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Unit 9.1 – Summary

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Unit 9.1 – Feedback and finishing the course

There were around 13,300 new kidney cancer cases in the UK every year between 2016-2018.[1]

And yet the condition rarely attracts much public attention. Over the last decade, kidney cancer incidence rates have increased by more than 29% in the UK. In UK women, kidney cancer is the 10th most common cancer and in UK men, it is the 5th most common cancer.[1] Kidney cancer is the 7th most common cancer in the UK, accounting for 4% of all new cancer cases (2016-2018).[1]

Unless diagnosed early in the progression of the disease, when surgery can be successful at preventing spread, there remains a distinct lack of targeted and effective treatment for late stage renal cancer. Currently, about 27% of cases present when the cancer has already metastasised, and only 44% are diagnosed when the cancer is localised. Therefore, survival rates are poor compared to other forms of cancer, In England more than 85% of people with kidney cancer at stage 1 survive their cancer for 5 years or more after they are diagnosed, 75% at stage 3, and only 10% at stage 4. [2]

Compared with people who are diagnosed with early stage breast cancer, almost all (98%) people with breast cancer will survive their disease for five years or more, compared with around 1 in 4 (26%) people when the disease is diagnosed at the latest stage. This is due to high awareness and effective screening programmes in place.[3]

There is not one specific cause for renal cancer. However, certain lifestyle risk factors predispose people to the disease, such as an unhealthy diet (obesity), smoking, age, and gender (men are more likely to suffer from renal cancer). However, because of this, renal cancer receives very little public attention, and there are no pressure groups, possibly because there is not the stigma associated with the causes of renal cancer as there are with higher profile cancers, such as lung cancer and smoking.

Renal cancer presents in a number of ways; however, many of the symptoms of renal cancer are similar to that of a urinary tract infection and can be missed by GPs, for example, haematuria (blood in the urine). Other signs or symptoms of renal cancer are an abdominal mass, with or sometimes without pain, back pain, weight loss and lethargy, and incidental findings on a computerised tomography (CT) scan.

Unlike some cancers, such as breast and cervical, which have very effective screening programmes, there is no screening programme for renal cancer. The advantage of early detection is successful removal of the tumour or the affected kidney to prevent the spread of the disease. As there are no effective screening tests or blood tests for renal cancer, clinical suspicion and imaging are used to identify renal cancer. CT is currently the gold standard for imaging renal tumours.

The only curative treatment for renal cancer is nephrectomy, occasionally with surgical removal of solitary metastases. In 1984 there were no treatments available for late-stage renal cancer. The situation didn’t change for more than 20 years, then since 2004 seven new biological therapies have been given a licence for the treatment of advanced renal cancer. To date, these treatments have only been able to suppress the disease and none has demonstrated curative potential. Also, due to limited experience with these new drugs, the medical fraternity are currently unsure how to use them for optimal benefit to the patients. Even with these new advances in drug development, there remain a number of challenges for the doctors treating renal cancer patients:

Which is the best first-line therapy?
Can treatment be individualised, as is the case for breast and lung cancer?
What is the role of nephrectomy, especially in patients with metastatic disease?
Which is the best second- and third-line treatment?

In many countries with national health services, new cancer treatments are appraised for cost: benefit before they are recommended for reimbursement by the government. In the UK, the National Institute for Health and Care Excellence (NICE) poses a constant challenge to getting new drugs reimbursed on the NHS. Currently avelumab and axitinib, nivolumab and ipilimumab, cabozantinib, tivozantinib, sunitinib, pazopanib are recommended for first-line treatment by NICE [4], and lenvatanib and everolimus, cabozantinib, everolimus, nivolumab, axitinib for second-line treatment [5]; NICE did not consider any other treatments as cost effective. The Scottish Medicines Consortium (the equivalent to NICE for NHS Scotland) approved Pembrolizumab with axitinib for the first-line treatment of advanced kidney cancer, but is still not available in the rest of the UK. [6] And most recently, Nivolumab and Cabozantnib are now available to patients in Scotland only as a first line treatment for advanced kidney cancer. [7]

The challenge facing cancer researchers today, and pharmaceutical companies in particular, is the discovery and development of safe and effective renal cancer treatments that offer value for money within the NHS.

The treatments for advanced renal cancer continue to be evaluated; new biological therapies, such as monoclonal antibodies (immunotherapy) and vaccines, are in development, and various combinations and sequences of drugs are being trialled to determine the optimal treatment regimen. Surgical techniques are also being refined to be less invasive so that patients experience less pain after the operation, need a shorter recuperation time in hospital, and have smaller wounds and subsequent scars.

Like all cancers, renal cancer is a distressing disease, which has a major impact on the quality of life of the patient and their families or carers. Education is critical in ensuring that all health care professionals involved in renal cancer are as well informed as possible so that both patients and carers affected by this disease remain well supported throughout their cancer experience.

When healthcare professionals do have the knowledge and understanding of renal cancer they can have an enormous positive impact on the patient. By completing this course, hopefully you will have gone some way to achieving these benefits for those affected by this disease.

Unit 9.1 References

Unit 9.1 – Summary

Kidney Cancer UK

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