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Kidney cancer occurs when cells begin to grow out of control within the tissues of the kidneys, two bean-shaped organs—one on each side of the lower back—that filter water, salt and waste from the blood and make urine. This disease is one of the 10 most common cancers in both men and women, accounting for approximately four percent of all new cancers in the U.S., according to the National Cancer Institute.

Asit Paul, M.D., Ph.D., a medical oncologist at VCU Massey Comprehensive Cancer Center, has dedicated his life’s work to the specialized treatment of kidney, bladder and prostate cancers, as well as other genitourinary cancers. He remains steadfast in his lifelong clinical mission: Provide state-of-the-art cancer care for his patients, train the next generation of oncologists and lead clinical trials to help transform new discoveries into the next standard of care.

“As a physician-scientist, my career goal always has been to work in an environment where there is a dual opportunity to serve patients and advance science. Massey offers me that opportunity,” said Paul, who is also a professor of medicine in the Division of Hematology, Oncology and Palliative Care at the VCU School of Medicine.

For Kidney Cancer Awareness Month, we sat down with Paul to learn more about kidney cancer symptoms, risk factors, treatment options, clinical trials and the benefits of receiving multidisciplinary cancer care.

Are there different types of kidney cancer?

There are more than 20 subtypes of kidney cancer. The most common form is clear cell kidney cancer, which accounts for approximately 75-80% of all kidney cancers. Among others, papillary kidney cancers account for about 10-15%.

What are the risk factors for kidney cancer?

Factors known to be associated with a higher risk of developing kidney cancer include high blood pressure, obesity, smoking, chronic kidney disease and exposure to carcinogens such as heavy metals or industrial solvents. Peak incidence occurs between ages 60-70, where men are more likely to develop the cancer than women, at a male to female ratio of 3:2. It is uncommon in people younger than 45.

Does kidney cancer run in the family?

Approximately six to eight percent of kidney cancers are hereditary, meaning that there are genetic changes which are inherited and cause kidney cancer. Hereditary kidney cancer is suspected when a patient presents with certain features. A patients who is diagnosed at a younger age, has a family history of kidney cancer, and has tumors in both kidneys or presents with tumors in other sites of the body as well should undergo genetic testing and genetic counseling to confirm the diagnosis.

How can I reduce my risk of kidney cancer?

The American Cancer Society recommends maintaining a healthy weight, avoiding smoking tobacco and controlling blood pressure as the most effective means to reduce kidney cancer risk.

Are there any screenings for kidney cancer?

There is no routine screening recommended for kidney cancer. However, patients who have an increased risk of hereditary kidney cancer should undergo recommended genetic testing and diagnostic screening.

Are there any symptoms? How is kidney cancer diagnosed?

An estimated 30-60% of kidney tumors are diagnosed through abdominal imaging—CT scans, ultrasound, MRI, etc.—performed for other reasons. Some patients present with blood in their urine, abdominal pain or an abdominal mass, leading to testing and a diagnosis.

What is the prognosis for kidney cancer?

The prognosis of kidney cancer depends on the stage at diagnosis. Most early-stage or localized kidney cancers are curable with appropriate management. Advanced or metastatic kidney tumors, which spread beyond the kidney, are associated with a tumor response between 40-70% when treated with the new generation of therapies, with a median survival of 46-56 months (three to four years).

What treatments are available?

Treatment varies depending on the disease stage when diagnosed. Kidney-limited or localized cancers are potentially curable with surgical resection through the partial or total removal of the kidneys. For smaller tumors—four centimeters or less—other options include active monitoring, ablation or focal radiation. For advanced kidney tumors that spread beyond the kidney, anticancer medications, including a new generation of immunotherapies and targeted therapies, can be effective options.

What are the benefits of multidisciplinary care?

Multidisciplinary care is important in deciding the appropriate and most cutting-edge and effective treatment plan based on the stage and type of the cancerm as well as a patient’s other medical conditions. Massey’s multidisciplinary kidney team includes urologists, medical oncologists, radiation oncologists, radiologists, pathologists, genetics counselors, and more.

Are there clinical trials available at Massey?

Yes. Several clinical trials testing new or novel treatments are available at Massey for kidney cancer patients based on the stage and type of kidney cancer. 

Are there any misconceptions about kidney cancers?

• Kidney cancer always causes blood in urine: While blood in urine can be a sign of kidney cancer, this can also be related to other cancers and medical conditions. Most kidney cancers are diagnosed by imaging done for another reason. However, it is important to seek medical attention when someone has blood in their urine.
• Smoking causes lung cancer, not kidney cancer: While smoking is a leading cause of lung cancer, smoking is also associated with a number of other cancers. Smokers have a 20-40% higher risk of kidney cancer compared to someone who has never smoked.
• All kidney cancers require surgery: Surgical resection—the partial or total removal of a kidney—is an important treatment option for many kidney cancer patients. However, smaller tumors can be monitored or treated with ablation or focal radiation.
• Kidney cancer surgery always leads to kidney failure requiring dialysis: For patients with normal kidney function, the risk of end-stage kidney failure requiring dialysis after surgery is very low (around one to three percent). For most patients, there may be a small decline in kidney function immediately after surgery, which stabilizes over time. It is possible to maintain a normal kidney function after surgery, with proper treatment of other conditions such as diabetes and high blood pressure.
• Kidney cancers are treated with chemotherapy: Chemotherapy is not recommended for common types of kidney cancers. Newer treatments such as immunotherapies and targeted treatments are mainstays of treatment for advanced kidney cancer treatment and have improved patient outcomes substantially in recent years.

Learn more about kidney cancer and available treatment options today. 

Written by: Blake Belden