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Daily Checkup: Kidney cancer gets too little attention

As assistant professor of urology at Mount Sinai Hospital, Dr. Reza Mehrazin specializes in treating cancers of the kidney, bladder and prostate.handout

As assistant professor of urology at Mount Sinai Hospital, Dr. Reza Mehrazin specializes in treating cancers of the kidney, bladder and prostate.

The Specialist:

As assistant professor of urology at Mount Sinai Hospital, Dr. Reza Mehrazin specializes in treating cancers of the kidney, bladder and prostate.

Who’s at risk:

Kidney cancer doesn’t grab a lot of headlines, but almost 65,000 new cases are diagnosed every year in the U.S. That’s enough to make kidney cancer one of the 10 most common cancer diagnoses.

“Kidney cancer is a malignancy that grows on the kidneys, which are organs vital for survival,” Mehrazin says. “The good news is that kidney cancer could be highly curable when it’s caught at early stages. Early detection can be associated with five-year survival rates above 90 percent.”

The kidneys sit at the back of the abdomen. They’re considered part of both the endocrine and urinary systems.

“The kidneys filter toxins from the blood to form urine, and control blood pressure, water balance, regulate red blood cells and acid balance,” Mehrazin says. “Also, kidneys produce and control hormones that maintain healthy calcium levels for the bones.”

Kidney function is essential for life. “Typically, one healthy kidney is enough to survive on,”Mehrazin says. “If both kidneys fail, patients either need a transplant or end up on dialysis.”

Kidney cancer remains elusive.

“We’ve done a lot of research, but there’s a lot we still don’t know,” says Mehrazin. “There are some genetic factors and smoking and obesity are factors that increase your risk. But for many patients, developing kidney cancer seems to be a random thing.”

All sorts of people are affected by this disease. “Men are slightly more prone than women to develop kidney cancer, but gender isn’t a huge factor and neither is ethnic background,” Mehrazin says. “And while the average age of diagnosis is 64, I’ve seen patients as young as 20 and others in their 90s. It’s something that can occur throughout life.”

Signs and symptoms:

Kidney cancer tends to be a silent disease.

“The challenge is that many kidney tumors are asymptomatic, so the patient may have no idea,” Mehrazin says. “At this point, most small tumors are diagnosed incidentally, when a patient just happens to have a CT scan or MRI for something entirely different.”

A small subset of patients do have red flags.

“About 10 percent of patients experience symptoms like pain or blood in the urine,” says Mehrazin. “Unfortunately, those signs tend to be associated with cancers that have already progressed to more advanced stages.”

Traditional treatment:

The treatment options depend on the stage of the cancer — as well as the patient’s age and overall health.

“If a patient is generally healthy and not extremely elderly, then the gold standard of treatment is surgery to remove the tumor,” Mehrazin says. “In the past, we would remove the whole kidney, regardless of the tumor’s size, but now advanced techniques allow us to spare a healthy kidney and just remove the tumor.” So far kidney cancer that has metastasized to other organs remains resistant to treatment.

Some kidney tumors can be removed using minimally invasive techniques, but others require open surgery, a decision that depends on the size and location of the tumor.

“Robotic surgery is minimally invasive and associated with less pain and faster recovery. Most patients leave the hospital in just one to two days,” Mehrazin says. “Patients with more complicated, bigger tumors may benefit from open surgery, which usually means another day or two in the hospital.”

For some patients, the best treatment option might be-doing nothing.

“Although surgical excision is the standard of care for localized kidney tumors, we’re now realizing that for patients with exacerbating health problems, the risks of surgery can outweigh the benefits,” Mehrazin says. “Not every tumor needs to be excised, and not every patient needs surgery.”

The idea of active surveillance is to sort out slow-growing tumors from more aggressive ones.

“We watch the patient carefully over a period of time — three months, six months, a year — to see how fast the tumor is growing, because some tumors don’t really grow or don’t grow quickly enough to be life-threatening,” Mehrazin says. “If we discover that the tumor is growing quickly, that probably means it’s more malignant, and those are the tumors we want to act on.”

Research breakthroughs:

Improved medical imaging is opening up new treatment possibilities.

“We have so much more information now that we can monitor the tumor size and appearance of the tumor,” Mehrazin says. “Active surveillance can be a safe option for many patients.”

Questions for your doctor:

If you’re diagnosed with kidney cancer, the first question to ask is a double-barreled one: “How big is the kidney tumor?” and “How complex does the tumor look?”

Followup with, “Has it spread anywhere outside the kidney?” And never hesitate to ask, “Do we need to act on this sooner rather than later, or do we have time to watch it?”

Mehrazin says: “Not every patient needs surgery to remove a kidney tumor. If other health factors mean that surgery carries extra risks for you, then active surveillance or observation could be your best option.”

What you can do:

Get informed.

There’s a plethora of helpful information online at the National Cancer Institute (cancer.gov/types/kidney) and Mount Sinai (mountsinai.org/profiles/reza-mehrazin)

Make healthy choices.

Doctors do not have a precise blueprint for preventing kidney cancer. But it helps to live a healthy lifestyle. It’s especially important to avoid smoking.

See a specialist.

Consult a doctor who specializes in kidney tumors. Be sure the doctor is comfortable with all the treatment options: robotic surgery, open surgery, or active surveillance.

By the numbers:

– In 2014, almost 65,000 Americans were diagnosed with kidney cancer.

– More than 20 percent of those patients will die of the disease.

– The average age of diagnosis with kidney cancer: 64.

Source: Dr. Reza Mehrazin

Lifestyle – NY Daily News

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