By Dr. Ajay Singh
Cancer is defined as the uncontrolled, abnormal growth of cells that causes the formation of tumors in the body. A characteristic of tumors related to this cancer is that they usually grow, spreading in a local, regional structure, either directly or through the lymphatic drainage system. Or they may spread again to distant structures via lymphatic vessels or the blood circulatory system. Kidney cancer is the formation of a tumor in the kidney that can arise from any of the kidney-forming cells. Typically, it appears from renal tubular cells. Currently, not much is known about the cause of kidney cancer. In some cases, it is part of a genetic syndrome, for example, von Hippel Lindau syndrome, or rarely a familial disease. Theoretically, some hypothesized etiologies include smoking, obesity, NSAID pain reliever abuse, hypertension, diabetes, alcohol abuse, and chronic kidney disease from any cause.
Kidney cancer is most commonly present in the elderly population, but it is not unusual to see this patient in any age group from newborn, teen to very elderly. Those who present at a younger age may be part of a syndrome that we should keep in mind when seeing these patients and rule it out by relevant evaluation. Kidney cancer classically manifests with pain, blood in the urine, and a mass or swelling in the abdomen. But today, due to easy availability of CT scan and sonography centres, it is usually detected incidentally, at an early treatable stage. But when it is seen through the above mentioned complaints, it is usually in advanced stage and mostly not curable. A significant proportion of patients also present at a very advanced stage with spread to the lungs, brain, bone and liver giving rise to symptoms related to organ spread.
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In the current era, we have many innovative systemic treatments that dramatically improve kidney cancer outcomes, compared to the time when patients with advanced kidney cancer did not have many treatment options, which led to their Survival and quality of life were poor. Today, we have simple targeted pills (drugs) called TKIs, which act against the cells that cause the formation of blood vessels in these tumors and cause tumor growth – by blocking/blocking these target cells. Killing causes tumor shrinkage and sometimes tumor shrinkage rarely resolves. of these masses. Today we are in the era of immunotherapy. Immuno-therapy has further improved the outcomes of these patients relative to control period QOL and may rarely lead to treatment in exceptional patients. Based on scientific data, the recommended first-line treatment option in these patients with advanced kidney cancer is a combination of TKI + immunotherapy. This usually results in disease control for years, which may be better than in early-stage cancer patients who often have recurrences, despite curative resection.
There are some exceptions to the above principle of treatment – rarely patients may present at a very early stage where with proper consultation and follow-up they can be protected. Rarely advanced stage patients can be treated initially with systemic therapy, and some show excellent response – later being considered for curative resection of the residual mass. In some patients with limited advanced stage disease called oligomers, it is possible to resect both the primary and the metastatic mass. Selected patients with favorable advanced stage can be treated with a TKI drug alone. All these decisions need to be taken in a multidisciplinary joint clinic, where experts from different fields take decisions. Patients treated with systemic therapy should be seen by doctors regularly to monitor side-effects and cancer progression to take timely action to avoid treatment or disease-related complications. People who undergo curative treatment need to visit their doctor regularly to check for disease recurrence and avoid any surgery complications.
Overall, in today’s era, kidney cancer is mainly detected at an early stage due to more and more scans being done for various reasons, thereby detecting it before time. People who are diagnosed even in advanced stages can enjoy a long life with currently available medications. The cost and side effects of therapy are significant, so they need good social and family support to maintain this treatment and enjoy a long life. Also, as these patients live longer, they need help in other areas, such as psychiatric counseling. They may face some mental problems with time which the primary care doctors should be aware of. Additionally, it is the responsibility of the treating physician to ensure that each patient receives approximately the standard recommended options with the resources available in the area.
Dr. Ajay Singh, Lead Medical Oncologist, Sunrise Oncology Center
(Disclaimer: The views expressed are solely those of the author and ETHealthworld does not necessarily subscribe to it. ETHealthwold.com will not be responsible for any damage caused to any person/organization, directly or indirectly.)
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