1. Green, Chuck

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About 63,990 new cases of kidney cancer (40,610 in men and 23,380 in women) will occur, according to most recent estimates for kidney cancer in the U.S. for 2017, according to the American Cancer Society (ACS). About 14,400 people (9,470 men and 4,930 women) will succumb to the disease. These numbers include all types of kidney and renal pelvis cancers.

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Most people with kidney cancer are older. The average age of people when they are diagnosed is 64. Kidney cancer is very uncommon in people younger than age 45.


Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk of developing kidney cancer is about one in 63 (1.6%). This risk is higher in men than in women.


For reasons that are somewhat unclear, the rate of new kidney cancers has been rising since the 1990s, although this seems to have leveled off in the past few years, stated the ACS. Part of this rise was probably due to the use of newer imaging tests such as CT scans, which picked up some cancers that might never have been found otherwise. The death rates for these cancers have gone down slightly since the middle of the 1990s.


Approximately 65 percent of people are diagnosed when the cancer is only located in the kidney, reported For this group, the 5-year survival rate is 93 percent. If kidney cancer has spread to surrounding tissues, organs, and/or the regional lymph nodes, the 5-year survival rate is 66 percent. If the cancer has spread to a distant part of the body, the 5-year survival rate is 12 percent.


Guiding Patients Through Care

Following a metastatic kidney cancer diagnosis, patients sometimes are forced to wait weeks and sometimes months for appointments with perhaps a battery of medical specialists, according to experts. In the meantime, coordination of care could become lopsided and confusing.


However, it's a far different story at institutions like the Seattle Cancer Alliance (SCCA), where the Kidney Cancer Multispecialty Clinic was launched in April. A team evaluation is conducted with a urologic oncologist, medical oncologist, radiation oncologist, pathologist, radiologist, and resident doctor or fellow-all of whom are UW Medicine doctors who specialize in kidney cancer. The multispecialty approach, explained oncologist Scott Tykodi, MD, PhD, Associate Professor in the Division of Medical Oncology at the University of Washington, provides patients the opportunity to discuss all aspects of their proposed treatment plan on the same day with each individual treating doctor. Patients will receive answers to all their questions along with a specially designed plan of care, he continued.


"Very often, cancer patients need to see more than one type of specialist. It's very challenging and stressful for patients with a new cancer diagnosis to coordinate and move between multiple specialists, even when they're in the same treatment network," stated Tykodi, also an Associate Member at the Fred Hutchinson Cancer Research Center in Seattle.


"There's time wasted" waiting to schedule appointments to see multiple specialists and the anxiety from waiting for weeks, sometimes stretching into months for a treatment plan can be daunting. By contrast, the SCCA devises an overall game plan, the goal of which is comprehensive treatment planning in one setting in a single afternoon visit, which helps circumvent delays, he explained. "[Patients] know exactly what we'd recommend and what should come next for patient care."


Physicians meet as a group to review new patients' medical history and diagnostic tests, including all pathology and radiology data, then meet with patients individually for up to two hours each to discuss a treatment plan.


What's more, a nurse coordinator basically serves as a traffic cop for the system. "[They're] someone who's going to track patients and ensure there's follow through on scheduling. [The coordinator] is a great resource for patients with questions. They know the overall treatment plan and help them navigate the process," Tykodi explained.


The SCCA clinic operates 2 half days a month, serving 6-8 patients. Based on interest and patient volumes, extended hours are possible. "We're starting a little conservatively with how many clinics we run," Tykodi said.


Multidisciplinary Care

A similar approach for the treatment of the disease is practiced at the University of Illinois at Chicago, where kidney cancer is treated in the UI Health Cancer Center, a multidisciplinary collaborative effort that boasts 97 members from 11 colleges spread across the university, including a tumor board. The center's dedicated to reducing the burden of cancer through an integrated program of excellence in clinical care, research, and education, according to Daniel Moreira, MD, Assistant Professor of Urology, University of Illinois at Chicago College of Medicine.


With cancer-related research funding exceeding $59 million, the UI Health Cancer Center is employing a "bench-to-community" model of cancer care into the communities it serves, while actively translating knowledge gained into improved quality of life for all who are impacted by cancer, said Moreira. Research initiatives range from basic to translational: cancer biology, genetics, therapeutics, diagnostics and imaging, cancer prevention, control, and early detection, as well as the psycho-social impacts of cancer.


Patients with kidney cancer are seen by a multidisciplinary team of experts, including urologists, medical and radiation oncologists, radiologists, and pathologists, he explained. Tumor staging with CT scan and MRI is key to the management of renal malignancies. Localized tumors are traditionally treated with active surveillance, percutaneous ablation, or partial or radical nephrectomy depending on size, location, symptoms, tumor growth, and a patient's preference.


Locally advanced and metastatic tumors are typically managed with a combination of systemic therapy and local therapies, including radical and partial nephrectomy, and percutaneous ablation, Moreira continued. For patients with metastatic kidney cancer, or for patients who have a high risk of recurrence following surgery, we also offer a number of clinical trials.


Even so, treatment, such as for renal tumors, poses challenges, he noted. They include:


* Accurate staging: Despite advances in medical imaging including CT scan and MRI, between 10-20 percent of the tumors initially thought to be contained within the kidney parenchyma show signs of invasion of structures near the kidney, such as the perirenal fat and renal vessels. In addition, nearly 10 percent of the solitary tumors found on preoperative imaging are found to be multifocal on final pathology.


* Renal function: The management of kidney cancer has to take into consideration the renal function. Studies have shown that men with reduced renal function may have reduced survival. The surgical management of renal cancer can lead to reduced renal function by the surgical removal of part or the entire kidney. A fine balance between safely removing the entire tumor and leaving the normal kidney is key.


* Prognosis of metastatic disease: In the past 5-10 years, there has been a revolution in the management of metastatic kidney cancer with the introduction of several new drugs. These drugs have dramatically increased the mean overall survival of patients with metastatic disease from 6-12 months to now almost 5 years. Although these are very encouraging results, there is still much more to be done.



Treatment aside, the multispecialty clinic process, of course, isn't completely unique to kidney cancer, "We have the same approach for other diagnoses, but kidney cancer isn't extremely common and you have to have a fairly big referral network and see enough patients to make it all sensible," Tykodi concluded.


Chuck Green is a contributing writer.