Table of Contents
Introduction vii
Part 1 The Basics 1
Questions 1-4 answer basic questions about the urinary system, such as:
1 What is kidney cancer?
2 Where are the kidneys located in the body?
3 What do the kidneys normally do?
4 How is kidney function measured?
Part 2 Causes and Risk Factors for Kidney Cancer 11
Questions 5-20 discuss various types of kidney cancer and their causes:
5 How common is kidney cancer?
6 Are there different types of kidney cancer?
7 What causes kidney cancer?
8 Is kidney cancer inherited?
9 What is the VHL syndrome?
10 What is a tumor suppressor gene?
11 What is an oncogene?
12 What is angiogenesis and what is VEGF?
13 Can kidney cancer be prevented?
14 Are all kidney cancers aggressive?
15 Should we be screening the general population for kidney cancer?
16 Who is at highest risk for developing kidney cancer?
17 Should my family members be evaluated for kidney cancer?
18 Is kidney cancer seen in children?
19 Are men or women more likely to have kidney cancer?
20 Are other types of cancer seen in the kidney?
Part 3 Presentation and Evaluation 39
Questions 21-32 discuss important issues in the doctor's office, such as:
21 What are the typical signs and symptoms of kidney cancer?
22 What is hematuria?
23 What kind of doctor should I be seeing?
24 Does the type of hospital matter?
25 What tests are usually performed?
26 What is an ultrasound?
27 What is a CT scan?
28 What is an MRI scan?
29 What is a bone scan?
30 Is there a blood test that can detect kidney cancer?
31 Are there benign kidney tumors?
32 Will a biopsy help sort this out?
Part 4 Staging of Renal Cell Carcinoma 65
Questions 33-41 deal with the staging of kidney cancer and how it spreads:
33 How is kidney cancer staged?
34 What does tumor grade mean?
35 What is a tumor thrombus?
36 What is a lymph node? How are the lymph nodes involved in kidney cancer?
37 Where does kidney cancer metastasize to?
38 What symptoms do metastases cause?
39 What is a paraneoplastic syndrome?
40 What causes weight loss or fatigue?
41 Do patients die from kidney cancer?
Part 5 Treatment of Localized Disease 89
Questions 42-56 answer questions regarding treatment of cancer confined to the kidney:
42 How is kidney cancer treated?
43 What are the treatment options for localized (stage I-II) kidney cancer?
44 What is the prognosis for patients with localized kidney cancer?
45 What is a radical nephrectomy?
46 What is a partial nephrectomy?
47 What is an "elective" partial nephrectomy?
48 What happens to the tumor after it is removed?
49 What is minimally invasive surgery, and how are laparoscopy and robotics different?
50 What is cryoablation?
51 What is radiofrequency ablation (RFA)?
52 What are the pros and cons of each of these ablation options?
53 Can I just be observed? What are the risks of not actively pursuing treatment for kidney cancer?
54 How will I be followed after a radical nephrectomy?
55 How will I be followed after a partial nephrectomy?
56 How will I be followed after cryoablation or RFA?
Part 6 Treatment of Locally advanced Disease 127
Questions 57-62 discuss treatment of locally advanced kidney cancer:
57 What is the treatment for locally advanced (stage III) kidney cancer?
58 How is a tumor thrombus removed?
59 What if the tumor thrombus goes into the heart?
60 What is the treatment of enlarged lymph nodes?
61 Why are adjacent organs sometimes removed?
62 What is an adjuvant treatment, and should I consider this?
Part 7 Treatment of Metastatic Disease: Overview 141
Questions 63-70 deal with cancer that has spread beyond the kidney:
63 What are the treatment options for metastatic kidney cancer (stage IV)?
64 What is the prognosis for patients with metastatic kidney cancer?
65 Should I have my kidney removed even if I have stage IV disease (cytoreductive or debulking nephrectomy)?
66 Can other sites of disease be removed surgically?
67 Is chemotherapy an option?
68 Is hormonal therapy on option?
69 Is there a role for radiation therapy?
70 Is there a role for vitamins and alternative treatments?
Part 8 Immunotherapy 155
Questions 71-77 deal with immunotherapy and its role in the treatment of kidney cancer:
71 What is immunotherapy?
72 What is imrnunogenicity? How do we know that kidney cancer is immunogenic?
73 What is interleukin-2 (IL-2) and what is interferon?
74 What is inhibition of checkpoint control and how do checkpoint inhibitors work?
75 What is the likelihood of a cure with checkpoint inhibitors?
76 What are the side effects of checkpoint inhibitors?
77 Can checkpoint inhibitors be combined with other treatments for metastatic kidney cancer?
Part 9 Targeted Molecular Therapy 165
Questions 78-87 discuss various molecular treatments of kidney cancer:
78 What is targeted molecular therapy?
79 How does bevacizumab work?
80 How do tyrosine kinase inhibitors work?
81 How do mTOR inhibitors work?
82 How were the VEGF-targeted molecular agents developed?
83 Do these targeted molecular agents work and which is best for me?
84 What is the likelihood of a cure with targeted molecular agents?
85 What are the side effects of targeted molecular agents?
86 How is hypertension caused by targeted agents treated, and what does it signify?
87 What is hand-foot syndrome?
Part 10 Summary of Systemic Therapy: What Treatment Should I Receive First or Subsequently? 181
Questions 88-95 discuss various systemic treatments of kidney cancer:
88 Do I need to start systemic treatment right away?
89 What systemic treatment should I get first for my metastatic kidney cancer? Checkpoint inhibitors or targeted agents or a combination of these?
90 How long should I be treated with therapy and how will I be followed?
91 Can one agent or protocol work when another has failed?
92 Is there still a role for nephrectomy in patients receiving targeted molecular therapy or immunotherapy?
93 Can I have surgery later to "clean things up?"
94 What new agents are on the horizon?
95 What is palliative care, and when should hospice be considered?
Part 11 Clinical Trials 191
Questions 96-100 aim to help kidney cancer patients navigate their way through various clinical trials and explain how to choose the right one:
96 What is a clinical trial?
97 What is informed consent? How do I know that someone Is making sure that the clinical trials are conducted in a safe and ethical manner?
98 How do I decide whether I should participate in a clinical trial?
99 How can I learn more about clinical trials?
100 How can I learn more about kidney cancer?
Appendix 203
Glossary 213
Index 225