kopn

Should we remove a left kidney with a tumor if pulmonary lymph nodes
are enlarged? The pulmonary lymph nodes are metastases probably. The
man has a hematuria ones in two weeks, an infrequent cough and an
aching [dull, boring] pain in his waist. The tumor is 5cmx4cm in size
and spreads to pelvis too of the kidney.

steph

If the kidney CAN be completely resected, it's worth doing for several
reasons:
It will control the haematuria; it will address the pain; and there are
(very rare) instances of spontaneous regression of metastases after removal
of a kidney for renal cell cancer.

If it would not be possible to completely resect the kidney and primary
cancer, an operation would be counter-productive. Some local radiotherapy
would provide best symptomatic palliation

kopn

How to know if the kidney with the cancer CAN be completely resected?
A computer-aided tomography and a nephrosonography imply a cancer. Is
there any chance this is not a cancer? The tumor is in my father.

kopn

Thank you for reply, Steph.
How to know if the kidney with the cancer CAN be completely resected?
A computer-aided tomography and a nephrosonography imply a cancer. Is
there any chance this is not a cancer? The tumor is in my father.

steph

You can't be certain until the surgery, but there are criteria on the scans
which the radiologist uses to assess the likelihood of cancer, and the
possibility of resection

steph

If the ct and ultrasound suggest a cancer, it almost certainly is..........

peter moran

I also assumed it was very rare, but this study is intriguing, with a 6%
spontaneous remission of metastases after treating kidney cancer, in a
group of about a hundred patients..

Placebo-associated remissions in a multicentre, randomized, double-blind
trial of interferon gamma-1b for the treatment of metastatic renal cell
carcinoma. The Canadian Urologic Oncology Group.


Elhilali MM, Gleave M, Fradet Y, Davis I, Venner P, Saad F, Klotz L, Moore
R, Ernst S, Paton V.


Department of Urology at the Royal Victoria Hospital (MUHC), Canada.


OBJECTIVE: To determine the validity of using an historical maximum
spontaneous regression rate (reportedly 0-1.1% in those with lung metastases
after nephrectomy) in clinical trials of treatments for patients with
metastatic renal cell carcinoma (RCC), as the eligibility criteria for most
studies will select patients with better performance status (and thus
excluding those who are unlikely to respond) and more modern staging methods
would potentially reduce the number of false-positives. PATIENTS AND
METHODS: A multicentre randomized,placebo-controlled, double-blind trial was
recently completed in which 197 patients with metastatic RCC from 17 study
centres across Canada were randomized to receive placebo or recombinant
interferon gamma-1b (60 microg/m2) subcutaneously once every 7 days until
disease progression. All tumour responses were validated by an independent
response committee unaware of the treatment. RESULTS: The median (95%
confidence interval) overall response rate (complete, CR, and partial, PR)
for those on interferon-gamma was 4 (1.4-11.5)% and for those on placebo was
6 (2. 5-13.2)% (P = 0.75). In the six patients who were receiving placebo
the CR and PR (three each) was considered to represent spontaneous
remission. Of these six patients (aged 44-64 years) five had undergone
nephrectomy, one a tumour embolization, four had clear cell carcinoma and
one an adenocarcinoma, and all had regression of lung and/or lymph node
metastases. CONCLUSION: The lack of efficacy of interferon-gamma in this
trial underlines the importance of continued research to identify
alternative therapeutic agents or combinations of agents in phase II
studies. However, the threshold response rate for initiating phase III
trials should be increased to 18% in the phase II trials, i.e. three times
the response rate on placebo.


Peter Moran

steph

I think it's important to distinguish between a "remission" (which is
meaningless) and a "complete remission" which MAY be meaningful

mary fisher

AH! Someone else with the same feeling as me :-)

I'm always being asked if I'm in remission. I say that I don't know what
that means. It's not quite as daft as 'cure' or 'in the clear' but on the same lines. Mary

peter moran

Yes, words are often used so loosely.. "In remission" should only apply to
very serious, mainly widespread, cancers which have responded well to
treatment, but are regarded as still a major threat.


I don't think "cure" and :"in the clear" are daft, in the right context.
You are to all intents and purposes cured of colon, and some other cancers,
if you are alive and free of cancer five years after treatment. Not so
with others, such as breast or melanoma, which can crop up (with
ever-decreasing frequency) after many more years. After, say twenty years,
survivors with those are approaching 100% certainty that they are "cured".

Also, about fifty per cent of cancers overall are "cured" permanently, with
the overall mortality rate of cancer running at about half that of its
incidence.

Peter Moran