Kidney cancer in the early stage of development does not show any symptoms. Patients who do not feel discomfort rarely come to the urologist's office for prophylaxis, although this is the only way to detect the problem in time. Marcelina Dzięciołowska talks about kidney cancer with a urologist from the European He alth Center in Otwock - Dr. Przemysław Szostek.
Marcelina Dzięciołowska: Doctor, how to recognize that something is wrong? When should you see a doctor?
Dr. Przemysław Szostek:Generally, the symptoms of kidney cancer are practically non-existent. This is a very big problem because this disease develops slowly. A kidney tumor grows about one to a maximum of two centimeters a year. It depends on the degree of malignancy. However, in the initial stage - up to about five centimeters in diameter of such a tumor, it may not show symptoms at all. Only tests that a person will want to perform are able to detect him.
So for example ultrasound?
Yes. Please note that a general urinalysis may not show any changes. If the tumor affects the outer part of the kidney, which is most often the case, even a general urine or blood test will not show any changes that may suggest a neoplastic disease. An ultrasound examination is such a screening test, which is quite accessible and relatively cheap. This is a basic test that is performed to identify and control a person for kidney cancer.
So it can be said that it is a very insidious disease?
Yes. Even five years after becoming ill, it may be asymptomatic.
Therefore, in order to react early, you must first of all research. So when should you go to your first appointment to check if everything is okay?
You have to get under control around the age of 35 - 45 and up. If someone assumes that they are young up to the age of 45, please kindly, but some patients, especially those who have family burdens, should start to be examined much earlier, i.e. from the age of 35, for example. I recommend my patients to do for themselves and their bodies every yeara birthday gift in the form of preventive examinations. This increases the chance that the patient will remember it.
Where did this idea come from?
Often, when I invite the patient, for example, for a control visit in six months, he shows up after 2-3 years, so I advise him to perform a set of basic tests around his birthday, i.e. blood and urine tests and a test USG.
This is a very good way!
Especially that if the patient adopts this practice, each year he will remember that he is older again, and a year has passed since the previous examinations. People forget about it, because there are always more important responsibilities, and he alth issues are relegated to the background.
This family burden doesn't just apply to kidney cancers, right?
Here we have very specific syndromes where kidney cancer occurs. Among urological neoplasms, kidney cancer is at the bottom end. There are, however, genetic syndromes that predispose him to develop. These people know this because specialist doctors who conduct certain types of genetic syndromes inform their patients widely about possible symptoms and sensitize them, which they should be careful about.
Which patients are most at risk?
Patients with prostate cancer are most at risk. This is a familial disease but kidney cancer is unique to the kidney. Patients in families with a history of kidney cancer are self-aware and have more control.
Apart from the genetic background, what other factors predispose to the development of kidney cancer? Smoking cigarettes, a sloppy lifestyle?
Not only. To begin with, we distinguish between two types of kidney cancer. The first is the kidney cancer we talked about earlier. The second is the upper urinary tract and includes transitional cell carcinoma, unlike the renal cell carcinoma we've talked about so far. In the case of transitional cell carcinoma, there are more symptoms that should be noted.
What are the symptoms, Doctor?
There may be hematuria that is difficult to overlook. Of course, a woman will come to the doctor sooner than a man, because men tend to downplay symptoms. Transitional cell carcinoma can be genetic as well as environmental.
So the environment in which we work and live is of great importance here?
Yes, the patient is exposed to external factors, mainly chemical ones, e.g. fuel vapors, paint, tar, smog and so on …chimney sweeps who come into direct contact with carcinogenic, toxic dust. Workers at gas stations, paint mixing plants, petrochemicals are mainly exposed to cancer of the urinary tract in the form of transitional cell carcinoma.
Another factor that exposes the patient, although not confirmed by tests, may be drinking insufficient amounts of fluids during the day. According to observations, tumors of the upper urinary tract in the form of transitional cell carcinoma lie in the area of the ureters in people who drink less. These are the main factors that can cause cancer of the upper urinary tract. Please remember that the symptom of hematuria is characteristic of a transitional cell carcinoma, not a renal cell carcinoma. It is a very dangerous cancer, it can spread very quickly and metastasize.
At what age most often patients come to your office with these types of cancer? Are these cancers that can still be treated with the intention of being cured?
For renal cell carcinoma, this age range is most commonly from the age of 40. Of course, there were cases where younger patients also fell ill, but after the age of 40 you should pay attention to it. Younger patients have more aggressive tumors, while the older ones tend to have less aggressive and malignant tumors, which grow much more slowly. In contrast, in the case of transitional cell carcinoma, if the patient is a smoker, if he deals with chemicals on a daily basis, these cancers may occur earlier. The youngest patient, who had transitional cell carcinoma, was 17 years old, living in a coal-fired house. Fortunately, this tumor did not recur after topical treatment. These cancers are much more dangerous in the context of life-threatening.
How is the prognosis? My guess is that it all depends on the patient's he alth and the severity of the disease?
The earlier a cancer is detected, the more possibilities. If a patient has hematuria, they usually see a doctor. In cases where the tumor grows very slowly and does not show any symptoms, the disease is very advanced and the prognosis drops significantly.
What are the treatments available for these two types of kidney cancer?
In the case of renal cell carcinoma, surgery is the most important thing. This is a cancer that actually fears the knife. There are many methods, one of them is complete nephrectomy, i.e. removal of the tumor together with the kidney. Another method is renal-sparing surgery, which is equivalent to the nephrectomy method.
In the case of cancerThere are more options for chemical treatment of transitional cells, e.g. neoadjuvant chemotherapy. The organ fragment can then be removed, and the tumor can also be removed endoscopically. This type of cancer is more sensitive to chemotherapy, and a treatment system has been developed for a long time. For renal cell carcinoma, which occurs on the outside of the kidney, chemotherapy is a relatively new topic and has been available for 10-15 years. We are currently lagging behind in this regard, but these distances are gradually shortening. This chemotherapy is quite expensive and difficult to obtain, but it offers the possibility of effective treatment of multifocal metastases, which was impossible in our country in 2005.
What about radiotherapy?
Radiation therapy in the treatment of renal cell carcinoma is practically not applicable, it is insensitive to this type of treatment. However, it is possible to treat transitional cell carcinoma, but only if it originates from the epithelium lining the kidney from the inside.
There are quite a lot of these possibilities.
Yes, but in the minds of Polish patients there is a thought that if I have cancer, I am written off, I will write a will and so on. That's not true. Of course, in many cases we only extend life - we remove the main mass of the tumor, the body is no longer poisoned with toxins from the decay of the tumor masses, thanks to which the patient can breathe, but of course we are aware that unfortunately he will not survive. However, it is related to the fact that the patient reports too late.
Most of the newly detected cases with low local advancement are curable - this is very important information, therefore this prevention is so important.
Referring to the will you mentioned earlier - please tell me what reactions to the diagnosis are observed by the medical community? Is it true that men don't want to talk about it?
Yes, the patient is an alpha male and assumes never to get sick. Many men do this when they find a cancer. However, about 30-40 percent. of the men maintains this attitude of the alpha male and decides that he will fight the disease and not give up. And that's the right choice.
The patient's attitude is important for the healing and recovery process.
Yes, if the man cooperates, the body will function better. This "drive" is very important. The moment a person gives up mentally, it will definitely be bad.
A person who finds out that he or she is sick can do unpredictable things against logic. Today I had todealing with a patient who decided to try urinotherapy, which is unreasonable and unreasonable. I don't know what went into his head!
Urynotherapy … that is?
Drinking your own urine. For medicinal purposes. It can be different, ideas from Chinese medicine to hundreds of thousands of zlotys spent in Tibet, which do not help and people squander their fortune.
This is probably not an isolated case, I have heard many similar stories.
Discontinuation of medical therapy is a crime against yourself. However, everyone has the right to choose. However, I had a patient who was dying of bladder cancer. He consciously chose this path, he did not want to be operated on. He did not seek help in alternative medicine, he simply waited to die. He was a sick and mentally burdened man, he chose this way of "elimination" of himself, he was fed up, he did not want to commit suicide, he accepted it. As in the case of Professor Religa, who, after receiving first-line chemotherapy, refused second-line chemotherapy because he knew that it did not help him and would only tire. It is very sensible. However, you have to be aware and have no doubts as to which path you are going to take. Here, too, is a great role for a doctor to ensure that the directions are clear and legible for such a patient.
In your opinion, do social campaigns and awareness-raising of patients in the field of cancer and prevention bring results?
Definitely yes, men finally started reading about it. Their spouses are also reading it. A big role of women is that they remind and sometimes force partners to take care of prophylaxis. Many men come voluntarily for preventive examinations precisely because they have heard or read somewhere that they should be tested.
We have seen a huge increase in prophylaxis patients over the last 10 years. Therefore, these campaigns should exist and be widely promoted.
Thank you for the interview.
Expert
Przemysław Szostek, MD, PhD, specialist surgeon, urologist, FEBU - Urology Department of the European He alth Center Otwock, 2nd Urology Clinic of the Medical Center of Postgraduate EducationHe obtained his doctor's diploma at the Medical Academy in Warsaw. He gained professional experience at the General and Transplant Surgery Clinic of Warsaw Medical University, Międzyleski Specialist Hospital, Urology Clinic of CMKP and during an internship in Paris. Senior lecturer at the Medical Center of Postgraduate Education. Author of many scientific articles in the field of urology. He specializes in urooncology, endourology, large onesopen urinary tract surgery, urological endoscopy, minimally invasive urology and new surgical techniques in urology. Member of the State Examination Commission in the field of urology.
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Marcelina Dzięciołowska Editor for many years associated with the medical industry. He specializes in he alth and an active lifestyle. A private passion for psychology inspires her to take up difficult topics in this field. Author of a series of interviews in the field of psycho-oncology, the aim of which is to build awareness and break stereotypes about cancer. He believes that the right mental attitude can work wonders, therefore he promotes professional knowledge based on consultations with specialists.