis.
Should I Enroll in a Clinical Trial?
“I highly recommend exploring clinical trials at any stage of your cancer journey. Many of the highly effective treatments we have today were in clinical trials just a few years ago,” says Dr. Sweis. Trials can offer the newest generation of therapies being developed and also give you an opportunity to help the next generation of patients as new strategies are developed. “Trials are conducted carefully to minimize risks, though the risks to any treatment should be discussed with your doctor before starting treatment (whether or not it is on a clinical trial),” adds Dr. Sweis.
Surgery: Translational Andrology and Urology. (2020.) “Minimally invasive radical nephrectomy: a contemporary review.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807355/
Targeted Therapies: Cochrane Database of Systematic Reviews. (2020.) “Targeted drug treatment for kidney cancer which has spread.” https://www.cochrane.org/CD012796/PROSTATE_targeted-drug-treatment-kidney-cancer-which-has-spread
Prognosis: World Journal of Surgical Oncology. (2020.) “A risk stratification model based on four novel biomarkers predicts prognosis for patients with renal cell carcinoma.” https://wjso.biomedcentral.com/articles/10.1186/s12957-020-02046-9
First-line Treatments: Everyday Urology - Oncology Insights. (2021.) “The Evolving Landscape of First-Line Therapy for Metastatic Clear Cell Renal Cell Carcinoma.” https://www.urotoday.com/journal/everyday-urology-oncology-insights/articles/126124-the-evolving-landscape-of-first-line-therapy-for-metastatic-clear-cell-renal-cell-carcinoma.html