Spare the Knife to Spare a Life, Perhaps

Kidney cancer in elderly people may be better watched than surgically treated

February 12, 2013 / Author:  / Reviewed by: Joseph V. Madia, MD

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(dailyRx News) Research is more often showing that all cancers don’t necessarily have to be treated right away. In fact, watchful waiting may be preferable for some tumors. Kidney cancer appears to fall into this category.

Elderly patients with small kidney tumors are just as likely to be alive five years after diagnosis whether they had surgery or were carefully monitored, according to a new study.

Those who did undergo surgery were actually at greater risk of developing cardiovascular disease and dying from any cause, the researchers found.

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William C. Huang, MD, assistant professor of Urologic Oncology at New York University Medical Center, led the study that looked at data on thousands of kidney cancer patients.

“Our analysis indicates that physicians can comfortably tell an elderly patient, especially a patient that is not healthy enough to tolerate general anesthesia and surgery, that the likelihood of dying of kidney cancer is low and that kidney surgery is unlikely to extend their lives,” Dr. Huang said in a statement.

Dr. Huang highlighted his study at a media briefing hosted by the American Society of Clinical Oncology at the fourth annual Genitourinary Cancers Symposium. “Incidence of kidney cancer is on the rise, believed to be largely due to imaging for unrelated conditions. And so, although we don’t screen for kidney cancers, most newly diagnosed kidney cancers are found to be of a very small size – roughly less than two inches,” he said.

These small tumors are picked up during an ultrasound, CT or MRI imaging for gallstones, abdominal pain or back pain. Just over 65,000 Americans will learn they have kidney cancer this year.

As is the case with most cancers, individuals are generally treated immediately with surgery to remove either part of or the whole kidney. Evidence is mounting that the risks associated with this surgery may outweigh the benefits – particularly for elderly individuals, those who have other conditions or those who have limited life expectancy.

For this study, the research team looked at data from people aged 66 and older who had been diagnosed with small kidney tumors. Of the total 8,317 people reviewed, 70 percent had surgery, while the remainder underwent surveillance, which involves carefully watching the growth of the mass using imaging technology.

During the roughly five years of follow-up, 25 percent of the individuals had died, but only 3 percent succumbed to kidney cancer. The mortality rates from kidney cancer were the same for patients who had undergone surgery and those who had been carefully monitored.

Those who underwent surveillance had substantially lower risks of dying from any cause, and were less likely to have cardiovascular disease, the researchers found.

The study also uncovered a trend of more patients and physicians opting more frequently for surveillance and less surgery. Researchers concluded that physicians are becoming more aware of the fact that kidney tumors aren’t typically life-threatening.

At the same time, it's also becoming better understood that removing a kidney can lead to chronic kidney disease, which increases the risk of kidney failure, cardiovascular disease and early death.

All research is considered preliminary before it is published in a peer-reviewed journal. The fourth annual Genitourinary Cancers Symposium is being held February 14-16, 2013 in Orlando, Florida.

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Review Date: 
February 12, 2013
Last Updated:
February 13, 2013