Patients are often referred to City of Hope following the discovery of a kidney mass, which may or may not be a malignant tumor (cancer).
Some masses are benign (not cancerous).
A careful diagnosis is needed to confirm the health problem and assess its extent.
Listen in as Sumanta Pal, MD discusses Kidney Cancer, it's diagnoses and treatments.
Selected Podcast
Kidney Cancer: The Latest Life Saving Treatments
Featured Speaker:
Sumanta Kumar Pal, MD
Sumanta Kumar Pal, MD is an assistant professor in the Department of Medical Oncology & Therapeutics Research and co-director of the Kidney Cancer Program at City of Hope. Having been appointed to the faculty for just over four years, Dr. Pal has been extremely productive, publishing more than 80 manuscripts in peer-reviewed journals. He has presented his work in multiple international meetings. Transcription:
Kidney Cancer: The Latest Life Saving Treatments
Melanie Cole (Host): Patients at City of Hope have access to the most innovative and advanced treatments available for kidney cancer. Because City of Hope offers the expertise of specialists in all fields related to kidney cancer, patients receive greater continuity of care and more coordinated treatment planning. My guest today is Dr. Sumanta Pal. He is a medical oncologist and co-director of the Kidney Cancer Program at City of Hope. Welcome to the show, Dr. Pal. What is kidney cancer, and who is most at risk?
Dr. Sumanta Pal (Guest): Thanks so much for having me, Melanie. It’s a great question. Kidney cancer certainly is not the most common cancer and actually represents just about 3 percent of all cancers out there. But having said that, it’s one of the few cancers we’re actually seeing increase in the risk year by year. Kidney cancer is a tumor that can oftentimes start and end in the kidney, but unfortunately, in many cases, it can spread to the lungs. It can spread to the bones and the brain. In those cases, unfortunately, kidney cancer can be invariably fatal. When I think about who gets kidney cancer, it tends to be a disease of the elderly. The mean age or average age that one gets kidney cancer is around 65. It’s not so different from prostate cancer and some of the other diseases that we associate with older individuals.
Melanie: Are there any known causes of kidney cancer?
Dr. Pal: Great question. And I have to say the science isn’t as fleshed out, for instance, as it might be in the context of breast cancer or prostate cancer, where there’s been a lot more research funding applied to those. One thing that I will say is that we know that smoking seems to be related to kidney cancer. The more you smoke, the higher risk of kidney cancer. In addition to that, we think that obesity is tied in to kidney cancer, and we’re finding that link between obesity and multiple other cancers, as I’m sure you’ve come across in the news recently. Finally, we’re finding that there are a lot of hereditary forms of kidney cancer. These are coming out of the woodwork over the past two or three decades or so. We’re finding multiple families where there seems to be some sort of genetic predisposition from one generation to the next of getting the disease.
Melanie: What are the early symptoms, Dr. Pal? Everybody always wants to know symptoms. Is there anything someone would notice before it’s too late to treat, and is there any screening options available?
Dr. Pal: Yeah, and I’m going to start with your second question first regarding screening options. I personally feel this is probably a matter of funding as well. Unfortunately, a disease like kidney cancer doesn’t garner as much funding as breast cancer research and prostate cancer research. This is my sly way of essentially calling out everybody who is listening to this to support kidney cancer research. We just don’t have a lot invested in understanding predictors of the disease. Whereas in prostate cancer we’ve got a simple blood test that you can take to detect the disease and in breast cancer we can do a mammogram to detect the disease early, in kidney cancer, you only know once you start having symptoms, unfortunately. In many cases, those symptoms can be blood in the urine. It could be pain that’s localized around the back area. These are the things that usually people manifest with first and foremost when they have kidney cancer.
Melanie: When you do go for diagnosis, what’s involved? If you see blood in your urine, everyone worries about that particular symptom. Then who would you go see even if you see blood in your urine, and then how is it diagnosed?
Dr. Pal: I think the most important thing to do is to get in early. That means seeing your internist first and foremost. That’s the wise thing to do. But usually, if somebody has a lot of blood in the urine, the first point of contact is going to be a urologist, somebody who really has a focus on the kidney and the urinary tract in general. The urologist may start with a couple of simple tests. This may involve a CT scan, for instance. I wouldn’t say that kidney cancer necessarily rises to the top of the list when we’re thinking about blood in the urine. We’d always want to rule out urinary tract infection first. We also want to rule out the possibility of kidney stones. Kidney stones can actually often cause blood in the urine. Through a couple of simple modalities, the urologist should be able to determine whether or not it’s a stone or a urinary tract infection or in fact kidney cancer that’s causing your symptoms.
Melanie: Then, what treatments are available?
Dr. Pal: I would suggest that if you have localized kidney cancer – cancer that’s really confined to the kidney itself – in many cases, you can be cured by surgery alone. But I always urge a lot of caution, because in many cases – and this is also true for breast cancer, colon cancer, et cetera – when you have that primary tumor affected, there’s always still some chance that the disease can relapse. That’s one of the things that I’m focused on in my research here at City of Hope. We have a lot of trials that address the population of patients who have their kidney mass removed. We’re testing out new strategies that might reduce their risk from the cancer recurring. Now, if you already have metastatic disease – meaning the cat is already out of the bag and the kidney cancer has moved to the lung or the bones, et cetera – there are a number of new therapies that have been utilized in this setting. We’re not talking about traditional chemotherapy. When I think of chemotherapy that’s applied for breast cancer, prostate cancer, these are drugs that really attack all cells indiscriminately. They certainly are going to fight the tumor, but they’re also going to also work on actively replicating cells like your hair follicles. Your hair will fall out. It will also work against the gut. You’ll develop diarrhea and so forth. In kidney cancer, we’ve gotten a little smarter and we’re actually using targeted treatments. And these are still pills or IV agents, but they’ll actually go straight to the tumor, and they’re specific enough to actually work against the proteins that drive the disease.
Melanie: If you have kidney cancer in one kidney, is there a risk then that that other kidney is going to get it as well?
Dr. Pal: Yeah, that’s a great question, Melanie. The chance of getting kidney cancer in the opposite kidney is actually dependent on your age. If you’re relatively young, the chance of having bilateral kidney cancer or kidney cancer in both kidneys actually rises. On the other hand, if you’re older, that risk falls to about 5 percent.
Melanie: Now they do look for protein in the urine when you get your blood test annually. Does that have anything to do with this?
Dr. Pal: I would suggest that that’s probably not the best indicator. What might be a more subtle indicator is any microscopic blood that shows up in the urine. We always think of blood in the urine as being very frank, red in color, et cetera. Even if you have totally clear urine, you might actually still have a couple of red blood cells that are filtering out. That annual urine test that you’re taking can potentially pick up on that.
Melanie: Dr. Pal, what advice do you tell patients when they are recently diagnosed with kidney cancer, and what are some of the latest research you’re doing there at City of Hope?
Dr. Pal: Right. So I think that the key is to really get into a center of excellence. Kidney cancer, as I’ve mentioned right at the outset, isn’t a very common disease. It’s only 3 percent of all cancers. So you want to make sure that the oncologist that you’re seeing sees a high volume of these cases so they know what they’re doing. I wouldn’t say the same is necessarily true for breast cancer, for prostate cancer, et cetera, where the average oncologist may have substantial experience. What I would propose is that you go to a center of excellence, a comprehensive cancer center like City of Hope, and ask about the possibility of clinical trials. I think that the drugs that we have right now for kidney cancer are better than the drugs that we had 10 years ago, but I’m going to guess that the drugs that we’ll have 10 years from now are going to surpass those that we’re using today. The only way to get access to those drugs is by getting involved in these clinical trials early.
Melanie: Dr. Pal, in just the last minute, give us your best advice for people who may have been diagnosed with kidney cancer and what inspires you daily. Why should people come to see you at City of Hope?
Dr. Pal: Right. I have to tell you when I started out in the field, I was a little daunted by some of the survival statistics. If you look at the data from about 10 or 15 years ago, patients with advanced kidney cancer are only living for about a year on average. But now we’ve improved our prognosis with some of the new treatments multifold and I’m really driven to see that we continue to improve the prognosis of kidney cancer through some of the new treatments that we’re introducing in clinical trials. I’m getting to that point in my career where I’ve had patients that despite that prognosis of one year are alive at six or seven years out. That’s incredibly encouraging. That keeps me passionate about what I’m doing here.
Melanie: Thank you so much, and we can certainly hear that passion and thanks for being with us today. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Kidney Cancer: The Latest Life Saving Treatments
Melanie Cole (Host): Patients at City of Hope have access to the most innovative and advanced treatments available for kidney cancer. Because City of Hope offers the expertise of specialists in all fields related to kidney cancer, patients receive greater continuity of care and more coordinated treatment planning. My guest today is Dr. Sumanta Pal. He is a medical oncologist and co-director of the Kidney Cancer Program at City of Hope. Welcome to the show, Dr. Pal. What is kidney cancer, and who is most at risk?
Dr. Sumanta Pal (Guest): Thanks so much for having me, Melanie. It’s a great question. Kidney cancer certainly is not the most common cancer and actually represents just about 3 percent of all cancers out there. But having said that, it’s one of the few cancers we’re actually seeing increase in the risk year by year. Kidney cancer is a tumor that can oftentimes start and end in the kidney, but unfortunately, in many cases, it can spread to the lungs. It can spread to the bones and the brain. In those cases, unfortunately, kidney cancer can be invariably fatal. When I think about who gets kidney cancer, it tends to be a disease of the elderly. The mean age or average age that one gets kidney cancer is around 65. It’s not so different from prostate cancer and some of the other diseases that we associate with older individuals.
Melanie: Are there any known causes of kidney cancer?
Dr. Pal: Great question. And I have to say the science isn’t as fleshed out, for instance, as it might be in the context of breast cancer or prostate cancer, where there’s been a lot more research funding applied to those. One thing that I will say is that we know that smoking seems to be related to kidney cancer. The more you smoke, the higher risk of kidney cancer. In addition to that, we think that obesity is tied in to kidney cancer, and we’re finding that link between obesity and multiple other cancers, as I’m sure you’ve come across in the news recently. Finally, we’re finding that there are a lot of hereditary forms of kidney cancer. These are coming out of the woodwork over the past two or three decades or so. We’re finding multiple families where there seems to be some sort of genetic predisposition from one generation to the next of getting the disease.
Melanie: What are the early symptoms, Dr. Pal? Everybody always wants to know symptoms. Is there anything someone would notice before it’s too late to treat, and is there any screening options available?
Dr. Pal: Yeah, and I’m going to start with your second question first regarding screening options. I personally feel this is probably a matter of funding as well. Unfortunately, a disease like kidney cancer doesn’t garner as much funding as breast cancer research and prostate cancer research. This is my sly way of essentially calling out everybody who is listening to this to support kidney cancer research. We just don’t have a lot invested in understanding predictors of the disease. Whereas in prostate cancer we’ve got a simple blood test that you can take to detect the disease and in breast cancer we can do a mammogram to detect the disease early, in kidney cancer, you only know once you start having symptoms, unfortunately. In many cases, those symptoms can be blood in the urine. It could be pain that’s localized around the back area. These are the things that usually people manifest with first and foremost when they have kidney cancer.
Melanie: When you do go for diagnosis, what’s involved? If you see blood in your urine, everyone worries about that particular symptom. Then who would you go see even if you see blood in your urine, and then how is it diagnosed?
Dr. Pal: I think the most important thing to do is to get in early. That means seeing your internist first and foremost. That’s the wise thing to do. But usually, if somebody has a lot of blood in the urine, the first point of contact is going to be a urologist, somebody who really has a focus on the kidney and the urinary tract in general. The urologist may start with a couple of simple tests. This may involve a CT scan, for instance. I wouldn’t say that kidney cancer necessarily rises to the top of the list when we’re thinking about blood in the urine. We’d always want to rule out urinary tract infection first. We also want to rule out the possibility of kidney stones. Kidney stones can actually often cause blood in the urine. Through a couple of simple modalities, the urologist should be able to determine whether or not it’s a stone or a urinary tract infection or in fact kidney cancer that’s causing your symptoms.
Melanie: Then, what treatments are available?
Dr. Pal: I would suggest that if you have localized kidney cancer – cancer that’s really confined to the kidney itself – in many cases, you can be cured by surgery alone. But I always urge a lot of caution, because in many cases – and this is also true for breast cancer, colon cancer, et cetera – when you have that primary tumor affected, there’s always still some chance that the disease can relapse. That’s one of the things that I’m focused on in my research here at City of Hope. We have a lot of trials that address the population of patients who have their kidney mass removed. We’re testing out new strategies that might reduce their risk from the cancer recurring. Now, if you already have metastatic disease – meaning the cat is already out of the bag and the kidney cancer has moved to the lung or the bones, et cetera – there are a number of new therapies that have been utilized in this setting. We’re not talking about traditional chemotherapy. When I think of chemotherapy that’s applied for breast cancer, prostate cancer, these are drugs that really attack all cells indiscriminately. They certainly are going to fight the tumor, but they’re also going to also work on actively replicating cells like your hair follicles. Your hair will fall out. It will also work against the gut. You’ll develop diarrhea and so forth. In kidney cancer, we’ve gotten a little smarter and we’re actually using targeted treatments. And these are still pills or IV agents, but they’ll actually go straight to the tumor, and they’re specific enough to actually work against the proteins that drive the disease.
Melanie: If you have kidney cancer in one kidney, is there a risk then that that other kidney is going to get it as well?
Dr. Pal: Yeah, that’s a great question, Melanie. The chance of getting kidney cancer in the opposite kidney is actually dependent on your age. If you’re relatively young, the chance of having bilateral kidney cancer or kidney cancer in both kidneys actually rises. On the other hand, if you’re older, that risk falls to about 5 percent.
Melanie: Now they do look for protein in the urine when you get your blood test annually. Does that have anything to do with this?
Dr. Pal: I would suggest that that’s probably not the best indicator. What might be a more subtle indicator is any microscopic blood that shows up in the urine. We always think of blood in the urine as being very frank, red in color, et cetera. Even if you have totally clear urine, you might actually still have a couple of red blood cells that are filtering out. That annual urine test that you’re taking can potentially pick up on that.
Melanie: Dr. Pal, what advice do you tell patients when they are recently diagnosed with kidney cancer, and what are some of the latest research you’re doing there at City of Hope?
Dr. Pal: Right. So I think that the key is to really get into a center of excellence. Kidney cancer, as I’ve mentioned right at the outset, isn’t a very common disease. It’s only 3 percent of all cancers. So you want to make sure that the oncologist that you’re seeing sees a high volume of these cases so they know what they’re doing. I wouldn’t say the same is necessarily true for breast cancer, for prostate cancer, et cetera, where the average oncologist may have substantial experience. What I would propose is that you go to a center of excellence, a comprehensive cancer center like City of Hope, and ask about the possibility of clinical trials. I think that the drugs that we have right now for kidney cancer are better than the drugs that we had 10 years ago, but I’m going to guess that the drugs that we’ll have 10 years from now are going to surpass those that we’re using today. The only way to get access to those drugs is by getting involved in these clinical trials early.
Melanie: Dr. Pal, in just the last minute, give us your best advice for people who may have been diagnosed with kidney cancer and what inspires you daily. Why should people come to see you at City of Hope?
Dr. Pal: Right. I have to tell you when I started out in the field, I was a little daunted by some of the survival statistics. If you look at the data from about 10 or 15 years ago, patients with advanced kidney cancer are only living for about a year on average. But now we’ve improved our prognosis with some of the new treatments multifold and I’m really driven to see that we continue to improve the prognosis of kidney cancer through some of the new treatments that we’re introducing in clinical trials. I’m getting to that point in my career where I’ve had patients that despite that prognosis of one year are alive at six or seven years out. That’s incredibly encouraging. That keeps me passionate about what I’m doing here.
Melanie: Thank you so much, and we can certainly hear that passion and thanks for being with us today. You are listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.