The Times - Stuttaford, Dr. Thomas
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2007.06.18 Hope for Kidney Cancer patients
Hope for Kidney Cancer patients
- Kidney Cancer is notoriously difficult to treat, although recently the gloomy prognosis has begun to improve with drugs increasing survival times, says Dr Thomas Stuttaford
Beetroot time is here again. Two generations ago beetroot was a favourite vegetable in rural households. British food writers have rediscovered its delights and are again including it in their recipes. It is recommended as a smart and colourful ingredient capable of sprucing up the most dowdy salad and it is delicious when served with a sauce.
There is one problem that Doctors face: the number of anxious patients who will visit them with medicine bottles or jam jars filled with red Urine is likely to soar. These patients may fear that it is blood in the urine but there is a difference between the colour and consistency of urine when blood has seeped into the renal tract and that of urine stained with beetroot pigment.
Even so, these urines are always tested by the Doctor, and the patient is congratulated for reporting such a possibly ominous sign as blood in the urine – Haematuria – so quickly. Haematuria may be the first and only clear-cut sign of a tumour] in the kidney or elsewhere in the renaltract. The other signs of Kidney Cancer, such as a vague persistent pain over a kidney, perpetual tiredness, loss of appetite, weight loss and anaemia are ill-defined and have many causes.
There are several explanations for Haematuria, but once blood in the urine has been isolated Doctors never rest until its origin has been explained. The early diagnosis of a kidney tumour is of paramount importance. If the cancer can be removed surgically before it has spread the patient has at least a 60 per cent chance of surviving for more than five years. Recent figures from the US have even shown that if the tumour is detected and removed surgically when confined to the [Kidney]] the five-year survival may be as high as 80 to 90 per cent. Conversely, only 20 per cent of patients whose cancer has spread beyond the kidney when first diagnosed are likely to be around in five years.
The most common kidney is a renal cell carcinoma. Every year in this country it is diagnosed in 6,500 people but the number is increasing. Just under half will lose their lives as a result.
Men are twice as likely as women to develop one and its incidence increases with age. Smoking increases the likelihood of renal cell cancer by more than 40 per cent and it is more common in the overweight. Obesity is a factor in 20 per cent of kidney cancers.
The 23rd edition of Bailey and Love’s standard British textbook of surgery suggests that although removal by chemotherapy, radiotherapy or otherwise of even the largest cancer may cure the patients, provided it hasn’t spread, only surgery gives a patient much chance of long-term survival. Kidney tumours as recently as six years ago failed to respond well to Radio Therapy, and conventional Chemotherapy was of little use. In the past few years this gloomy prognosis has begun to improve. The use of interferon alpha-2a therapy increases survival times. Recently Avoren (bevacizumab) has been taken with [Interferon|interferon]] with positive results.
Furthermore, the time has been extended before the tumour starts to become active and cause symptoms after the start of treatment. The results of a trial using Avoren, which is the same compound as Avastin, was given to a recent meeting of cancer specialists in Chicago. When taking Avoren with the interferon twice as many patients were likely to respond, and the combination gave them a chance to live almost twice as long without the symptoms of their disease returning as they would have if they had taken interferon alone.
As Dr. Peter Harper, consultant at Guy’s] and St Thomas’ Hospital in London, said: “Results in terms of both efficacy and safety achieved with Avoren represent a big step forward in a difficult-to-treat cancer.”
Avoren is made by Roche. Another drug likely to be of use in advanced cases of kidney cancer that has been impossible to remove entirely with surgery is Sutent (sunitinib malate), made by Pfizers. Although there have as yet been no large, randomised trials of Sutent that demonstrate a clinical benefit, several smaller trials with patients suffering from advanced kidney cancer have shown that it is likely to make a considerable difference to the survival time that remains free of recurrence.
with thanks to The Times & The Author Dr. Thomas Stuttaford for raising awareness of Kidney Cancer.
The original of this article can be found at:
2007.06.28 Clarification
My piece on June 18 in times2 on the use of Avastin in the treatment of renal cell cancers, the most common form of kidney cancer, included one possibly misleading comment. Avastin is a remarkable and versatile drug that is already of proven use in treating colon and breast cancer. It is awaiting license for revolutionary treatment of kidney cancer and some forms of lung cancer, in which it seems to be unusually useful. I suggested, with a hint of disapproval, that having the same drug with two trade names is confusing, that Avastin was to be known as Avoren when used for treating kidney cancer. This is not and will not be so. Avoren was only the code name used to describe the large trial that demonstrated the ability of Avastin to double the survival time of people with advanced kidney cancer that had not been amenable to surgery. It will be available as Avastin.
Dr. thomas Stuttaford See the foot of the article where there is a comment on KC at:
2007.01.25 better NHS treatment in Scotland?
Would my cancer receive better NHS treatment in Scotland?
by: Dr Thomas Stuttaford
Readers' questions are answered as examples of general problems commonly met in practice. It is a good rule in medicine that only their own doctors know the patient well enough to pontificate on the case as there are often other factors unknown to strangers.
A 60-year-old reader went for a consultation with his doctor recently, and the latter detected a trace of blood in his urine. The reader had observed that once or twice his urine had a slightly pink hue to it, and that the occasional urine stain was similarly discoloured. His doctor organised a consultation with a urologist, who arranged full examinations including X-rays and scans. To the reader’s surprise, his doctor said that he had a cancerous growth in one kidney. The kidney has now been removed but the surgeon said that the cancer had spread through the kidney capsule into surrounding tissue and that one lymph node was positive. The reader was told that had he lived in Scotland there would have been chemotherapy available that might have helped him, but that this is not being paid for in England. Is this, he asks, an example of medical services looking after the elderly better north of the border?
Yes, the Scottish equivalent of NICE has sanctioned the use of two new forms of chemotherapy that have been shown to be useful in the treatment of kidney cancer that has spread beyond the organ. Unfortunately, although they have been approved for prescription in Europe, including Scotland and England, NICE has not recommended that they should be paid for by the NHS in England.
The previous first line of treatment for patients with kidney cancer such as our reader has been interferon alpha. It doesn’t give as good results as either Sutent (sunitinib malate) or Nexavar (sorafenib tosylate). Both have been shown to be more effective against metastatic kidney cancer, and have been described as the first truly effective chemotherapeutic drugs for metastatic (advanced) kidney cancer.
The term metastatic means that the cancer has spread beyond the kidney, even if, as in the reader’s case, it is only to one of the lymph glands that the surgeon took out for microscopic examination, and into the fat around the kidney.
Both Sutent and Nexavar, the new drugs, have been favourably reviewed by the New England Journal of Medicine, a publication regarded as being the arbiter of good medicine.
Unfortunately, too often kidney cancers are silent cancers, and diagnosed only when there is blood in the urine. That is why doctors are so careful at routine examinations to check for any evidence of blood in the urine. Often there is a benign cause but no one can take chances.
The good news is that if cancer is detected early, before it has extended into the lungs, bones or lymph glands, the prognosis is comparatively good: 70 per cent of patients are well after three years and 60 per cent after five years. Extension into the tissue around the kidney, or even into a lymph gland, doesn’t make the situation impossible even though our reader will be deprived on the ground of cost of the treatment that might have given him the best chance of survival.
It is amazing how many patients who have frank haematuria — not just a pinkish hue to the urine — which also needs investigation, don’t see their doctors at once despite passing blood. All haematuria needs investigating. And once the condition is diagnosed, the patient should have the best treatment possible. It is suggested that the NHS needs to cut its coat according to the cloth available. As Britain is one of the richest countries in the world, our cloth should be larger than those of similar Western countries.
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