Most kidney masses (or tumors) are discovered incidentally - meaning that they are found by chance during radiologic studies obtained for an unrelated medical condition.
Most solid kidney masses (or tumors) are cancerous, but fortunately, many can be cured with surgery. The most common type of kidney cancer is renal cell carcinoma. Each year in the United States, approximately 30,000 new cases of renal cell carcinoma are identified. A second type of kidney cancer is transitional cell cancer. This type of cancer is very similar to bladder cancer and can involve the kidney or the ureters, the tubes that empty the kidney and drain urine to the bladder. These cancers are relatively rare, affecting approximately 4,000 people in the United States each year. There are other tumors that can affect the kidney. There are other tumors that can affect the kidney, these are managed a variety of ways including surgery, non-surgical minimally invasive procedures such as embolization (blocking the blood supply to the tumor), and medical treatments.
Our research efforts are equally important in the fight against kidney cancer. We are exploring new biologic and immunologic approaches to kidney cancer treatment. The goal of immunotherapy is to boost the body's immune system causing it to seek out and destroy kidney cancer cells. Anticancer compounds such as interleukin-2, alpha -interferon show promise in treating advanced kidney cancer that is at risk of or has already spread to distant locations outside of the kidney. The agents work by supercharging the immune system and by interfering with cell division and growth. In the, future bad genes that are discovered in cells changing to cancer may be effectively combated by adding normal genes into tumor cells to reverse their cancerous behavior. These are examples of multiple new processes that can move from research to treatment of renal cell carcinoma.
The following are summaries of recent and current research projects in kidney cancer:
- Open NSS is the current standard of care for small renal tumors. Research efforts are being made in the use of laparoscopic nephron sparing surgery (NSS) with hilar clamping in place of open NSS. Complications resulting from open NSS have significantly decreased over time, supporting its use in more cases meeting appropriate clinical criteria.
- Consideration of ways to use gene expression profiling to identify novel biomarkers that can predict aggressive behavior in clear cell renal cell carcinoma (CCRCC). Research has focused on using a combination of genomic profiling to identify a panel of candidate biomarkers to determine CCRCC aggressiveness. Current studies indicate that the gene expression alterations that result in aggressive behavior and metastatic potential can be identified in the primary tumor.
- Renal cell carcinoma (RCC) often appears in metastatic form, or progresses after treatment. While the management of metastatic RCC has historically been mainly surgical, contemporary approaches often incorporate systemic immunotherapy. As immunotherapy develops further, the precise timing and role of surgery in multimodality treatment will need to be carefully evaluated, and other less invasive therapies may be equally effective, such as:
- Cytoreductive surgery prior to immunotherapy, which appears to increase survival in selected patients are suitable for this treatment regimen.
- Primary immunotherapy followed by surgical removal of the tumor.
- Prognostic markers for renal cell carcinoma (RCC), such as patient symptoms, tumor stage, tumor size and tumor grade, are useful for determining appropriate follow-up and selecting patients for adjuvant therapy. Histologic coagulative tumor necrosis, also reported to be a prognostic marker for RCC, has not been extensively described or investigated. Research is necessary to characterize tumor necrosis as a prognostic feature of RCC.
- The study of B7-H1, a costimulatory glycoprotein in the B7 family. Our research has shows that patients with high tumor and/or lymphocyte B7-H1 levels are 4.5 times more likely to die from their cancer than patients exhibiting low levels of B7-H1, implying that there is a mechanism whereby RCC may impair host immunity to foster tumor progression. B7-H1 may prove useful as a prognostic tool for RCC patients both pre- and post treatment. In addition, B7-H1 may represent a promising target to facilitate more favorable responses in patients who require immunotherapy for treatment of advanced RCC.