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Kidney Cancer- A Case Study

A case study on the diagnosis and treatment of kidney cancer.

Roham is a 57- year old male who works in a multinational company. He has a 9 to 6 desk job, leading to him being overweight due to lack of exercise.

For the past three months, he has been noticing dull aching pain in the right flank. He managed to control the pain with intermittent pain killers but did not bother to investigate it further. However, he was alarmed when he noticed blood while passing urine and immediately consulted a local physician who got a urine examination and ultrasound of the abdomen done.

The ultrasound revealed a lump in his right kidney. He was then sent to a urologist who ordered more tests that included blood investigations, and CT scans of the chest and abdomen to see the extent of disease. His disease was found to be limited to the kidney and hence he underwent removal of the right kidney. The specimen was examined under the microscope which revealed cancer.  Since Nephrectomy was done, being localized cancer it was removed completely.

Since then, Roham has been periodically following up with the doctor to see if there is recurrence so that it is detected early and interventions can be planned.

Cancer arising from kidneys is one of the most lethal cancers. The predominant risk factors are obesity/overweight, smoking, history of hypertension and strong family history. As far as the symptoms are concerned- these tumors remain hidden for a very long time before showing up as symptoms such as blood in urine, pain or feeling of a mass in the flanks. The other symptoms are kidney stones and infections. Like other cancers, treatment and outcomes depend upon the extent of involvement or the “stage” of the disease. Stage 1, 2 and 3 are curable, though the chance of disease recurrence increases with an increased stage. Stage 4 is a disseminated form where the treatment aims to reduce symptoms, improve the quality of life and prolong life. The most common sites for the spread of kidney cancer are lung and bones, though it can go to any part of the body including brain, liver, and muscles. Any cancer has the ability to release cancer cells in blood circulation. Due to this, they can spread to many other organs.

The mainstay of the treatment of kidney cancer in stage 1, 2 and 3 is surgery or partial nephrectomy or radical nephrectomy.

For stage four- the main option is oral drugs are better known as –Targeted therapy. These are oral tablets or capsules which act selectively on pathways responsible to drive cancers.

There has been a newer addition to the list: immunotherapy.

Immunotherapy drugs are injections given once in 2-3 weeks.

Kidney cancer is one wherein body immunity plays a major role in controlling cancer growth. Hence these tumors are good targets for immunotherapy. Immunotherapy drugs act by selectively stimulating cancer specific immunity which in turn suppresses cancer growth. They have changed the treatment landscape of kidney cancer. Their side-effect profile is different from targeted drugs and in many cases, they have been able to induce long term remission in cancer patients.

Chemotherapy and radiation therapy do not work in such tumors though both radiotherapy and chemo are beneficial for many other cancers.. In order to prevent kidney cancer, it is important to quit smoking, exercise for half an hour at least five days a week and maintain healthy body weight.

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This case study has been authored by  Dr. Priya Tiwari, Lead Medical Oncologist at Fortis Hospital Gurgaon

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