My Doctor Online The Permanente Medical Group

Symptoms

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Early kidney cancer often produces no symptoms. We most commonly find this type of cancer while performing a CT or an ultrasound to evaluate other unrelated conditions. These imaging studies allow us to diagnose kidney cancer early and help improve treatment outcomes. However, some signs of kidney cancer can include the following:

• Visible blood in your urine, without painful urination. This is different from infections of the bladder or kidneys with which pain associated with urination is common, in addition to fever and increased frequency of urination.
• A lump in the abdomen. 
• A persistent pain in your side.
• Unexplained weight loss.
  

Risk Factors

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Most kidney cancers are not hereditary and are not clearly due to any specific cause.  However, there are some known risk factors, including:

• Older age.
• Male: Men are twice as likely to get kidney cancer than women.
• Smoking: Cigarette smoking doubles one’s risk of kidney cancer. Quitting decreases this risk.
• Obesity, physical inactivity.
• High blood pressure.
• Exposure to certain carcinogenic chemicals, such as asbestos or cadmium.
• Treatment for kidney failure with long-term dialysis.
• Rare genetic conditions.

Diagnosis

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We diagnose kidney cancer with a combination of medical imaging procedures that may include CT, ultrasound, or MRI. This usually gives us enough information to develop a treatment plan. Kidney cancer usually has a characteristic appearance on CT scan. We therefore generally do not always need a kidney biopsy prior to treatment. Biopsies are only recommended if there is a reason to suspect another type of cancer, or if the cancer has spread beyond the kidneys.

Staging

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Staging is a process that helps determine the spread and the severity of the cancer:

• Stage I. The tumor is 7 cm or less and limited to the kidney.
• Stage II. The tumor is more than 7 cm and limited to the kidney.
• Stage III. The tumor is any size and still limited to the kidney, with lymph node involvement. Or the tumor extends into major veins or into tissue beyond the kidney.
• Stage IV. The tumor invades beyond Gerota’s fascia (the covering around the kidney), including extension into the adrenal gland. Or the cancer has spread to other organs.
  

Treatment

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When we evaluate the test results in order to develop your treatment plan, we consider several factors, including other medical conditions, the location and size of the tumor, the status of the unaffected kidney, the stage of the cancer, and your preferences for treatment.

Surgery

Surgical removal of the cancer is the mainstay of treatment if we think the disease is confined to your kidney. Specific operations used to treat kidney cancer include:

• Removal of the entire kidney containing the tumor (radical nephrectomy). 
• Removal of only the portion of the kidney involved with cancer (partial nephrectomy).

Each can be done with conventional "open" surgery or less invasive "laparoscopic" techniques. We will work with you to determine which choice is best.

Surgical treatment provides an accurate, specific diagnosis and can also provide some information regarding your prognosis or long-term outlook. Kidney cancers that are completely removed often have a long-term remission rate approaching 90 percent.

Other Treatments

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In some cases, surgery may be too risky. We may recommend other minimally invasive treatments, including the following:

• Cryotherapy. Destruction of the tumor by cold
• Radiofrequency ablation. Destruction of the tumor by heat

These types of treatments may have an increasing role in the management of certain tumors.

Clinical trials

We may also discuss the possibility of enrolling in a clinical trial if you decide it might benefit your treatment. Clinical trials are research studies designed to improve treatment for cancer patients. Some trials investigate new cancer drugs and treatments, while others compare standard treatments to new treatments.

Advanced Kidney Cancer

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Treatment for metastatic kidney cancer, when the tumor has spread beyond the kidney to other organs, has evolved dramatically over the last decade. Approximately 10 years ago, the treatment options for metastatic kidney cancer only included removal of the affected kidney (nephrectomy), and treatment with interferon, interleukin-2, and chemotherapy. These treatments were helpful to some patients, but often did not work very well.

Fortunately, we now have many different drugs available for effectively treating metastatic kidney cancer. These drugs are called molecular targeted therapeutics because they target a few proteins that often stimulate kidney cancer to grow. By blocking these proteins, these drugs can shrink the tumors or slow their growth rate.

While not all patients with kidney cancer will benefit from these drugs, they have dramatically changed the life expectancy of some patients with advanced kidney cancer.

There is a wide range of side effects associated with these drugs, including fatigue, tiredness, weakness, fever, body aches, malaise, headache, high blood pressure, loss of small patches of skin color, skin rash, diarrhea, and others. We can discuss specific side effects with you.

Recurrence

While most patients who have surgery for early stage kidney cancer will remain cancer free, about 10 to 20 percent may have a recurrence of their cancer. There is currently no treatment that has been shown to reduce the risk of relapse.

Follow-up Care

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We will work with you to develop recommendations for your follow-up care depending on your condition, your health, and factors that become evident during treatment. For example, we will evaluate whether to administer chemotherapy.

One of the most important aspects of cancer therapy is good self-care throughout the treatment period and beyond. There are several things that you can do:

• Eat a nutritious diet.
• Stay as active as possible.
• Continue your regularly scheduled follow-up appointments. 
•  Join a support group where you can talk to people who may have had an experience similar to yours.

All cases will include a treatment plan and information on when to contact us.

Clinical trials

We may also discuss the possibility of enrolling you in a clinical trial if you decide it might benefit your treatment. Clinical trials are research studies designed to improve treatment for cancer patients. Some trials investigate new cancer drugs and treatments, while others compare standard treatments to new treatments.

Your Care with Me

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If you are having symptoms that concern you, your first contact will typically be with your personal physician, who will evaluate your health and symptoms.

If specialty care is needed, your personal physician will facilitate the process of scheduling an appointment in my department. If appropriate, she or he might call me or one of my colleagues while you are in the office so we can all discuss your care together. If we decide you need an appointment with me after that discussion, we can often schedule it the same day or soon thereafter.

During your office visit, we will discuss your medical and family history and I will perform a physical exam. I will explain the findings of your exam and answer any questions or concerns you may have. We will discuss treatment options and develop a treatment plan that is right for you.

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If you need to talk with me after your visit or procedure, please call my office. You can also e-mail me with nonurgent issues from this website whenever it is convenient for you.

For general medical advice, our Appointment and Advice line is available 24 hours per day, 7 days per week.

If you have urgent concerns or issues while my office is closed, or need general medical advice, you can call the Appointment and Advice line. You will be connected with a nurse who can give you immediate advice.

If you are experiencing a serious problem or an emergency, call 911 or go to the nearest Emergency Room when the clinic is not open.

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Coordinating Your Care

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Having all of our Kaiser Permanente departments located together or nearby, including pharmacy, laboratory, radiology, and health education, makes getting your care easier for you.

Another major benefit is our comprehensive electronic medical record system, which allows all of the doctors and clinicians involved in your care to stay connected on your health status and collaborate with each other as appropriate.

When every member of the health care team is aware of all aspects of your condition, care is safer and more effective.

If you come to an office visit

• At the beginning of your visit, you will receive information about when you are due for your next test, screening, or immunization. We can discuss and schedule any preventive tests that you need. 
• At the end of your visit, you may receive a document called the “After Visit Summary” that will summarize the issues we discussed during your visit. You can refer to it if you forget what we discussed, or if you just want to recheck your vital signs and weight. You can also view it online under Past Visits.
• To help you prepare for your visit, please see additional details under Office Visit. 

If I prescribe medications

We will work together to monitor and assess how your medications are working and make adjustments over time. Prescriptions can be filled at any Kaiser Permanente pharmacy. Just let me know which pharmacy works best for you, and I will send the prescription electronically in advance of your arrival at the pharmacy.

If refills are needed in the future, you can:

• Order them online or by phone. Order future refills from my home page or by phone using the pharmacy refill number on your prescription label.
• Have them delivered to you by mail at no extra cost. Or you can pick up your medications at the pharmacy. If no refills remain when you place your order, the pharmacy will contact me regarding your prescription.

If lab testing or imaging is needed

For lab tests, I will use our electronic medical record system to send the requisition to the Kaiser Permanente laboratory of your choice. For imaging procedures, we will schedule an appointment with the Radiology department. When the results are ready, I will contact you with your results by letter, secure e-mail message, or phone. In addition, you can view most of your laboratory results online, along with any comments that I have attached to explain them.

If I refer you to another specialty colleague

If we decide together that your condition would also benefit from the care of other types of specialists, our staff will help arrange the appointment(s) with one or more of my specialty colleagues.

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Convenient Resources for You

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As your specialist, I have a goal to provide high-quality care and to offer you choices that make your health care convenient. I recommend that you become familiar with the many resources we offer so that you can choose the services that work best for you.

My Doctor Online is available at any time that is most convenient for you. From my home page you can:

Manage your care securely

• View and compose secure e-mail messages.
• Manage your prescriptions.
• View your past visits and test results.
• View your preventive services to see whether you are due for a routine screening or updated immunization.

Learn more about your condition

• Read about causes, symptoms, treatments, and procedures.
• Find interactive health tools, videos, and podcasts to help you manage your condition.
• View programs to help you decide on or prepare for a surgery or procedure.

Stay healthy

• Locate health education classes and support groups offered at every medical center.
• Explore interactive programs, videos, and podcasts that focus on helping you stay healthy.
• View your Preventive Services to see whether you are due for a routine screening or updated immunization.

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