Kidney cancer expert Dr. Evan Hall explains the common side effects of treatment, including fatigue, rash, gastrointestinal issues, blood pressure changes, and hormone changes. Dr. Hall explains why it’s important to tell your care team about any new or unusual symptoms and to talk with them before making changes to your treatment or taking a break from therapy.
Dr. Evan T. Hall, MD, MPhil is a medical oncologist and researcher at the Fred Hutchinson Cancer Center and an Associate Professor at both Fred Hutch and the University of Washington School of Medicine.
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Transcript
Katherine Banwell:
Dr. Hall, what are the treatment options for renal cell carcinoma?
Dr. Evan Hall:
Yeah, so going back to that two-scenario approach.
If the cancer is known or suspected to be confined to the kidney, the usual treatment option is surgery or one of those other things that I mentioned that really delivers focused treatment to the tumor itself. Depending on what is known about the cancer after surgery, patients who are at high risk to develop other sites of cancer in the future, even if we don’t see them at the time they’re diagnosed, may be recommended to begin medicine therapy we call adjuvant or post-operative therapy.
That really is informed by what we see in the surgical specimen, so how aggressive or high risk does this cancer seem? If a patient is diagnosed in the other scenario where there is cancer that has moved beyond the kidney into other parts of the body, oftentimes those are situations where we start with medication, try to establish that we’re in control of the cancer in the body.
And then consider doing things like surgery later on to remove the kidney if the cancer is well-controlled in other places. So, I think that the two main treatments that we often think of are surgery and medicine, and then radiation can be used for a variety of reasons, both to treat the kidney tumor itself, especially if there are concerns about the risks of something like surgery, and to treat areas of pain or other symptoms that the cancer may be causing. Radiation can be a very effective treatment tool for that.
Katherine Banwell:
Do you always remove the entire kidney? If you see that there’s a tumor or a growth in the kidney, would you take out the tumor and leave the rest of the kidney, or are there options?
Dr. Evan Hall:
That’s a great question. Yeah, the size and the location of the tumor in terms of where it is related to the rest of the kidney’s anatomy could guide the potential for either removal of less than the total kidney.
Sometimes that’s called a partial nephrectomy versus a radical or total nephrectomy, where the entire kidney is removed, and there are even ways that small kidney cancers can be treated without full surgery. They can be treated with ablation, where we basically can use either different techniques to kind of freeze or deliver energy to the tumor through a catheter that can eradicate the tumor and the kidney stays in place, or even now there’s a growing data that for some patients they might be able to have their cancer treated with radiation as the main therapy.
Surgery is still generally the default preferred option, so there are several alternatives for certain patients and scenarios. So, to answer your question simply, in not all cases is the entire kidney removed, but depending on the location and the size, sometimes that’s necessary.
Katherine Banwell:
What questions should patients ask their medical team about options for care?
Dr. Evan Hall:
Yeah, I think exactly what you said is a great question. What options do I have? In many situations in cancer medicine, there may be more than one reasonable option, and different patients with different preferences and values, there may be a preferred option among medically reasonable options.
So, I usually like to think about things in that there are usually different choices or options the patient has, no matter the situation, and I think it’s a nice framing to ask your physician directly, “What are my options here?” or if a clear path is presented, ask if there are any other alternatives that would also be reasonable that should be considered.
Katherine Banwell:
Why is it essential for patients then to take an active role in treatment decisions?
Dr. Evan Hall:
Well, no one knows the patient better than themself and their loved ones, so I think again there’s really no one-size-fits-all approach to treat patients. We have lots of amazing tools to treat kidney cancer problems. They all have side effects and potential downsides, and learning a lot about what the patient values, what concerns or fears they have about treatment, or things they know they’d like to avoid, what their priorities are – that really helps us guide patients to the right treatment or in the right direction.
And really, by having a strong sense of that as a patient, not being afraid to advocate for oneself, it can become clear to the team in any given patient what the right way is to proceed. So, I think it’s really important to be active and involved in one’s care.