Many seniors with kidney cancer do not need surgical removal reports new study

Robin Wulffson MD's picture
kidney cancer, seniors, unnecessary surgery, death, complications
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In many cases, after a diagnosis of cancer is made, surgical removal is recommended. However, a new study has reported that for many seniors with kidney cancer, the patient would be better off by not going under the knife. The surprising findings were discussed on February 13 in a telephone news conference sponsored by the American Society of Clinical Oncology and two other cancer groups.

The study was Dr. William Huang of New York University Langone Medical Center. They accessed federal cancer registries and Medicare records from 2000 to 2007 and located 8,317 individuals 66 and older with kidney tumors less than 1.5 inches wide. Cancer was confirmed in 7,148 of them. About 75% of them had surgery and the rest opted to be monitored with periodic imaging tests. After five years, 1,536 had died, including 191 of kidney cancer. The investigators found that for every 100 patients who chose monitoring, 11 more were alive at the five-year mark compared to the surgery group. Only 6% of those who chose monitoring eventually had surgery. Furthermore, 27% of the surgery group but only 13% of the monitoring group developed a cardiovascular problem such as a heart attack, heart disease or stroke. These problems were more likely if doctors removed the entire kidney instead of just a portion of it. Overall, only 3% of people in each group died of kidney cancer.

The researchers note that the study only involved individuals 66 and older; however, half of all kidney cancers occur in this age group. They stressed that younger individuals with longer life expectancies should still be offered surgery. They also noted that the study also was observational; rather than an experiment where some people were given surgery and others were monitored. Although it cannot prove which approach is best, it offers a real-world look at how more than 7,000 Medicare patients with kidney tumors fared.

Approximately 65,000 new cases of kidney cancer and 13,700 deaths from the disease occur in the United States each year. About two-thirds of cases are diagnosed at the local stage, when five-year survival is more than 90%; however, currently, most kidney tumors are found not because they cause symptoms, but are spotted by accident when people are undergoing an X-ray or other imaging procedure for something else, such as back pain or chest pain. Cancer experts are increasingly question the need to treat certain slow-growing cancers that are not causing symptoms; one example is prostate cancer.

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Renal cell carcinoma is the most common type of kidney cancer in adults. It occurs most often in men aged 50-70. The exact cause is unknown. Risk factors include:

  • Dialysis treatment
  • Family history of the disease
  • Genetics
  • Smoking
  • Von Hippel-Lindau disease (a hereditary disease that affects the capillaries of the brain, eyes, and other body parts)

Symptoms:

  • Abdominal pain
  • Abnormal urine color (dark, rusty, or brown)
  • Back pain
  • Blood in the urine
  • Emaciated, thin, malnourished appearance
  • Enlargement of the veins around a testicle (varicocele)
  • Flank pain
  • Swelling or enlargement of the abdomen
  • Unintentional weight loss of more than 5% of body weight

Other symptoms that can occur with this disease:

  • Constipation
  • Cold intolerance
  • Excessive hair growth in females
  • Paleness
  • Vision abnormalities

Sometimes both kidneys are involved. The cancer spreads easily, most often to the lungs and other organs. In about one-third of patients, the cancer has already spread (metastasized) at the time of diagnosis.

Reference: American Society of Clinical Oncology

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