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Episode #23 - Kidney Cancer

Steve Abbott:

So hello everybody. And welcome back to episode 23 of CCA's Medical Minute Podcast by Kroger Health. I am here today, I'm kind of by myself, and I'll explain that here in just a minute. I took a break from paying bills and trying to solve plumbing problems here in the building to talk to Jill while she's on vacation. So hopefully that will go well for her as we're all trying to kind of cover for Jill. So not to make her feel bad or anything but that's just kind of what's going on here.


Jill:

So I just thought that I would go ahead and change up the scenery a little bit, considering that I still am not sold on Chris's greenery. So I thought instead of greenery, I would offer the ocean.


Steve Abbott:

The greenery has gotten some positive feedback as has the curtain just so you know. I've heard good things from people. So anyway, we'll close out March with this episode where we've already talked about colorectal cancer and myeloma, but as luck would have it March is also kidney cancer awareness month. So we'll talk about that today with Jill, we were going to have Jenna here, which is Jill's mini me but unfortunately Jenna is busy doing Jill's work as well. So we can't have Jenna here. So I'm just going to roll with it myself. Sherry is out for a family member surgery. So we're going to just wing this bad boy. So anyway, that's true. Chris is here. That's right. Good point. So we're going to do our first ever remote podcast. That'll be fun. That's going to be Chris's problem as well. So anyway, Jill, how are things going?


Jill:

Things are very good. It's beautiful and sunny here in Jacksonville. We will be headed to the Bahamas momentarily. So life is good today.


Steve Abbott:

If it makes you feel better, it's nice in the parking lot here.


Jill:

Yes, well I'm making sure to stay very well hydrated, applying lots of sunscreen, lots of sun safety going on here.


Steve Abbott:

It's always a good idea. Okay. Well, listen, since you are on vacation, I'll do most of the work this time. So I'll read lots of things to you and you can just agree or disagree. Occasionally I will seek your expert opinion on a few things, but we will go ahead and get started. So Jill, is it true that when you hear kidney cancer and then another term that you hear fairly often is renal cell carcinoma. Is it true that those are synonymous terms?


Jill:

Correct? Both of those are the same. So kidney cancer can be used as just as renal cell carcinoma can and it's just getting a little bit more specific. It's like the difference between bone cancer and osteosarcoma. It's just specifically talking about the specific type of cell that's being affected.


Steve Abbott:

Gotcha. But it proves once again, that doctors use unnecessarily complicated language to describe things. Would you agree?


Jill:

Correct. It'd be so much easier if we just called a spade a spade.


Steve Abbott:

Right? Exactly. So a couple facts that these come directly from the kidney cancer association's website at kidneycancer.org . So at any given time, there are 580,000 people walking around with renal cell carcinoma. About 79,000 new cases get diagnosed every year. And the good news is that's not a terribly high incidence rate. So that's about 24 people out of 100,000. So that's 24 too much. But as far as other cancers go, that's not too terrible. 14,000 deaths, unfortunately though, which is still too high. So hopefully that continues to improve over time, but we've come a long way already. And can you talk about, because I can't speak to the degree to which this has helped or where the status is, but can you talk a little bit about how maybe immunotherapy works and how it's been helpful with renal cell carcinoma?


Jill:

Yes. Immunotherapy has offered a significant improvement in overall survival with its addition to the treatment options for kidney cancer patients. It's well tolerated. Previously, they would just use chemotherapy, some patients just weren't great candidates for chemotherapy. And so immunotherapy, obviously, as we've talked previously is much better tolerated, the overall response rate and complete responses in kidney cancer are just staggering. And the thing that's even more impressive is as we've talked about in other conditions that immunotherapy and kidney cancer is not any different in the fact that the responses are durable. So patients are living longer with metastatic disease.


Steve Abbott:

That's fantastic. I mean, I was looking at the stats today and the five year survival rate's about 76%, which is, I mean, you wish it were even higher than that, but that's pretty good when you look at kind of other types of cancers. And did you say when we talked earlier, I thought you said that oftentimes that this is found as an incidental finding, right? People don't go in thinking they had kidney cancer.


Jill:

That's just a fancy medical term for saying they found it when they were looking for something else. And so quite often patients will have CAT scans or ultrasounds for other reasons. And they'll find a mass that the patient is not having any symptoms for in the kidney.


Steve Abbott:

When they find it like that is it's typically, do people think they have like something else or is it a whole range of things that are maybe being looked at where they stumble onto that?


Jill:

It can be from one end of the spectrum to the other. So you can have some patients who are having some blood in the urine. And so they're having tests done because of that. And then it's found, but you can have patients that are having no kidney symptoms whatsoever, no blood in the urine. No anything. They may have just had some GI symptoms and they did a CT of the abdomen and it showed up on the CAT scan. So it can go from one end to the other.


Steve Abbott:

Gotcha. Yeah. I'm struggling here because I keep looking at the phone, which I'm not sure if that's what I should be looking at or not. The phone is safely resting against a bottle of Kroger water, but I'm not sure where my eye contact if it's right or not, but there you are. Look at you.


Jill:

I know. I'm just trying to make sure I hear you.


Steve Abbott:

Okay. I'm not looking at the ceiling anymore, which is good.


Jill:

Right. Fair enough.


Steve Abbott:

So you mentioned blood in the urine there's probably a couple other symptoms, right? That people should be aware of.


Jill:

Yes. Some people can also experience flank pain or that like one sided, lower back pain in severe cases. When the kidney function is starting to be impacted by the mass that's in the kidney, you can start seeing some anemia, you can start seeing some fatigue. So the severity of the symptoms, like most things are worse. The more extensive of the disease there is.


Steve Abbott:

And if you have maybe other than the blood in the urine, if you have some of those other things, I mean, it needs to go on for a little while, right before you'd be concerned about something like that? If you have back pain for three days, that may not mean you've got kidney cancer to worry about.


Jill:

Back pain for three days and maybe a little bit of blood in the urine. I think we were talking to you about that about a month ago. It could be a kidney stone. Not all blood in the urine and flank pain is related to kidney cancer, but you know, because of the area, that's why those symptoms typically correlate.


Just means that it's another reason why people shouldn't downplay symptoms. You've got symptoms and you blow it off and you think, oh, it's just a kidney stone. Well then you look up and it's been four or five weeks and the symptoms are still ongoing. And so it obviously needs to be looked into a little bit more.


Steve Abbott:

Gotcha. I can assure you, I would not have gone four or five weeks with the way I felt for those three days. Just a couple little demographics. These are things I found on the website today as well. So when you talk about risk factors, it's some of the big three, so it's smoking, obesity of course, high blood pressure, but then you get into kind of a family history and then genetics, gender and race. So once again, African American and American Indian communities are more likely to see this. And this strange thing is like it's about twice as likely to occur in men as it is in women. And is that fairly consistent with what you've seen over the years as well?


Jill:

Correct.


Steve Abbott:

Yeah. So, another crazy thing I noticed today, even though the medicine's gotten better and things like that, but I talked to Dr. Leming about it today. And I think we figured out why, but even though the incidence rates are fairly low, they've actually increased over the years. Since if you go back to 1975, the incidence rates are up about double, but I talked to Dr. Leming this morning and we think that maybe is a good news scenario where the diagnostics are better and people are finding it more often as opposed to in the past. So are there any kind of screening test? I don't think there's a lot there, but some of these new predictive tests, is there a chance that some of those may find kidney cancer earlier?


Jill:

No. And unfortunately, there's no traditional screening test for kidney cancer. So, with colon cancer, you have your colonoscopy with breast cancer, you have your mammograms. With kidney cancer it really is when you identify the symptoms, you have tests done. Now, there aren't any specific genetic mutations that they've identified that are familial, that are passed down. Like with the BRCA one and BRCA two mutations, they're automatically looking for specific types of cancers. As soon as they see that. There hasn't really been one when it comes to kidney cancer. So right now, just making sure that you're seeing your family doctor for your yearly physicals, if you have any symptoms like blood in urine or any flank pain that you're following up on it and not blowing it off. And then obviously the other would be with the new Galleria test. If you do have a significant family history and any of the risk factors, you can have the test done checking for any circulating cancer cells.


Steve Abbott:

Okay. To kind of close out though, how would you characterize this? It's a little bit like when you think about prostate being a slower growing cancer on that continuum is this a slower growing cancer by, by comparison to some others?


Jill:

Absolutely. And it can be really unnerving to people when they're initially diagnosed with a mass in the kidney, because what often will happen is the doctor will tell them we're not really going to do anything, we're just going to watch it and they'll do follow up CAT scans, ultrasounds or MRIs, depending on what shows the best imaging and they'll go months or years without actually having any surgical procedure done to confirm the diagnosis.


Steve Abbott:

Okay. I mean, a lot of the prostate cancer guys say the same thing. It's kind of a little bit maddening because you know, you've got something happening inside you, but there's really nothing being done about it. So anyway. Okay. Well this was good. I'm glad we got a chance to catch up.


Jill:

Glad I got to share a little bit of the sunshine with you all.


Steve Abbott:

All right. Well, like I said, it's sunshiney here in beautiful downtown Norwood.


Jill:

Yes.


Steve Abbott:

So we got that going for us. Anyway, I'm going to head off to my next meeting. We'll try to solve the plumbing problems before you get back.


Jill:

Awesome. It was great to meet with you guys. Have a great day.


Steve Abbott:

All right, sounds good. Talk to you later. All right, thanks everybody. And we'll see you back here next Wednesday at noon. Thanks.


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