Renal cell carcinoma affects 30,000 people per year and 10,000 deaths from kidney cancer per year are expected in 1997. Renal carcinoma is an incurable disease if the cancer is beyond the confines of the kidney. Unfortunately, there are no early diagnostic tests for kidney cancer and oftentimes when symptoms do occur, such as blood in the urine, flank pain, or feeling an abdominal mass, the cancer is already large. We have several active research protocols ongoing to try to detect kidney cancer at an earlier stage and understand the genetic causes for this disease. The treatment for kidney cancer depends on the extent of the disease. This can be broken down into three groups: 1) the cancer is completely confined to one kidney, 2) the kidney cancer involves both kidneys, 3) the cancer has spread to other organs.

For kidney cancer that is confined to one kidney, the standard treatment would be complete removal of that kidney. This can be done through a variety of approaches including minimally invasive surgery. We are investigating these new modalities to improve patient outcome. This treatment can now be done safely with 3-4 day hospital stay.

In certain circumstances, if the patient has only one kidney or the other kidney is not normal, then partial removal of the kidney is warranted (partial nephrectomy). We have particular expertise in this type of surgery. This technique can preserve kidney function and possibly improve patient outcome compared to complete removal of the kidney. Although not all patients are candidates for this treatment, the indications for partial removal of the kidney are expanding every day. Another unusual situation involving kidney cancer is if the cancer extends outside the kidney into the main blood vessel to the heart called the vena cava. This occurs in approximately 5% of kidney cancers and can be a significant problem. At Wayne State University and the Barbara Ann Karmanos Cancer Institute, we have particular expertise in the use of cardiopulmonary bypass to remove the kidney cancer and the tumor thrombus from the vena cava even if it is extending into the heart. With the renal cancer team approach, a cardiac surgeon and a urologic oncologist work in tandem to safely remove the tumor.

In some instances, renal carcinoma will involve both kidneys. This can be a significant problem because the standard treatment would be to remove both kidneys and place the patient on dialysis. However, the quality of life in such situations can be sharply diminished. For these reasons, we recommend bilateral partial nephrectomies in the treatment of this tumor. We insure that all tumor is removed at the time of surgery through pathologic evaluation of the tumor completed during the surgical procedure. With the team of the urologic oncologist and urologic pathologist we are able to accurately make these diagnoses quickly and efficiently with patient under anesthesia.

There is no standard treatment for kidney cancer that has spread to other organs. This is an unfortunate situation but not an uncommon finding. We are actively pursuing novel methods in the treatment of metastatic kidney cancer including immunotherapy, gene therapy, and chemotherapy. We offer a variety of clinical trials in the treatment of metastatic renal carcinoma. We are actively pursuing novel methods for the identification of new treatments for renal carcinoma in the laboratory. These would include a combination of immunotherapy with a variety of other agents including radiation therapy. We hope to identify new methods for the treatment of metastatic renal cell carcinoma and improve the overall survival rate