Kidney Cancer Awareness 2022

Transcript

00:00 --> 00:02Funding for Yale Cancer Answers is
00:02 --> 00:04provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers with
00:08 --> 00:10your host doctor Anees Chagpar.
00:10 --> 00:12Yale Cancer Answers features the
00:12 --> 00:14latest information on cancer care by
00:14 --> 00:16welcoming oncologists and specialists
00:16 --> 00:18who are on the forefront of the
00:18 --> 00:20battle to fight cancer. This week,
00:20 --> 00:22it's a conversation about kidney
00:22 --> 00:24cancer with Doctor David Braun.
00:24 --> 00:26Doctor Braun is an assistant professor
00:26 --> 00:27of medicine and medical oncology
00:27 --> 00:29at the Yale School of Medicine,
00:29 --> 00:31where Doctor Chagpar is a
00:31 --> 00:32professor of surgical oncology.
00:34 --> 00:35David, maybe we can start off
00:35 --> 00:37by you telling us a little bit
00:37 --> 00:39about yourself and what you do.
00:39 --> 00:40Yeah, absolutely.
00:40 --> 00:43So I'm actually new to the Connecticut area.
00:43 --> 00:45I'm a physician, scientist and really
00:45 --> 00:48my focus has been on kidney cancer.
00:48 --> 00:49That's both in the clinic where
00:49 --> 00:51I see patients with variety of
00:51 --> 00:53different types of kidney cancer,
00:53 --> 00:54including advanced kidney cancers.
00:54 --> 00:56And then I spent a large portion of
00:56 --> 00:58my time in the laboratory as well,
00:58 --> 00:59really trying to understand this disease
00:59 --> 01:01and think of are there new approaches,
01:01 --> 01:04particularly using the immune system itself.
01:04 --> 01:04Immuno therapies.
01:04 --> 01:08To try to attack and tackle kidney cancer.
01:08 --> 01:10Wow, there's a. There's a lot to
01:10 --> 01:12unpack in which you just said so maybe
01:12 --> 01:14we'll start off with kind of a bigger
01:14 --> 01:16understanding of kidney cancer in general,
01:16 --> 01:18especially because kidney cancer Awareness
01:18 --> 01:21Month is coming up and a lot of us might
01:21 --> 01:23not be very familiar with kidney cancer.
01:23 --> 01:26We hear a lot about breast cancer
01:26 --> 01:28and colon cancer and lung cancer,
01:28 --> 01:29but we don't really hear a
01:29 --> 01:30whole lot about kidney cancer.
01:30 --> 01:32So tell us a little bit more about it.
01:32 --> 01:34How common is it?
01:34 --> 01:35Who gets affected by it?
01:35 --> 01:36Then why should we care?
01:37 --> 01:38Yeah, absolutely.
01:38 --> 01:40And so I think you're absolutely right.
01:40 --> 01:42I think you know a lot of the time
01:42 --> 01:43when people think about cancers.
01:43 --> 01:45They think about the really common types.
01:45 --> 01:46Unfortunately, breast cancer and
01:46 --> 01:48colon cancer and lung cancer.
01:48 --> 01:50But kidney cancer is still effects
01:50 --> 01:51a very large number of people.
01:51 --> 01:53So just in the US,
01:53 --> 01:55each year there's about 75,000 people that
01:55 --> 01:58will be diagnosed with kidney cancer.
01:58 --> 01:59And unfortunately,
01:59 --> 02:00even with our advancements in
02:00 --> 02:02medicines and new types of therapies,
02:02 --> 02:04still nearly 15,000 people a
02:04 --> 02:06year will die from kidney cancer.
02:06 --> 02:07And so it really is.
02:07 --> 02:09An important and impactful illness
02:09 --> 02:12that that really needs to be
02:12 --> 02:13addressed in terms of who it can
02:13 --> 02:15affect the short answer is anyone.
02:15 --> 02:17It does have a little bit of
02:17 --> 02:18a preference for certain ages
02:18 --> 02:20and these sorts of things,
02:20 --> 02:22but really can affect people
02:22 --> 02:23across the spectrum.
02:23 --> 02:25If we say what is the sort of most
02:25 --> 02:27common person who might get it?
02:27 --> 02:30It does have a a slight increase
02:30 --> 02:32in men versus women,
02:32 --> 02:34so about twice as many men will
02:34 --> 02:36get kidney cancer as as women and
02:36 --> 02:38then it does tend to affect people.
02:38 --> 02:40Who are a little bit on the older side,
02:40 --> 02:43so the median age would be in
02:43 --> 02:46the 60s and it can be anywhere,
02:46 --> 02:48though from you know people that
02:48 --> 02:50are in their 80s and 90s and beyond
02:50 --> 02:51and unfortunately can happen in
02:51 --> 02:53the other direction as well,
02:53 --> 02:54where I've had patients in their
02:54 --> 02:5730s or 40s who have been diagnosed,
02:57 --> 02:59and so it really can affect a
02:59 --> 03:00really wide range of ages,
03:00 --> 03:03but typically in that early 60s range
03:04 --> 03:07cool and so you know,
03:07 --> 03:08just while you're talking about
03:08 --> 03:10kidney cancers and. And age groups.
03:10 --> 03:13Some people may have heard about
03:13 --> 03:15kidney cancers occurring in
03:15 --> 03:17pediatric patients in children.
03:17 --> 03:21Things like, you know,
03:21 --> 03:24Wilms tumors and nephroblastoma's
03:24 --> 03:26talk about how that is different from
03:26 --> 03:28what I think you're talking about in
03:28 --> 03:31terms of kidney cancers in adults,
03:31 --> 03:34absolutely so. By and large,
03:34 --> 03:36this very rare exception to this,
03:36 --> 03:38but for the vast majority of cases,
03:38 --> 03:40the kidney cancers that occur in adults.
03:40 --> 03:42Are completely different biologically.
03:42 --> 03:45They they start in a different way.
03:45 --> 03:46They function in a different
03:46 --> 03:48way and they're treated in a
03:48 --> 03:50different way than kidney cancers.
03:50 --> 03:53Kidney tumors that might occur in kids.
03:53 --> 03:56Again, this very slight exception to that,
03:56 --> 03:58but I think as a general rule,
03:58 --> 04:00the the Group of kidney cancers or
04:00 --> 04:02kidney tumors that might occur in
04:02 --> 04:04kids are really almost different.
04:04 --> 04:05Disease bucket a completely different
04:05 --> 04:08entity than the ones that occur in adults.
04:09 --> 04:12They just wanted to gain of get that
04:12 --> 04:15out at the top simply so that our
04:15 --> 04:18audience really knows that we're we're
04:18 --> 04:20talking about what in medical lingo
04:20 --> 04:24is is known as a renal cell carcinoma.
04:24 --> 04:26For the most part, is that right?
04:27 --> 04:28Absolutely, that's exactly right.
04:28 --> 04:30The the technical term
04:30 --> 04:31is renal cell carcinoma,
04:31 --> 04:34and that's a group of kidney cancers
04:34 --> 04:36that happen for adult patients.
04:36 --> 04:38And it actually encompasses a whole
04:38 --> 04:40range of diseases, including.
04:40 --> 04:42Significantly more common ones,
04:42 --> 04:44but also rare types of kidney cancer as well,
04:44 --> 04:47but that is the a good general term to
04:47 --> 04:49describe the this bucket of illnesses,
04:49 --> 04:52and so you know when you say
04:52 --> 04:53that everybody can get this.
04:53 --> 04:55I'm sure that people are wondering,
04:55 --> 04:57you know, are there things
04:57 --> 04:59that can increase your risk or
04:59 --> 05:00decrease your risk so you know?
05:00 --> 05:01Oftentimes we're asked?
05:01 --> 05:03While does smoking increase
05:03 --> 05:04my risk of kidney cancer?
05:04 --> 05:07Does alcohol consumption increase my risk?
05:07 --> 05:10What about occupational hazards?
05:10 --> 05:11Environmental risks?
05:11 --> 05:12Tell us more about that.
05:13 --> 05:15Yeah, it's a good question and I
05:15 --> 05:18think the short answer is we don't
05:18 --> 05:19have the same association between
05:19 --> 05:21kidney cancer and certain risk factors
05:21 --> 05:23like lung cancer has with smoking.
05:23 --> 05:25So you know lung cancer.
05:25 --> 05:28There's a really huge increase
05:28 --> 05:29with with smoking.
05:29 --> 05:30For kidney cancer,
05:30 --> 05:33there are things that change the
05:33 --> 05:35likelihood by relatively small amounts,
05:35 --> 05:37so people who have inflammatory conditions
05:37 --> 05:40of the kidney and these sorts of things
05:40 --> 05:43do increase it by a small amount there.
05:43 --> 05:43Similarly,
05:43 --> 05:46these rare cases of exposures,
05:46 --> 05:48military exposures that have sort
05:48 --> 05:50of been associated with these
05:50 --> 05:51clusters of kidney cancers,
05:51 --> 05:54but the transfer is those tend to be the
05:54 --> 05:57exception more so than the rule in general.
05:57 --> 05:58For most patients,
05:58 --> 06:00kidney cancers tend to be sporadic.
06:00 --> 06:02Again, there's always exception to this.
06:02 --> 06:03There's sometimes genetics,
06:03 --> 06:05might play a role.
06:05 --> 06:07Kidney cancers can run in the family.
06:07 --> 06:09This particular types of
06:09 --> 06:10hereditary cancer syndromes.
06:10 --> 06:12There's again these histories of particular
06:12 --> 06:15exposures or things that might make a
06:15 --> 06:17difference truthfully around the margins.
06:17 --> 06:19But by and large,
06:19 --> 06:21these sporadic kidney cancers
06:21 --> 06:23that occur are really.
06:23 --> 06:27There's not a huge association between that
06:27 --> 06:30and particular modifiable lifestyle factors.
06:30 --> 06:32And so I think the general advice
06:32 --> 06:33I would have is you know the things
06:33 --> 06:35that are good for your heart and
06:35 --> 06:36your health overall are are probably
06:36 --> 06:38good for your cancer as well,
06:38 --> 06:39and so I encourage patients you
06:39 --> 06:41know to have a well balanced diet.
06:41 --> 06:45I encourage patients to, you know,
06:45 --> 06:46engage in regular exercise.
06:46 --> 06:48These sorts of things because that's
06:48 --> 06:49good for someone's overall health.
06:49 --> 06:51But in terms of particular risk
06:51 --> 06:53factors for kidney cancers,
06:53 --> 06:55it probably makes less of an impact.
06:55 --> 06:57So so really, you know,
06:57 --> 06:59getting kidney cancer is really
06:59 --> 07:01a matter of just bum bad luck.
07:01 --> 07:02Somebody's gotta get it.
07:02 --> 07:03And so you know,
07:03 --> 07:05people who get it kind of get it is
07:05 --> 07:06basically what you're telling us.
07:06 --> 07:08They're the the the risk
07:08 --> 07:09factors that you can really
07:09 --> 07:11modify are few and far between.
07:12 --> 07:13I I think that's absolutely right,
07:13 --> 07:15and I think honestly, that's something
07:15 --> 07:16I highlight to my patients as well,
07:16 --> 07:18because sometimes people come in and
07:18 --> 07:20there's almost a sense of guilt.
07:20 --> 07:22What could I have done differently
07:22 --> 07:24to have not gotten this this illness?
07:24 --> 07:25The short answer is,
07:25 --> 07:27this is just terrible luck that
07:27 --> 07:29we don't fully understand yet,
07:29 --> 07:31but that it's not something where there is a.
07:31 --> 07:33A clear modifiable thing that someone
07:33 --> 07:35could have done to prevent it,
07:36 --> 07:38and so David, given the fact that you
07:38 --> 07:40know kidney cancers aren't something
07:40 --> 07:42that we often think about top of
07:42 --> 07:45mind in terms of the the more common
07:45 --> 07:47cancers and the fact that it can
07:47 --> 07:48affect almost anybody who has a kidney,
07:48 --> 07:51which is pretty much everybody.
07:51 --> 07:54Tell us about how you would pick this up.
07:54 --> 07:56I mean there there doesn't seem to
07:56 --> 07:58be any real screening tests for
07:58 --> 08:00kidney cancer like there is for
08:00 --> 08:03breast cancer or colorectal cancer.
08:03 --> 08:05So what signs or symptoms should
08:05 --> 08:08people be looking for and seeking
08:08 --> 08:10attention for that might lead
08:10 --> 08:12to a diagnosis of kidney cancer.
08:14 --> 08:15It's a, it's a wonderful question and
08:15 --> 08:18I think the first thing I'd address is
08:18 --> 08:20maybe the screening aspect that you know.
08:20 --> 08:22I think that's an area of
08:22 --> 08:23active investigation and we
08:23 --> 08:24hopefully will do better.
08:24 --> 08:25We need to do better,
08:25 --> 08:28but we're we're really not there yet
08:28 --> 08:30and there's many research groups.
08:30 --> 08:31Wonderful research groups that
08:31 --> 08:33have are working on this idea.
08:33 --> 08:35Can we have a blood based test or
08:35 --> 08:37something where we be able to pick up
08:37 --> 08:38kidney cancer at an earlier stage,
08:38 --> 08:41but we have to make sure that we
08:41 --> 08:43rigorously test those and and see how
08:43 --> 08:45those performing those coming years.
08:45 --> 08:47'cause that would be a wonderful
08:47 --> 08:47tool to have,
08:47 --> 08:49but you're absolutely right right now.
08:49 --> 08:51What is the way that we would
08:51 --> 08:52pick up kidney cancer?
08:52 --> 08:54It's something I would call clinically.
08:54 --> 08:56Who's a patient comes with particular
08:56 --> 08:59signs or symptoms or incidentally,
08:59 --> 09:01meaning people are having an
09:01 --> 09:03evaluation for another purpose,
09:03 --> 09:05and this happens to just be found.
09:05 --> 09:07So I would say historically there's
09:07 --> 09:10a group of symptoms that a patient
09:10 --> 09:12might experience that have been
09:12 --> 09:13associated with kidney cancer.
09:13 --> 09:15There's a sort of classic symptoms.
09:15 --> 09:19Of blood in the urine of having flank pain.
09:19 --> 09:21Pain towards the side or the
09:21 --> 09:24back where the kidney tumor is.
09:24 --> 09:27These sorts of symptoms actually occurred.
09:27 --> 09:28A really a minority of patients
09:28 --> 09:30that you know the the group of
09:30 --> 09:31patients really experiencing.
09:31 --> 09:33All of these constellation of symptoms
09:33 --> 09:35is probably less than one out of 10,
09:35 --> 09:38and so I would say a few things.
09:38 --> 09:40One is a large proportion are
09:40 --> 09:42actually picked up incidentally,
09:42 --> 09:44so people have back pain or some
09:44 --> 09:45other issues. Stomach pains.
09:45 --> 09:47Totally unrelated to the kidney cancer
09:47 --> 09:50and they have a CAT scan or an MRI
09:50 --> 09:52and the kidney cancer is just picked up.
09:52 --> 09:52Incidentally,
09:52 --> 09:54that's sort of one group of patients.
09:54 --> 09:56The second group of patients are
09:56 --> 09:58ones I would say have something
09:58 --> 10:00I would term local symptoms,
10:00 --> 10:02meaning symptoms that they experience
10:02 --> 10:04because of the kidney tumor itself.
10:04 --> 10:06So there are patients that experience,
10:06 --> 10:06for instance,
10:06 --> 10:08blood in the urine that they
10:08 --> 10:09can actually see.
10:09 --> 10:10If anyone sees that,
10:10 --> 10:11that's something that's a definitely
10:11 --> 10:13a good idea to talk to your doctor
10:13 --> 10:15about and to pursue an evaluation for
10:15 --> 10:17if there's ever blood in the urine.
10:17 --> 10:18Sometimes that's really blood
10:18 --> 10:20that you can see.
10:20 --> 10:21Sometimes people have a urine
10:21 --> 10:22test for another reason,
10:22 --> 10:24and there's microscopic blood that too
10:24 --> 10:27should be evaluated more thoroughly.
10:27 --> 10:29It's can sometimes cause pain
10:29 --> 10:31in the area or discomfort these
10:31 --> 10:32kidney tumors you know,
10:32 --> 10:34for some patients they're
10:34 --> 10:35they're totally asymptomatic,
10:35 --> 10:37but for some they can grow to
10:37 --> 10:39size where they actually cause
10:39 --> 10:40bloating or discomfort,
10:40 --> 10:42and so any of those things that happen
10:42 --> 10:44because they're just where the kidney
10:44 --> 10:46tumor itself itself is either pain
10:46 --> 10:48or bloating or even blood in the urine.
10:48 --> 10:50That's a second group of patients.
10:50 --> 10:52I would call the local
10:52 --> 10:54symptoms and the final group,
10:54 --> 10:56which is less common but can
10:56 --> 10:58occur, are what I would call
10:58 --> 11:00systemic symptoms and what I mean
11:00 --> 11:02by that is it's not related to the
11:02 --> 11:04position of the kidney tumor itself,
11:04 --> 11:07but the kidney cancer can sometimes
11:07 --> 11:09produce factors and things in the body
11:09 --> 11:12that just make people generally feel on
11:12 --> 11:14where well they might experience fevers
11:14 --> 11:17or weight loss sweats during the night.
11:17 --> 11:18Things that are not sort
11:18 --> 11:19of accounted for for.
11:19 --> 11:22Other reasons, again less common,
11:22 --> 11:24but some patients really can't
11:24 --> 11:26present with those systemic symptoms.
11:26 --> 11:29And so that's a that's a a lot of things,
11:29 --> 11:31and so I would say my my sort of
11:31 --> 11:33general approach to these things.
11:33 --> 11:35Are there certain things like
11:35 --> 11:36blood in the urine?
11:36 --> 11:37I really think of getting into
11:37 --> 11:39valuation with your doctor.
11:39 --> 11:40I think that's that's always a good
11:40 --> 11:42idea for things that are, you know,
11:42 --> 11:44more common aches and pains.
11:44 --> 11:46Things that we were all gonna
11:46 --> 11:47experience in our lives,
11:47 --> 11:50the sort of rule I have is everyones
11:50 --> 11:51entitled to those aches and pains.
11:51 --> 11:53But if there's something
11:53 --> 11:54that's unusually severe,
11:54 --> 11:56you know it's not not something that.
11:56 --> 11:57Feels like you've had in the past.
11:57 --> 12:00It really is more severe in terms of its
12:00 --> 12:03intensity or it's lasting longer than that.
12:03 --> 12:04You think it should?
12:04 --> 12:05You know you've had back pain in
12:05 --> 12:07the past and it comes and goes.
12:07 --> 12:08This is kind of there and it's
12:08 --> 12:10really lingering for quite a while.
12:10 --> 12:11Those are are, you know,
12:11 --> 12:13maybe a little bit of a red flag.
12:13 --> 12:14That's time to go.
12:14 --> 12:15See your doctor and get an evaluation.
12:17 --> 12:18Especially because some of
12:18 --> 12:19these things, like you know,
12:19 --> 12:21having a little bit of blood in the
12:21 --> 12:23urine and a little bit of flank pain.
12:23 --> 12:25Most people would think of a kidney
12:25 --> 12:27stone rather than a a kidney tumor,
12:27 --> 12:28and me say, well,
12:28 --> 12:30you know I've had kidney stones in the past,
12:30 --> 12:33and so this is just yet another bout.
12:33 --> 12:34Speaking of which, though,
12:34 --> 12:36does having a history of kidney
12:36 --> 12:38stones increase your risk of
12:38 --> 12:39developing kidney cancer?
12:40 --> 12:41It's a good question.
12:41 --> 12:43I would say anything that can
12:43 --> 12:45cause inflammation in the kidney.
12:45 --> 12:47In theory, can create an
12:47 --> 12:49environment that's more susceptible
12:49 --> 12:50to developing kidney cancer,
12:50 --> 12:53and so you know on a routine basis,
12:53 --> 12:55someone who gets the stone here there,
12:55 --> 12:57you know probably doesn't have that
12:57 --> 12:59much of a different risk unfortunately.
12:59 --> 13:02Some patients who really get a lot
13:02 --> 13:04of effects of that kidney stone.
13:04 --> 13:06Those blockages and infections,
13:06 --> 13:08and recurrent inflammation.
13:08 --> 13:10Those probably do have a slightly
13:10 --> 13:11higher risk just because of that.
13:11 --> 13:12That inflammation within the
13:12 --> 13:14Kitty it sort of creates an
13:14 --> 13:15environment that's more pervasive
13:15 --> 13:17to developing a kidney cancer,
13:17 --> 13:20and so you know, when you think about it,
13:20 --> 13:22you know the the kind of you
13:22 --> 13:24know a little bit of flank pain,
13:24 --> 13:26maybe a little bit of blood in
13:26 --> 13:28the urine in a minority of cases.
13:28 --> 13:31Maybe you know a little bit of aches
13:31 --> 13:34and pains when things that you know
13:34 --> 13:37without something that is rip roaring.
13:37 --> 13:40You know, alarm bell ringing.
13:40 --> 13:42Many of these patients are
13:42 --> 13:43either going to be.
13:43 --> 13:45Picked up incidentally on a CAT scan
13:45 --> 13:48that they're having for another reason.
13:48 --> 13:51Or it may be delayed and so that
13:51 --> 13:53brings us to the question of
13:54 --> 13:56what is the stage distribution of
13:56 --> 13:58kidney cancers when they present.
13:58 --> 13:59So that is to say,
13:59 --> 14:02are most of these cancers picked up
14:02 --> 14:05late simply because there is no alarm
14:05 --> 14:07bell ringing symptoms that cause
14:07 --> 14:09people to seek medical advice sooner?
14:11 --> 14:13Good question. I think something
14:13 --> 14:15that's evolving in and really changing
14:15 --> 14:17overtime because things like CAT scans
14:17 --> 14:19are more common now either for other
14:19 --> 14:21reasons that are unrelated to the
14:21 --> 14:23kidney cancer or because people do have
14:23 --> 14:25that twinge of pain or have blood in
14:25 --> 14:27the urine and they see their doctor.
14:27 --> 14:28And appropriately they say,
14:28 --> 14:30let's let's get a CAT scan to evaluate.
14:30 --> 14:32I think things are being picked
14:32 --> 14:33up earlier and earlier and so
14:33 --> 14:35the majority of kidney cancers,
14:35 --> 14:37which is good news are picked up at
14:37 --> 14:39a localized stage as a stage where
14:39 --> 14:41they're confined the kidney and.
14:41 --> 14:43Where surgery can be performed or
14:43 --> 14:44other there's other methods as well,
14:44 --> 14:47but basically that single tumor
14:47 --> 14:49can be can be addressed,
14:49 --> 14:51and in most cases eliminated,
14:51 --> 14:53and that's that's wonderful news.
14:53 --> 14:54That being said,
14:54 --> 14:55you know there are select group
14:55 --> 14:57of patients that we don't have
14:57 --> 14:59great screening for and that don't
14:59 --> 15:01have any warning signs early on.
15:01 --> 15:03And by the time that you know
15:03 --> 15:04the really symptoms develop,
15:04 --> 15:05it is at a more advanced stage.
15:05 --> 15:07And while that's the minority
15:07 --> 15:08of patients at this point,
15:08 --> 15:11it is still a sizable fraction.
15:11 --> 15:13And so something that I think
15:13 --> 15:14motivates our need to really
15:14 --> 15:16do better in terms of coming up
15:16 --> 15:18with better screening tests.
15:18 --> 15:20And so we're going to pick up the
15:20 --> 15:21conversation, learning more about
15:21 --> 15:22the research that's evolving in
15:22 --> 15:24terms of screening and treatment,
15:24 --> 15:26right after we take a short break,
15:26 --> 15:27quit for a medical minute.
15:27 --> 15:29Please stay tuned to learn more
15:29 --> 15:30about kidney cancer with my
15:30 --> 15:31guest Doctor, David Braun.
15:32 --> 15:34Funding for Yale Cancer Answers
15:34 --> 15:36comes from Smilow Cancer Hospital,
15:36 --> 15:39where the breast Cancer Prevention Clinic
15:39 --> 15:40provides comprehensive risk assessment,
15:40 --> 15:42education and screening for women
15:42 --> 15:44at increased risk of breast cancer.
15:44 --> 15:46To learn more, visit
15:48 --> 15:50yalecancercenter.org/genetics.
15:50 --> 15:53Over 230,000 Americans will be
15:53 --> 15:55diagnosed with lung cancer this
15:55 --> 15:57year and in Connecticut alone
15:57 --> 16:00there will be over 2700 new cases.
16:00 --> 16:02More than 85% of lung cancer
16:02 --> 16:05diagnosis are related to smoking and
16:05 --> 16:07quitting even after decades of use
16:07 --> 16:09can significantly reduce your risk
16:09 --> 16:12of developing lung cancer each day.
16:12 --> 16:14Patients with lung cancer are surviving
16:14 --> 16:16thanks to increased access to advanced
16:16 --> 16:18therapies and specialized care,
16:18 --> 16:20new treatment options and surgical
16:20 --> 16:22techniques are giving lung cancer survivors
16:22 --> 16:24more hope than they have ever had before.
16:24 --> 16:26Clinical trials are currently
16:26 --> 16:28underway at federally designated
16:28 --> 16:30Comprehensive cancer centers,
16:30 --> 16:32such as the battle two trial at
16:32 --> 16:34Yale Cancer Center and Smilow
16:34 --> 16:36Cancer Hospital to learn if a drug
16:36 --> 16:38or combination of drugs based on
16:38 --> 16:40personal biomarkers can help to
16:40 --> 16:43control non small cell lung cancer.
16:43 --> 16:46More information is available at
16:46 --> 16:47yalecancercenter.org you're listening
16:47 --> 16:49to Connecticut Public Radio.
16:50 --> 16:52Welcome back to Yale Cancer Answers.
16:52 --> 16:54This is doctor Anees Chagpar and I'm joined
16:54 --> 16:56tonight by my guest Doctor David Braun.
16:56 --> 16:58We're learning about the care of
16:58 --> 17:00patients with kidney cancer in
17:00 --> 17:02advance of kidney cancer awareness
17:02 --> 17:04Month and right before the break,
17:04 --> 17:07you know, David, you were telling us
17:07 --> 17:10a bit about kidney cancers and the
17:10 --> 17:13fact that almost anybody had is at
17:13 --> 17:15risk of developing kidney cancers.
17:15 --> 17:17But you did mention a few things
17:17 --> 17:19that I think were really.
17:19 --> 17:22Interesting in terms of where the
17:22 --> 17:25science is going in terms of picking
17:25 --> 17:27up cancers earlier and treating
17:27 --> 17:29them perhaps more effectively.
17:29 --> 17:31So tell us a little bit more about some
17:31 --> 17:34of the research that's ongoing that will
17:34 --> 17:36help us to find kidney cancers early,
17:37 --> 17:38absolutely, and so there's really,
17:38 --> 17:40I think, dramatic advances that are
17:40 --> 17:43being made both in terms of research
17:43 --> 17:45into screening and then ultimately,
17:45 --> 17:47which is a huge focus of mine treatment.
17:47 --> 17:49Unfortunately, for patients who
17:49 --> 17:51develop more advanced disease where.
17:51 --> 17:53A surgery is not possible or not effective.
17:53 --> 17:55What are the treatments
17:55 --> 17:57available in terms of screening?
17:57 --> 17:58You know historically,
17:58 --> 18:00a lot of the screening that's been
18:00 --> 18:02done for many types of cancer
18:02 --> 18:03has been imaging based this some
18:03 --> 18:05sort of picture that's taken,
18:05 --> 18:07whether that's a form of an X ray,
18:07 --> 18:08like a mammogram,
18:08 --> 18:11or whether that's a CT scan at low doses
18:11 --> 18:13like they have available for lung cancer,
18:13 --> 18:15and so that's one bucket that people have
18:15 --> 18:17looked at and are continuing to look at.
18:17 --> 18:20Even simple tools like ultrasound.
18:20 --> 18:21Whether that might be helpful.
18:21 --> 18:24In terms of really picking up kidney cancer,
18:24 --> 18:26particularly in certain populations.
18:26 --> 18:28That being said,
18:28 --> 18:30you know I'm not as optimistic
18:30 --> 18:32that we're gonna really have a
18:32 --> 18:33pure imaging based solution,
18:33 --> 18:35and that's where some of the research
18:35 --> 18:37into what I would call blood tests
18:37 --> 18:39as a general bucket is really,
18:39 --> 18:40really exciting.
18:40 --> 18:42We know that cancer is even
18:42 --> 18:43at an early stage,
18:43 --> 18:45sometimes shed some of their blueprints that
18:45 --> 18:48shed some of their DNA into the bloodstream.
18:48 --> 18:49Very,
18:49 --> 18:50very small amount and kidney
18:50 --> 18:52cancer in particular.
18:52 --> 18:53Actually sheds less of this DNA
18:53 --> 18:56than a lot of other tumor types,
18:56 --> 18:58but it still does shed some some DNA,
18:58 --> 19:00and so the question is,
19:00 --> 19:02can we actually use new and advanced
19:02 --> 19:04methods of picking up that needle
19:04 --> 19:06in a haystack that little bit of
19:06 --> 19:09shed DNA from a tumor and being
19:09 --> 19:11able to identify it in a patient
19:11 --> 19:12with an early stage kidney cancer?
19:12 --> 19:14But they're still at the research phase,
19:14 --> 19:16so not the phase where they've been
19:16 --> 19:18proven to really be effective in a
19:18 --> 19:20large group of patients with picking it up.
19:20 --> 19:22But I still think there's room
19:22 --> 19:23there for cautious optimism.
19:23 --> 19:26The second bucket just mentioned briefly
19:26 --> 19:28is we know that cancer in general
19:28 --> 19:29and kidney cancer is no exception,
19:29 --> 19:31can alter patients metabolism in
19:31 --> 19:34subtle ways the the make up of,
19:34 --> 19:35you know, simple things,
19:35 --> 19:38amino acids and fats in our in our
19:38 --> 19:40bloodstream and so another area
19:40 --> 19:42of investigation that a number of
19:42 --> 19:44groups including our own has been
19:44 --> 19:46involved in is saying can we actually
19:46 --> 19:47pick up on those subtle changes
19:47 --> 19:49and their metabolites that might be
19:49 --> 19:51present in a patient's blood and
19:51 --> 19:52see if that can help us actually
19:52 --> 19:54distinguish patients with even an
19:54 --> 19:55early stage cancer from patients
19:55 --> 19:57who don't have cancer and so.
19:57 --> 19:58Again,
19:58 --> 20:01exciting sort of areas of investigation,
20:01 --> 20:03but nothing where we have a test today
20:03 --> 20:04or tomorrow that I can say this is
20:04 --> 20:06a good test for screening for kidney cancer.
20:07 --> 20:09You know, the kidney is one of these organs.
20:09 --> 20:12That is one would think would be
20:12 --> 20:14particularly ripe for for screening
20:14 --> 20:17in the sense that it generates urine.
20:17 --> 20:20So are there urine based tests
20:20 --> 20:23that are being looked at for
20:23 --> 20:25screening and early detection?
20:25 --> 20:27Or is it all blood based?
20:28 --> 20:30No, it's it's a wonderful point and
20:30 --> 20:32so essentially everything I said that
20:32 --> 20:34was applied to blood based tests.
20:34 --> 20:36People are looking at within the
20:36 --> 20:38urine as well to see, you know,
20:38 --> 20:39is there DNA that shed that
20:39 --> 20:41can be picked up in the urine?
20:41 --> 20:44It turns out at least our early experiences.
20:44 --> 20:46It seems like it's a little bit more tricky.
20:46 --> 20:47For whatever reason,
20:47 --> 20:49it tends to be shed a little bit
20:49 --> 20:51less in the urine than the blood,
20:51 --> 20:53even though it's not very prevalent
20:53 --> 20:54in the blood either.
20:54 --> 20:55That being said,
20:55 --> 20:57I think that's an area for
20:57 --> 20:58continued investigation.
20:58 --> 20:59The one urine test,
20:59 --> 21:00which is an old one but still a
21:00 --> 21:02tried and true is if there is blood
21:02 --> 21:03that's picked up on a urine test,
21:03 --> 21:05even microscopic blood.
21:05 --> 21:07That's something that's certainly
21:07 --> 21:09worthwhile to evaluate more fully,
21:09 --> 21:11because that can be an early sign
21:11 --> 21:13of of something going on within
21:13 --> 21:15the kidney or or other areas within
21:15 --> 21:17that that track that urinary tract.
21:18 --> 21:20You know that I I always like to
21:20 --> 21:22think about urine tests just in
21:22 --> 21:24case there are people out there who
21:24 --> 21:26don't particularly love needles.
21:26 --> 21:28Even though the the tests that we get
21:28 --> 21:30for blood tests are a small needle.
21:30 --> 21:32But some of us are still little gun shy.
21:34 --> 21:37So so you know we we kind of left off
21:37 --> 21:40the conversation before the break at.
21:40 --> 21:42You know, detecting kidney cancers
21:42 --> 21:46tell us what the state of the art is at
21:46 --> 21:49the moment in terms of how effective
21:49 --> 21:52treatments are for kidney cancers.
21:52 --> 21:54I mean, it's great that most of them
21:54 --> 21:56are picked up at a local stage,
21:56 --> 21:57so how are they treated?
21:57 --> 22:00Is this just a surgery or are do
22:00 --> 22:03people need radiation and systemic
22:03 --> 22:05therapy like chemotherapy
22:05 --> 22:07as well? It's it's a great
22:07 --> 22:10question and the the short answer
22:10 --> 22:12really depends on where it is.
22:12 --> 22:14And so anytime there's a patient that I
22:14 --> 22:16meet that's diagnosed with a new cancer.
22:16 --> 22:18I always ask 3 fundamental questions.
22:18 --> 22:21What is it? Where is it and what
22:21 --> 22:22are we going to do about it?
22:22 --> 22:24And that's where the treatment
22:24 --> 22:26comes in and so the what is it is
22:26 --> 22:28what type of kidney cancer we have,
22:28 --> 22:30much more common types like clear cell
22:30 --> 22:33kidney cancer that account for about 80%,
22:33 --> 22:35but there's also less common
22:35 --> 22:36types these variantes allergies.
22:36 --> 22:39That have unique biologies that we need
22:39 --> 22:40to understand that sometimes might
22:40 --> 22:42affect treatment in certain ways.
22:42 --> 22:44The next big question is where is
22:44 --> 22:46it and that that really ties in
22:46 --> 22:47with the stage and the prognosis,
22:47 --> 22:50and that's ultimately what will help
22:50 --> 22:52to determine the treatment and so
22:52 --> 22:54patients who have an early stage
22:54 --> 22:57kidney cancer stage one or stage two.
22:57 --> 22:59Those are ones where treatments that
22:59 --> 23:01that tumor itself, usually surgery,
23:01 --> 23:03though there's emerging roles for
23:03 --> 23:05other techniques like ablation
23:05 --> 23:06or even radiation as well,
23:06 --> 23:08but for the majority of patients surgery.
23:08 --> 23:10To remove that kidney tumors,
23:10 --> 23:10highly,
23:10 --> 23:13highly effective and patients with early
23:13 --> 23:16stage kidney cancer who have surgery.
23:16 --> 23:18The far majority of those patients
23:18 --> 23:19are cured with surgery alone.
23:19 --> 23:22The second bucket are patients that
23:22 --> 23:24have what I would term locally
23:24 --> 23:26advanced or locally aggressive
23:26 --> 23:28disease that's kidney cancer.
23:28 --> 23:30That's still within the kidney itself.
23:30 --> 23:31It hasn't spread far,
23:31 --> 23:33but maybe it started to go into a little
23:33 --> 23:36bit of a blood vessel or surrounding area,
23:36 --> 23:37or it has features under the
23:37 --> 23:39microscope that look really aggressive.
23:39 --> 23:40Still,
23:40 --> 23:41the mainstay of treatment for
23:41 --> 23:43that is surgery,
23:43 --> 23:44and that's that's curative for
23:44 --> 23:46a large number of patients.
23:46 --> 23:48But unfortunately there are still a
23:48 --> 23:51number of patients who after surgery.
23:51 --> 23:53Will have the disease come back and
23:53 --> 23:56so there haven't been great tools in
23:56 --> 23:58terms of being able to help prevent
23:58 --> 24:00it from coming back like radiation
24:00 --> 24:03after surgery or chemotherapy just now.
24:03 --> 24:05In the last really year,
24:05 --> 24:07we're beginning to have some evidence
24:07 --> 24:09that actually immunotherapy might help
24:09 --> 24:11to decrease the risk of it coming back.
24:11 --> 24:12It still needs a little bit
24:12 --> 24:13of longer follow up,
24:13 --> 24:15but that's that's actually has led
24:15 --> 24:17to the FDA approval of one of these
24:17 --> 24:19immunotherapy drugs for exactly this purpose.
24:19 --> 24:22Those patients with kind of a higher risk.
24:22 --> 24:24Local kidney cancer that's removed
24:24 --> 24:24by surgery.
24:24 --> 24:27Can we get another medicine and
24:27 --> 24:28immunotherapy to help decrease the
24:28 --> 24:30chance of it coming back? And the last?
24:30 --> 24:31The last group of patients?
24:31 --> 24:33And this is largely the group of
24:33 --> 24:35patients that I see are unfortunately
24:35 --> 24:37those with advanced or metastatic disease.
24:37 --> 24:39Kidney cancer that's either spread
24:39 --> 24:41to different areas at the beginning
24:41 --> 24:43or start off in the kidney and
24:43 --> 24:45recurred or came back later at
24:45 --> 24:46different parts of the body.
24:46 --> 24:49And so that point in general,
24:49 --> 24:50with with some exceptions.
24:50 --> 24:51But in general those are patients
24:51 --> 24:53that are not cured by surgery alone.
24:53 --> 24:54And that's where we really
24:54 --> 24:55think of medicines.
24:55 --> 24:57Systemic therapy as the the
24:57 --> 24:59really the mainstay of treatment.
24:59 --> 25:02Now, what are those medicines
25:02 --> 25:04kidney cancers really by and large,
25:04 --> 25:06not been historically responsive to
25:06 --> 25:07the conventional chemotherapies we
25:07 --> 25:09think of the stuff that you know,
25:09 --> 25:11come through the Ivy that we think.
25:11 --> 25:13Make people feel really sick.
25:13 --> 25:15Those are things that you know for.
25:15 --> 25:16For the majority of kidney
25:16 --> 25:18cancers are against small,
25:18 --> 25:18rare exceptions here,
25:18 --> 25:20but for the majority
25:20 --> 25:21they're just not effective,
25:21 --> 25:23and so there's been two big waves
25:23 --> 25:25of treatment for kidney cancer.
25:25 --> 25:26The first wave,
25:26 --> 25:28which started around 15 years
25:28 --> 25:30ago were group of medicines,
25:30 --> 25:30mostly pills.
25:30 --> 25:33But there's other Ivy form as well that
25:33 --> 25:35helped to block new blood vessel formation.
25:35 --> 25:36So called anti angiogenic.
25:36 --> 25:39So those were really effective for a while.
25:39 --> 25:40They they truthfully didn't
25:40 --> 25:41really cure patients,
25:41 --> 25:42they the farm majority didn't
25:42 --> 25:43get rid of it but they provided
25:43 --> 25:45a treatment that could at least
25:45 --> 25:47keep the kidney cancer at Bay for
25:47 --> 25:48some amount of time and went from
25:48 --> 25:50having very little in the way
25:50 --> 25:52of treatment to actually being
25:52 --> 25:53able to keep the disease under
25:53 --> 25:55control for some amount of time.
25:55 --> 25:57So that was a really important
25:57 --> 25:57and exciting advance.
25:57 --> 26:00What I think has been transformative, really.
26:00 --> 26:02Over the last five or so years has
26:02 --> 26:04been the the introduction of this
26:04 --> 26:06next generation of immune therapy.
26:06 --> 26:08There's actually an older form of immune
26:08 --> 26:10therapy that was used 20 or 30 years ago,
26:10 --> 26:11which you know,
26:11 --> 26:13actually had some favorable responses
26:13 --> 26:16for a very small group of patients,
26:16 --> 26:17maybe 5 or 7%.
26:17 --> 26:20But with this new wave of immune therapy,
26:20 --> 26:23these so-called immune checkpoint inhibitors,
26:23 --> 26:24it's I think,
26:24 --> 26:26really marked an inflection point
26:26 --> 26:27for kidney cancer where there's
26:27 --> 26:29a group of patients now and.
26:29 --> 26:29Unfortunately,
26:29 --> 26:31it's still not the majority,
26:31 --> 26:33but a growing group of patients who
26:33 --> 26:35really get a tremendous benefit.
26:35 --> 26:36And when I say that it's not
26:36 --> 26:38just that it shrinks the cancer
26:38 --> 26:40by a little bit or or leads to
26:40 --> 26:41survival for some amount of time,
26:41 --> 26:43but there's certain patients again,
26:43 --> 26:44unfortunately,
26:44 --> 26:45still a small fraction,
26:45 --> 26:47but a a notable fraction where this these
26:47 --> 26:49drugs can actually work for a really,
26:49 --> 26:50really long time.
26:50 --> 26:52And so I think we're at this
26:52 --> 26:54important moment in kidney cancer
26:54 --> 26:56where we now have these tools that
26:56 --> 26:58are almost proof of concept that
26:58 --> 27:00for a small group of patients.
27:00 --> 27:01Were able to really, really,
27:01 --> 27:04really good job of controlling their cancer,
27:04 --> 27:06and for some of those actually
27:06 --> 27:07doing so for really long time.
27:07 --> 27:08Yeah,
27:08 --> 27:10really these long term durable
27:10 --> 27:12kind of can't cancer control,
27:12 --> 27:14but there's still a large group of patients,
27:14 --> 27:14unfortunately,
27:14 --> 27:16probably still the majority of
27:16 --> 27:17patients with advanced disease,
27:17 --> 27:19for which these this long term control
27:19 --> 27:22this long term benefit is not there.
27:22 --> 27:23And so it's this proof of concept.
27:23 --> 27:24We can do it,
27:24 --> 27:25but we need to figure out how
27:25 --> 27:27to do it for more people.
27:27 --> 27:28And that's where I think the
27:28 --> 27:28research is so important.
27:29 --> 27:31Well, in the. The other question
27:31 --> 27:33that springs to mind is,
27:33 --> 27:35can you identify which patients are
27:35 --> 27:37going to do well with immunotherapy
27:37 --> 27:39and which patients are not?
27:40 --> 27:42Absolutely, I think that's a an
27:42 --> 27:43A critical critical question.
27:43 --> 27:46I think you really hit the nail on the head.
27:46 --> 27:48You know, I think for patients
27:48 --> 27:49who are getting immunotherapy,
27:49 --> 27:51we really need to study this.
27:51 --> 27:53We need to understand where the patients
27:53 --> 27:55that really do well and wine who are the
27:55 --> 27:57patients for which the therapy fails them.
27:57 --> 28:00That doesn't have the benefit it should and.
28:00 --> 28:02And what's happening biologically then,
28:02 --> 28:04and I think that gives us
28:04 --> 28:05two pieces of information.
28:05 --> 28:07One is exactly what you're talking about,
28:07 --> 28:09which is the sort of term biomarker
28:09 --> 28:10can we actually help to select
28:10 --> 28:12patients and select drugs.
28:12 --> 28:13Meaning we match the right
28:13 --> 28:15drug with the right patient.
28:15 --> 28:16That's a really important sort
28:16 --> 28:19of goal of some of this work.
28:19 --> 28:20The other bucket is,
28:20 --> 28:22can we actually understand why
28:22 --> 28:23certain tumors are resistant,
28:23 --> 28:24and if we have that understanding,
28:24 --> 28:26then in in our laboratory can we
28:26 --> 28:27actually think of strategies,
28:27 --> 28:29ways to overcome that resistance
28:29 --> 28:31and bring benefit to more patients?
28:32 --> 28:34Doctor David Braun is an assistant
28:34 --> 28:36professor of medicine and medical
28:36 --> 28:38oncology at the Yale School of Medicine.
28:38 --> 28:40If you have questions,
28:40 --> 28:42the address is canceranswers@yale.edu
28:42 --> 28:45and past editions of the program
28:45 --> 28:47are available in audio and written
28:47 --> 28:48form at yalecancercenter.org.
28:48 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public
28:55 --> 28:56radio funding for Yale Cancer Answers
28:56 --> 29:00is provided by Smilow Cancer Hospital.

Information

Kidney Cancer Awareness 2022 with guest Dr. David Braun February 20, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095