Navigating Your Early-Stage Kidney Cancer Diagnosis

What Does it Mean to Have Early-Stage Kidney Cancer?

Kidney cancer, also known as renal cell carcinoma (RCC), is a type of cancer that begins in the cells of the kidneys. The kidneys are two organs located on either side of your spine, below your rib cage. Their main job is to filter waste products from your blood and produce urine.

When a person has early-stage or stage 1 kidney cancer, it means the tumor is small and contained within the kidney, typically measuring less than seven centimeters (about the size of a small orange). Because the cancer is still confined to its origin, it has not spread to other organs or to the lymph nodes. This is a very important distinction, as early-stage kidney cancer is often highly treatable and has a very good prognosis.

How Do Doctors Find Kidney Cancer Early?

Early-stage kidney cancer often doesn't cause any symptoms. It's frequently discovered by chance when a person has an imaging test, such as an ultrasound, CT scan, or MRI, for an unrelated medical condition.

The diagnostic process is designed to confirm the presence of cancer, determine its type and stage and assess the overall health of your kidneys. The main diagnostic tools include:

• Imaging Tests: These are the primary way kidney tumors are found. A CT scan of the abdomen and pelvis is the most common test, providing detailed pictures of the kidneys and surrounding structures. An MRI or ultrasound may also be used.

“A lot of times, kidney cancer, especially, is found incidentally. It might be discovered after a car accident, or [something that prompts] needing a scan. You get a scan, and they find a mass on your kidney. They ask, "What is this? Let's investigate further. But if you have symptoms like blood in the urine, pain or other unusual symptoms, talk to your doctor about it,” Sid Sadler, a patient advocate and survivor of kidney cancer, emphasized when talking about his initial diagnosis with CURE.

• Biopsy: In some cases, your doctor may recommend a kidney biopsy. This involves taking a small sample of the tumor with a needle to analyze it under a microscope. A biopsy can confirm if the tumor is cancerous and determine the specific type of kidney cancer, which helps in guiding treatment decisions.
• Blood and Urine Tests: These tests provide your doctor with important information about your overall health and kidney function, which can be affected by the tumor.

How is Early-Stage Kidney Cancer Treated?

The treatment for early-stage kidney cancer is highly personalized and depends on several factors, including the tumor's size and location, your age, and your overall health. The primary goal of treatment is to remove the tumor while preserving as much of the kidney as possible.

• Surgery: This is the most common and definitive treatment for stage 1 kidney cancer.
• Partial Nephrectomy: This is often the preferred option for early-stage tumors. It's a surgery to remove only the tumor and a small margin of healthy tissue around it, leaving the rest of the kidney intact. This is sometimes called "kidney-sparing" surgery.
• Radical Nephrectomy: In some situations, removing the entire kidney may be necessary, especially if the tumor is very large, located in a difficult-to-reach area, or if the partial nephrectomy would not be a safe option.
• Minimally Invasive Therapies (Tumor Ablation): These are non-surgical options that destroy the tumor without removing it. They are typically considered for very small tumors, especially for patients who may not be good candidates for surgery.
  • Radiofrequency Ablation (RFA): This procedure uses heat generated by high-frequency radio waves to destroy the cancerous cells.
  • Cryoablation: This procedure uses extreme cold to freeze and destroy the tumor.
• Active Surveillance: For very small tumors, particularly in older patients or those with significant other health conditions, a "watch and wait" approach may be an option. This involves closely monitoring the tumor with regular imaging tests to see if it's growing before deciding to treat it.

What New Therapies are Being Tested for Early-Stage Kidney Cancer? How Can I Join a Clinical Trial for Early-Stage Kidney Cancer?

While surgery remains the standard of care for most early-stage kidney cancers, there has been significant progress in using advanced treatments to reduce the risk of the cancer returning, particularly for patients with a higher risk of recurrence. This is known as adjuvant therapy, which is treatment given after the main treatment (like surgery) to eliminate any remaining microscopic cancer cells.

• Immunotherapy: This is a key area of focus. A type of immunotherapy called a checkpoint inhibitor is now a standard adjuvant therapy option for some patients with higher-risk kidney cancer. One drug, Keytruda (pembrolizumab), has been shown to improve the time that patients live without their cancer returning when used for a year after surgery.

“The target of immunotherapy is actually immune cells in the tumor microenvironment, not the tumor itself. Different immunotherapies have different targets on these immune cells, and it's important to understand which immune cells express those markers,” Dr. Berkay Simsek, of Brigham and Women’s Hospital, explained to CURE.

• Targeted Therapy: This class of drugs works by interfering with specific molecules that help cancer cells grow and spread. While many targeted therapies are approved for advanced kidney cancer, there have been clinical trials to test them in the adjuvant setting.
  • While some of these drugs have shown a benefit in preventing recurrence, the side effects can be a concern, and they are not as commonly used in the adjuvant setting as immunotherapy.
• Clinical Trials: Research is constantly evolving. Ongoing clinical trials are exploring many new approaches, including:
  • Combination Therapies: Combining immunotherapy with targeted therapy to see if they can work even better together.

“New combinations, especially after immunotherapy failure, are on the way, and precision medicine is getting stronger through exploratory analyses for selecting the right patient for the right treatment. Today, we have more hope than yesterday,” Dr. Emre Yekedüz, of the Dana-Farber Cancer Institute, informed CURE.

• Personalized Vaccines: Creating a vaccine tailored to a person's specific tumor to help their immune system recognize and attack the cancer.

“We are still in the very early stages of development. The hope is that this will be another tool in our arsenal for treating patients with kidney cancer. [Personalized cancer vaccines] are being tested first in what is called the adjuvant setting, for patients who have had a kidney tumor removed and have no evidence of cancer elsewhere in the body but are at risk of a recurrence,” Dr. David A. Braun, of the Yale Cancer Center, said in an interview with CURE on the topic of personalized cancer vaccines. “The question is, can we give a treatment that decreases the chance of the kidney cancer returning?”

• Tumor Ablation in Combination with Immunotherapy: Early studies are looking at whether using a non-surgical therapy like ablation to “agitate” the tumor could release signals that make a person's immune system more receptive to immunotherapy.

What Should I Expect During Kidney Cancer Treatment?

Like any medical procedure, treatments for kidney cancer can have side effects. Discussing these with your doctor is crucial, as many can be managed with medication or supportive care.

• For Surgery (Partial or Radical Nephrectomy): Common side effects include pain or discomfort at the incision site, fatigue, and temporary or permanent changes in kidney function, especially with a radical nephrectomy. There is also a small risk of bleeding or infection.
• For Minimally Invasive Therapies (Ablation): Side effects are generally less severe and may include mild pain, bruising, or discomfort at the treatment site.
• For Active Surveillance: The main "side effect" is the emotional toll of living with a cancer that is being monitored rather than treated.

Tips For Talking With Your Healthcare Team About Early-Stage Kidney Cancer

A diagnosis of early-stage kidney cancer can be frightening, but the good news is that it is a very treatable condition with an excellent long-term outlook. This overview is just a starting point for your journey.

“I encourage you to find a doctor who listens to you and is willing to treat you on an individual basis,” Sadler said in his interview when asked about early detection.

The most important step you can take now is to partner with your healthcare team. Ask them questions, share your concerns, and be open about any symptoms or side effects experienced. They are your best resource and will help you make the most informed decision for your unique situation.

Editor’s note: This guide is designed to be a starting point. Your personal experience will be unique. By using this information as a foundation for your discussions, you can partner with your oncologist to make the best decisions for your health.

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