Meet the tumor that does not warn

One of the problems in science’s tireless search for solutions against cancer is that some tumors do not give symptoms and, when they appear, the disease is already very advanced. Kidney cancer is one of those tumors. “Between 20% and 30% of patients are diagnosed with metastasis,” says Cristina Suárez, oncologist at the Vall d’Hebrón Hospital in Barcelona and researcher at the Tumor Group Genitourinary of the center. As in other cancers, the prognosis at this stage, the last of the four in which the disease is classified, is more compromised. However, the immunotherapy that has been used for a few years has been an important advance, as Dr. Suárez points out: “A subgroup of patients have become long survivors, thanks to the treatment the cancer has not progressed.”

The kidneys are a kind of multitasking organ in the body, they fulfill many functions and all of them are key to survival. On the one hand, they get rid of end products of metabolism, such as urea. In addition, they regulate the fluid balance in the body: they retain water when they are in danger of dehydration and get rid of it when they have too much. A third function is to adjust the content of minerals such as sodium or potassium in the blood. Finally, they synthesize hormones that stimulate the production of red blood cells and regulate blood pressure.

Medicine knows very well the functions of the kidneys, but, contrary to what happens in other tumors Until now, no determining risk factors have been described in the appearance of kidney cancer. “The most clearly associated is the consumption of tobacco and it seems that obesity could also be related, as well as poor blood pressure control and advanced kidney disease,” says Cristina Suárez. However, specialists do not have a clear answer if patients ask them about a possible origin of the tumor. It is not known how to prevent it, apart from leading healthy lifestyles.

Kidney cancer is also related to age. The longer life expectancy, the more cancer cases. In the body, mutations are continually being produced in cells that could lead to a tumor were it not for the immune system to eliminate them. But with age this body keeper loses its effectiveness. That is one of the reasons why the probability of suffering from cancer over the years is higher than at an early age. Kidney tumors are most frequently diagnosed between the fifth and seventh decade of life and the most typical symptom is hematuria, bleeding in the urine.

Although until 30% of kidney tumors are diagnosed with metastases, more and more cases are detected in the early stages. “There are people who undergo an imaging test for other reasons and there is an incidental finding of a small kidney injury,” explains Cristina Suárez. Surgery is applied in the first three stages of the tumor. In the latter, when it has already spread, it is necessary to resort to other therapies. The most innovative in recent years and the ones with the best results have been antiangiogenic drugs, which cut off the blood supply to the tumor, and immunotherapy. Both were a turning point in the approach to the disease. Proven its effectiveness, “the objective now is to optimize management to keep the disease under control for as long as possible,” says Dr. Suárez.

Until a few years ago the life expectancy of a patient with cancer metastatic kidney disease was very limited. However, the picture has completely changed with the emergence of antiangiogenic and immuno-oncological treatments, research confirms. Specifically, immuno-oncology increases survival and reduces metastatic lesions, and it can also be used in virtually all patients. With this option, for the first time the disease can be controlled and prevented from progressing. “The different studies confirm that between 8% and 10% of cases there is a complete remission, that is, we stop seeing disease in imaging tests,” says the Hospital oncologist Vall d’Hebrón.

Despite advances in the treatment of renal cancer with metastases, the ideal is to prevent it from reaching this stage, say the specialists. There is no screening test like in other tumors that allows it to be detected early, but it is necessary to be alert to any abnormal symptoms that may appear. The body expresses health problems through signs and it is the health professionals who must assess them. Fatigue, loss of appetite, or pressure in the side or back can be due to a mild health problem, but are sometimes also symptoms of a major disease such as kidney cancer. In these cases, it is advisable to act as soon as possible.

Oncology already has tools so that the news that the patient diagnosed with a kidney tumor may receive in a few months is good. In people who ten or fifteen years ago would have had a fatal short-term prognosis, immuno-oncology and other therapeutic advances have represented a giant step in the treatment of a cancer that is so stealthy, such as kidney cancer.

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