2023-12-20 08:27:28
Author: Care Online
Image: shutterstock (illustration not party involved)
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“Doctor, I recently discovered hematuria.” 58-year-old Mr. Chen said.
“Will it hurt?” the doctor asked.
“It doesn’t hurt when I urinate.” Mr. Chen thought for a while and said, “But I often have back pain.”
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Further examination revealed that the patient had a fist-sized tumor on his right kidney. The tumor had spread into the renal vein and had bone metastasis. Dr. Yu Kaijie, director of the Department of Urological Oncology at Linkou Chang Gung Memorial Hospital, pointed out that the diagnosis was confirmed to be metastatic renal cell carcinoma with lung metastasis.
After discussing with the patient, they used immunotherapy combined with targeted drugs. Dr. Yu Kaijie said that after about half a year of treatment, the patient’s kidney tumors and metastases shrank significantly, and there was no tumor in the renal vein, so surgery was arranged. After radical nephrectomy, the patient recovered smoothly after surgery and can continue to use immunotherapy and targeted therapy. His current condition is stable and he continues to be tracked steadily in the outpatient clinic.
The doctor shared that there are actually many similar cases in the world where immune combined therapy was used for renal cell carcinoma that was not suitable for surgery. After the tumor shrank, surgical resection was arranged to help improve the prognosis.
According to the cell type, malignant tumors of the kidney can be divided into renal cell carcinoma, urothelial carcinoma, nephroblastoma, renal sarcoma, etc. Among them, renal cell carcinoma accounts for about 80% to 90%, and renal cell carcinoma is more likely to occur in the middle. For the elderly, risk factors include smoking, obesity, end-stage renal disease, long-term exposure to certain chemicals or carcinogens, family history, etc., and since renal cell carcinoma has no obvious symptoms in the early stages, patients usually find microscopic hematuria through health examinations. Or the diagnosis is confirmed only after an abnormal mass in the kidney is seen on ultrasound. Doctors remind that by the time the patient develops symptoms such as hematuria, low back pain, and palpable masses, it is usually a more serious stage. Therefore, high-risk individuals are reminded to undergo regular screening and Before it’s too late.
Combined immune therapy improves treatment efficacy for advanced renal cell carcinoma
Early renal cell carcinoma is mainly treated with surgery or local treatment. Dr. Yu Kaijie said that surgery involves total or partial resection of the kidney. Traditional surgery or minimally invasive surgery such as laparoscopy or Da Vinci robotic arm can be used. Local treatment methods include cryotherapy, radiation therapy, etc.
If the renal cell carcinoma is early stage and has not metastasized to the lymph nodes or invaded the tissues outside the kidney, as long as it is followed up regularly after surgery, most of them will be fine. However, if the renal cell cancer has invaded the tissues outside the kidney or entered the kidney In major blood vessels, the risk of surgery is relatively high, and you may need to receive some systemic treatment first, and then perform surgical treatment after the tumor shrinks.
If renal cell carcinoma has metastasized or local invasion is very serious, systemic drug treatment will be the main treatment. Dr. Yu Kaijie explained that systemic drug treatment includes targeted therapy, immunotherapy, or a combination of the two, using “immunotherapy”. Different immune combined treatment combinations such as “target plus target” or “immune plus immune” are carried out.
At present, most immunotherapy combination therapies use “immune plus target” or “immune plus immune” dual immunotherapy. Doctors say that such a combination can not only significantly improve the patient’s survival rate, but also have a higher treatment response rate. Both the United States and European treatment guidelines currently regard combined immunotherapy as the first-line treatment for metastatic renal cell carcinoma. Using different treatment mechanisms to fight cancer cells has the opportunity to achieve better therapeutic effects.
Thoughtful reminder
Renal cell carcinoma has no obvious symptoms in the early stage and is mostly discovered accidentally during ultrasound examination. As the tumor worsens, symptoms such as hematuria and low back pain may appear.
The five-year survival rate of early-stage renal cell carcinoma is about 90%. Dr. Yu Kaijie said that when renal cell carcinoma spreads into large blood vessels, metastasizes to lymph nodes or distant organs, the five-year survival rate will be greatly affected. However, with the development of targeted therapy and immunotherapy, the treatment effectiveness of advanced renal cell carcinoma has improved significantly.
Combination immune therapy uses “immunity plus targeting” or “immunity plus immunity” to combine different mechanisms to fight cancer cells. The treatment response rate is higher and the treatment effect of advanced renal cell carcinoma can be further improved.
Dr. Yu Kaijie pointed out that patients with advanced renal cell carcinoma can consider receiving combined immune therapy. After the tumor shrinks, they will then evaluate whether they have the opportunity to receive surgical treatment. Patients in need are advised to discuss in detail with their attending physician to formulate a personalized treatment plan. Let’s work together to achieve a better prognosis!
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(This article is reprinted with permission from “Care Online”, the original text is published here)
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