5 Critical Facts About Kidney Cancer

Kidney cancer is among the 10 most common cancers worldwide, accounting for approximately 2% of all diagnosed cancers. Its most common subtype is renal (kidney) cell carcinoma, accounting for 90% of cases.

2020 Turkey Cancer Statisticsshow that kidney cancer, with 5.125 new cases annually, was the 15th most common cancer in our country. That year, 1.965 deaths from kidney cancer were reported, and the number of people living with the disease (5-year prevalence) was recorded as 14.172.

This article presents five things every doctor treating renal cell carcinoma and every patient receiving treatment for it should know about the latest evidence on risk factors and treatment.

1. Hereditary conditions account for 3-5% of all renal cell cancers

Associated with renal cell cancer, hereditary syndromes include von Hippel Lindau disease, BAPT1-mutant disease, succinate dehydrogenase-associated renal cancer, hereditary leiomyomatosis, hereditary papillary renal cancer, Birt-Hogg-Dubé syndrome, tuberous sclerosis complex, Cowden syndrome and hyperparathyroidism-jaw tumor syndrome.

Genetic counseling should be considered in people whose renal cell cancer begins at age 46 or younger. Besides young age, bilateral / multifocal tumors are a well-known feature of hereditary renal cell cancer.

2. Active surveillance is a reasonable initial treatment option in selected patients

Particularly for solid kidney masses smaller than 2 cm or Bosniak 3/4 complex cystic masses, active surveillance is an initial treatment option.

When the expected risk of intervention outweighs its potential oncological benefits, physicians should prioritize active surveillance. For patients whose treatment risk-benefit balance is equal and who prefer surveillance, doctors should, within 3-6 months, repeat oncological imaging in follow-up.

One study reported that 70% of patients choosing active surveillance were alive at year 5.

3. Targeted cancer drugs, combined immunotherapy or combining these two treatment types have provided major benefit in advanced kidney cancer and become the new standard

Current standard treatment for metastatic clear cell kidney cancer includes a targeted therapy or immunotherapy ; however, new data also combine these two strategies. Renal cell cancer is resistant to conventional chemotherapy .

Approved targeted cancer drugs for renal cell cancer include agents such as axitinib (Inlyta), bevacizumab (Altuzan), cabozantinib (Cometriq, Cabometyx), lenvatinib (Lenvima), pazopanib (Votrient), sunitinib (Sutent) and sorafenib (Nexavar), as well as agents inhibiting the rapamycin complex 1 (mTORC1) target. These involve blocking signals from the vascular endothelial growth factor receptor [everolimus (Afinitor) and temsirolimus (Torisel)].

4. Folic acid may treat mucositis, a common side effect

Mucositis (mouth sores)is a common side effect in patients with advanced renal cell cancer treated with targeted therapies and immunotherapy. It reduces quality of life and may lead to dose reductions or treatment discontinuation.

Doctors often underestimate the severity of mucositis. Among patients treated with targeted drugs, it affects approximately 20% of patients, and the character of mouth sores caused by targeted drugs differs from the classic oral injuries seen with chemotherapy or radiotherapy. Standard mucositis management includes good daily oral hygiene and regular dental care.

In a recent small study, folic acidsignificantly reduced mucositis in patients treated with sunitinib, pazopanib, everolimus, axitinib, temsirolimus, interleukin-2 / interferon-alpha, cabozantinib, bevacizumab and nivolumab (Opdivo), who had grade 2 or more severe mucositis. For this side effect, a double-blind, placebo -controlled prospective clinical trial is ongoing.

5. Partial nephrectomy is recommended if possible

More frequent diagnosis of smaller kidney masses, particularly those <7 cm, has changed the perspective on kidney cancer surgery. Treatment guidelines from the American Society of Clinical Oncology (ASCO) and the US National Comprehensive Cancer Network recommend partial nephrectomy whenever possible. Partial nephrectomy reduces ischemic (reduced blood flow) time, and outcomes are more favorable for long-term disease control, the incidence of chronic kidney failure, delayed cardiovascular disease and improved survival. Partial nephrectomy is standard management for a cT1a renal mass (a tumor 4 cm or smaller), and recent data suggest considering it for larger cT1b and cT2 tumors as well, namely kidney tumors smaller than 7 cm.

*

Manage preferences to view external content

Manage preferences to view external content

• Related topic: Rare Kidney Tumors – Current Treatments