Kidney Cancer: Serendipity – Dr. Nilesh D. Mehta
One of my clinic patients recently asked me, “Why was my kidney cancer not diagnosed earlier?”
Diagnosis of cancer is made in earlier stages when we can screen for the disease. In breast cancer, we have screening guidelines with mammography in women and this strategy has been shown to save lives. A blood test, Prostate Specific Antigen (PSA) in men performed annually has been shown to detect prostate cancer at an earlier stage and has made an impact in reducing mortality in this disease. Similarly, in Cervix cancer in women, PAP smears performed regularly has had a similar favorable result in reducing death rates from this cancer. Colonoscopy done in patients over the age of 50 also detects colorectal cancer in earlier stages which contributes to favorable results.
Why don’t we do screening tests for kidney cancer?
In the United States, there are approximately 65,000 new annual cases of kidney cancer and nearly 15,000 deaths yearly related to this disease. For a successful screening test for cancer diagnosis in the general population, we need to have a test which can be utilized for the masses to detect early cancers. Performing a Computerized Axial Tomography (CAT) scan on a repeated basis would expose patients to radiation and cumulatively it potentially could have an additive detrimental effect. Risks and benefits of screening tests have to be taken into consideration when doctors advise screening for less common cancers. At the present time, there are no screening tests approved for kidney cancer.
Kidney cancer is 50 percent more common in men than women. It is usually detected in the sixth to eighth decade of life. Cigarette smoking is associated with an increased risk of developing kidney cancer. High blood pressure, obesity, occupational exposure to certain chemicals have also been found to be risk factors.
Patients with kidney cancer can present with or without symptoms. Often times, patients are getting tested for other diseases with ultrasound for their gall bladder or abdominal pain and incidentally kidney tumors are detected. This leads to further diagnostic testing and ultimately a diagnosis of kidney cancer is made. In the early stages of the disease, patients often times do not experience any symptoms. At later stages, patients can experience back pain, blood in urine, weight loss, anemia, and fever. These symptoms are vague and do not necessarily suggest malignancy in all patients. Patients need to seek medical care if they are experiencing any of these symptoms.
55-year-old male while traveling to India developed low back pain. He took some over the counter medicines without any relief. Upon his return, he had an MRI of his spine to figure out his spine abnormality. A slipped disc was suspected based on his symptoms. MRI confirmed a disc problem, however, there was an unfortunate surprise with a detection of right sided kidney tumor measuring five cm. He went to see a specialist surgeon who removed part of his right kidney with laparoscopic robotic surgery. Good news for him was that the cancer was confined to the kidney and he will not need any additional treatment. He will need surveillance CAT scans to be done every few months to ensure that there is no spread in the future.
An ounce of prevention is worth a pound of cure. Advise to patients is always to maintain a balance in their lifestyle by sticking to the basics of good nutrition, exercise, moderation in alcohol consumption, eliminating nicotine consumption and regular checkups with their health care provider.
Dr. Nilesh D. Mehta