In Singapore, kidney cancer is the eighth most common cancer in men, but with the bulk of patients cutting across both genders who are aged in their 60s.
Infamously known as a ‘silent killer’, symptoms of kidney cancer often appear late as the kidneys are located in the abdomen’s large cavity, allowing tumours to hide without displaying any visible signs.
“Kidney cancer can be quite a silent disease, and it can remain undetected for a long time” cautions Dr Richard Quek, a Senior Consultant Medical Oncologist, at the Parkway Cancer Centre.
“The classic triad of symptoms in kidney cancer include blood in the urine, loin pain, and a large abdominal mass for which the patient will complain of abdominal distention (bloatedness). As the disease progresses, other symptoms may then appear, which include persistent fever, weight loss, loss of appetite and bone pains if the bones are affected by the tumor.”
From Toxic to Targeted Treatments
Historically, the treatment options for patients with kidney cancer were limited, being a very chemo-resistant cancer.
“The standard chemotherapy that we use in other cancers do not work in kidney cancers. Typically we tend to give patients high dose interleukin-2, and this is given in an ICU (Intensive Care Unit) setting and the treatment is toxic” says Dr Quek who adds that even with high doses, patients were still responding poorly to the treatment.
“But that all changed in 2007, when oral targeted therapies were introduced. This treatment saw an increase in response rates from 10 per cent to 30 per cent, explains Dr Quek of the rates of the shrinkage of cancerous tumours.
Now a standard of care treatment, oral targeted therapy sees more manageable side effects from the medicines that are taken orally by patients in the comfort of their own home.
“But the benefits are only applicable to a certain group of patients” points out the oncologist. “The period of control tends to be six to nine months. So beyond which, the disease may then progress again.”
The search therefore continued for new treatments, important to help salvage the condition of patients, delay the worsening of the disease and to improve survival rates.
In 2015, immunotherapy was introduced, and as Dr Quek quips, “that really changed the way we looked at kidney cancer.”
“Immunotherapy was effective both in patients with relapse disease and in patients with untreated diseases. In particular, it was useful in patients with high risk renal cell cancer.”
Immunotherapy, which activates the body’s own immune system to target and eliminate cancer cells, is now available as a “best-of-both-worlds” treatment says Dr Quek, where a combination of immunotherapy and oral targeted therapies are used.
“That resulted in even higher responses from a traditional 30 per cent, to the new 60 per cent … a benefit applied to patients with low risk disease, as well patients with high risk disease. And that brought good cheer to both patients and physicians alike.”
The oncologist also points out, “with the newest round of research combining immunotherapy and targeted therapy, survival benefit has been demonstrated.”
“Treatment is well tolerated by patients and the duration of the disease control is longer as well. Survival of patients has also significantly improved with this new strategy”.
Are You At Risk?
While kidney cancer affects older men, more than women, Dr Quek lists smoking, hypertension and obesity as the main risk factors that can lead to kidney cancer.
“To deter kidney cancer” says Dr Quek, “one can adopt a healthy lifestyle.”
“Reduce weight, quit smoking, and manage your blood pressure, and that can really reduce the risk of contracting kidney cancer.”
Smoking is a major contributing factor, he points out.
“Quitting smoking alone can reduce the risk of kidney cancer by a third.”
Produced in partnership with Parkway Cancer Centre