Kidney Cancer Facts and Treatment

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Hello and welcome to the show. I am Deborah Howell, and today our guest is Dr. Don T. Bui, a board-eligible urologist at Orange Coast Memorial Medical Center and with Orange County Urology Associates. Kidney cancer represents 3% of all adult cancers in the US, and it is the most fatal of common urological cancers. Dr. Bui is here to discuss common symptoms and risk factors associated with this disease, as well as the latest in kidney-sparing treatment. Welcome, Dr. Bui.

Don Bui, MD: Good morning, Deborah. Thank you for having me.

Deborah Howell (Host): Such a pleasure to have you. Can you tell us in a nutshell what is kidney cancer?

Don Bui, MD: Essentially, kidney cancer is sort of a catch-all phrase for any masses on the kidney. Generally, these masses are growths coming from different portions of the kidneys, but for the most part, they have a commonality in that they're almost always surgically treated. They're generally not treated with chemotherapy or radiation.

Deborah Howell (Host): Are these growths usually on the inside of the kidneys or the outside?

Don Bui, MD: It's variable. Sometimes it's on the outside, and sometimes on the inside. Sometimes, for example, when taking a look at the kidney directly, you can't even tell it's there because it's so hidden underneath the shell. But that's part of the surgical challenge.

Deborah Howell (Host): Yeah. And when they are that hidden, do they show up on scans?

Don Bui, MD: On a CAT scan, nothing hides from a CAT scan from the kidney. So with a good CAT scan or a good MRI, you're able to get excellent detail in three dimensions as far as how much the kidney is involved with these masses.

Deborah Howell (Host): I see. And what are the different kinds of kidney cancers?

Don Bui, MD: The different kind of kidney cancers, the most common one in America is what they call clear cell. And roughly 80% are clear cell. And the other ones are papillary, chromophobe. From a treatment perspective, it truly doesn't make that much of a difference. Really the difference is in the long-term evaluation of the patient afterwards.

Deborah Howell (Host): I see. Okay. So what are some of the common symptoms you might have if you're having a kidney cancer, I guess you'd call it an episode?

Don Bui, MD: Well, that's the problem with kidney cancers is that the vast majority of kidney cancers have no symptoms whatsoever. In fact, over 60 to 65% of new diagnoses of kidney cancers in America are found incidentally. Which means that a patient comes in, sees a primary care physician, has some abdominal pain or some other vague symptoms, and they go off for an ultrasound or a CAT scan, and these masses are found. Only about 5 to 10% of kidney cancers in America now have symptoms. And generally, those would be blood in the urine, flank pain, night sweats, weight loss, but often if you do have symptoms, it's a symptom of advanced disease.

Deborah Howell (Host): I can't believe that. I mean, someday you have night sweats, you go in the next day and wow, you have a diagnosis of kidney cancer. You would never normally just associate those two things.

Don Bui, MD: I actually have a good story where when I was a resident, a patient came in, he was robbed at the gas station, he was stabbed. So part of the trauma workup is you get a CAT scan. And incidentally, there was a very large tumor in his kidney. And we ended up taking it out and he did fine. But after discussion in the post-op, he was reflecting upon this, and he was thinking, wow, getting stabbed actually saved my life in the long run. And it's very true.

Deborah Howell (Host): That is ironic. Now, how does one get diagnosed with kidney disease and when should someone seek treatment?

Don Bui, MD: Again, the vast majority in America is found incidentally on incidental CAT scans, MRIs, ultrasounds. And usually, from the ER or the primary care physician, they're referred over to a urologist for further information and treatment.

Deborah Howell (Host): I'm still trying to get my mind around no symptoms. How in the world would you know? Is this something that we should start getting screenings for?

Don Bui, MD: Unfortunately, screening doesn't necessarily make sense only so much that the cost-to-benefit ratio of screening is not necessarily in the screening's favor. Screening is a very hot topic lately because of the economic issues that are in headlines nowadays. How many do you need to treat versus how many scans need to be done. And scans themselves, if we scan everybody, isn't necessarily good anyways because there's radiation involved and things like that. So at this time, a global screening for everybody program isn't necessarily good.

Deborah Howell (Host): So listen to your body, and if you have any symptoms at all, talk to your doctor, and he would be the one to advise you whether or not you need this kind of screening.

Don Bui, MD: Absolutely.

Deborah Howell (Host): What are some of the advanced treatment options available now to save the kidney?

Don Bui, MD: Well, if you go back 10, 15 years, anybody with any sort of bump on the kidney would have the entire kidney removed. We call that a radical nephrectomy. And then afterwards, we discovered that the entire kidney doesn't need to come out. We can only take a small portion of the kidney or just a tumor and have just as good long-term oncological or cancer outcomes. And so we started doing what we call a partial nephrectomy, which means only removing part of the kidney. The problem was at that time, our technology wasn't sophisticated enough to do a minimally invasive form of partial nephrectomies. Which means that patients require a large open incision, recovering in the hospital usually about a week, and after that, patients usually aren't back up to speed for three to six months. With the advent of the robot, or the da Vinci robot, we're now able to do very aggressive partial nephrectomies and have all the benefits of minimally invasive surgery and yet all the benefits of a partial nephrectomy as well.

Deborah Howell (Host): That is awesome news for kidney cancer patients.

Don Bui, MD: Absolutely. As far as numbers go, most of my patients are up and moving by the next day, eating. Most of my patients go home within two days. And within three to four weeks is back to their normal daily lives.

Deborah Howell (Host): Absolutely incredible.

Don Bui, MD: Absolutely. With no sacrifice in long-term oncological outcomes. And the difference between taking part of the kidney and taking the entire kidney is dramatic. There are a lot of good studies that show patients have long-term improved survival by taking part of the kidney, and not just from an oncological perspective or cancer perspective, but improved heart disease, less risk of renal failure and dialysis because you're able to keep most of that kidney. So by all metrics, a partial nephrectomy is the way to go.

Deborah Howell (Host): It almost reminds me of a lobectomy when you take part of the lung and the rest of the lung sort of compensates for the part that's lost.

Don Bui, MD: Absolutely. Exactly. That's exactly a great analogy, Deborah.

Deborah Howell (Host): And how recent is this development?

Don Bui, MD: They started doing partial nephrectomies I would say less than a decade ago. I think they started dabbling in it in the later 2000s, but really it's picked up in the last couple years. Robotics itself, we started doing robots for prostates, for example, in 2000, 2001, and from there it's just been exponential growth in that field just because the outcomes for the patients are so good.

Deborah Howell (Host): Take me once again through the process. So if you're a patient, you come in, you're diagnosed, you're going to have the robotic surgery, you're going to have the da Vinci. Give me the day in the life of the patient.

Don Bui, MD: So generally, for example, the patient is referred to me with some sort of imaging, like a CAT scan or ultrasound with a mass on it. And if it's appropriate for a partial nephrectomy, the surgery itself takes anywhere between two, two and a half hours, somewhere around there. The incisions are generally about three incisions, three to four incisions. The smallest one is about five millimeters in diameter. And the largest one is just big enough to get the tumor out, whatever size the tumor may be. Recovery post-op process is relatively benign. Most of my patients don't complain of too much discomfort. Staying in bed for the first night. The next morning I expect my patients to be up walking around and starting to take clear broth and start fluids. By the second day, they're usually on a regular diet, up and moving around, and home by then.

Deborah Howell (Host): What about exercise? How long do they need to wait?

Don Bui, MD: Great question. I expect my patients to be walking every day during the post-op process. It's really the heavy lifting that I want them to avoid. And it's not until about four weeks that they're able to get back to their complete normal daily activities. And the reason for that is incisions don't regain their full strength up until about four weeks out. So if you do any sort of heavy lifting, more than ten pounds, you run the risk of injuring those incisions and giving yourself a hernia.

Deborah Howell (Host): After all that good work the doctors have done, just don't blow it, just take it easy. You can get back to your step class soon enough, no push-ups, no sit-ups just for a little while. This is wonderful news, Dr. Bui. Do you have anything else you want to add?

Don Bui, MD: Robotic surgery is pretty impressive. But the key thing with robotic surgery is that it's just like any other tool. It's like the analogy that I tell my patients, it's like a very expensive sports car. It's not about the car, it's about the driver. So all robotic surgeons are not made equal. So it's very important to vet your surgeon out and make sure that he's qualified as far as numbers and training that he's capable of doing it.

Deborah Howell (Host): Okay, and I have one last question. What about diet, how can we treat our kidneys better?

Don Bui, MD: Obesity and high blood pressure are two of the risk factors for kidney cancer, as well as smoking. So as long as you have good clean living, your kidneys... If you take care of your kidneys, they'll take care of you. Take care of yourself, exercise, low salt diets, low fat diets, and the kidneys will treat you well.

Deborah Howell (Host): Eat your greens and your kidneys will be good to you.

Don Bui, MD: Exactly.

Deborah Howell (Host): Thanks so much for taking time out of your day to be on the show, Dr. Bui. Where can people go to get more information?

Don Bui, MD: A good website is just www.orangecountyurology.com. And from there we have a lot of great links to different resources regarding kidney cancers, robotic surgeries, or any other urological needs.

Deborah Howell (Host): Thank you, Doctor, for all the good work you do and for being on the show today.

Don Bui, MD: Deborah, thank you so much for your time. Thanks for having me.

Deborah Howell (Host): For further information or to listen to a podcast of this show, please visit memorialcare.org. That's memorialcare.org. That's all this time. I am Deborah Howell. We will see you soon for another Weekly Dose of Wellness brought to you by MemorialCare Health System. Have yourself a fantastic day and eat your greens.