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In the US, 36,000 new cases of kidney cancer were reported in 2004,
and 12,500 deaths. (1) Cigarette smoking predisposes to the disease,
with up to 20-30% of cases linked to the habit. Researchers have
suggested associations with obesity, polycystic kidney disease,
von Hippel Lindau Disease, and certain genetic aberrations. In recent
years, though the incidence has been increasing steadily, no clear
cut environmental risk, other than cigarette smoking, has been confirmed.
Renal cell carcinoma, the most common form of kidney cancer, accounts
for 90-95% of all cases. In this type, the disease begins in the
epithelial lining cells of the proximal tubules and if localized,
can be cured in well over 50% of patients with surgery alone. (2)
Once the disease metastasizes, it usually spreads quickly with deadly
results. Conventional therapies such as chemotherapy and immune
modulation offer little benefit. As Harrison’s reports bluntly,
“Investigational therapy is first-line treatment for metastatic
disease as no immune approach or chemotherapeutic agent has shown
significant antitumor activity.” (3) Interleukin-II, once heralded
as a miracle cure in the mid 1980’s based on anecdotal evidence,
in controlled clinical trials worked no better than placebo.
Some 2500 cases of cancer of the renal pelvis are diagnosed each
year. In its histology, this form resembles transitional cell cancer
of the bladder, and if localized, like renal cell, can be cured
with surgical resection. When metastatic to distant organs, oncologists
treat the disease as they would bladder cancer though with little
success. Few patients with metastatic disease survive six months.
Patient DQ: a 15-Year Survivor of Renal Cell Carcinoma
Patient DQ is a 82 year-old man who had past history pertinent
for celiac disease, gout and chronic borderline anemia. In October
of 1990 his primary physician noted an abdominal mass during a routine
yearly physical examination. Subsequent MRI and CT scan studies
revealed a 14 cm tumor in the left kidney, with no evidence of metastases.
Chest X-ray and bone scan were both clear, and in late October 1990
DQ underwent exploratory laparotomy and left nephrectomy. Pathology
studies confirmed renal cell carcinoma, with 1/1 adjacent nodes
positive for invasive cancer.
DQ was then referred to a major New York medical center for additional
evaluation and treatment. There, in December 1990 he agreed to enter
a clinical trial testing alpha-interferon, an immune stimulant,
against kidney cancer. After repeat chest and abdominal CT scans
showed no evidence of residual or recurrent disease, DQ then began
an eight-cycle course of intensive interferon, which he completed
in August of 1991.
Thereafter, DQ did well until November 1991, when he noticed a
lump in the left parietal-occipital region of the skull that rapidly
enlarged over a period of several days. In early December needle
aspiration of the mass confirmed “Adenocarcinoma, consistent with
metastatic renal tubular carcinoma.”
A subsequent CT of the head indicated that the tumor had penetrated
through the skull into the cranium, as the report states:
“There is a lytic lesion within the left parietal bone with an
associated enhancing soft tissue mass, consistent with a metastasis.
There is intracranial extension of the enhancing soft tissue,
as well as extension into the subcutaneous tissues of the left
parietal scalp.”
A bone scan revealed “a large focal area of increased radiopharmaceutical
uptake with a photopenic center consistent with metastatic disease
in the left occipital region of the skull.” A CT scan of the chest
indicated “Small nodule at the left lung base…which may be an area
of fibrosis as described. Two other smaller densities in the middle
lobe and the left lower lobe as described of questionable significance.”
However, these lung findings had not been reported on the chest
CT of December 1990.
DQ then began a one month course of radiation to the skull mass,
totaling 4000 rads and completed in January 1992. Despite the treatment,
the tumor regressed only marginally. DQ, having been told he had
incurable disease, began looking into alternative approaches, learned
of my work and decided to pursue my protocol. When we first met
in January 1992, only a week after he had finished radiation, DQ
reported significantly diminished energy, along with a 20 pound
weight loss occurring during the previous six weeks. On exam, I
immediately noticed a lemon sized mass sticking out of his skull
in the left parietal area.
Shortly thereafter, DQ began his nutritional protocol, complied
well and within weeks reported a significant improvement in his
energy and well being, as well as a 20 pound weight gain. After
three months on his nutritional protocol, the previously noted large
skull mass completely resolved. A repeat bone scan in June 1993,
after DQ had completed some 16 months of treatment, revealed “No
evidence of bony metastatic disease.” Not only had the lesion disappeared,
but the underlying skull had healed. Today, nearly 15 years since
he first consulted me, DQ remains completely adherent to his treatment,
is in excellent health and cancer-free.
Several points need mentioning. Renal cell carcinoma once metastatic
is a very deadly disease: DeVita reports a median survival of only
50 days for patients with stage IV kidney cancer, despite treatment.
(4) This neoplasm resists not only chemotherapy and immunotherapy,
but radiation as well. In this case, DQ’s doctors suggested radiation
not as a potential cure but as palliation, hoping to slow the spread
of the tumor into the brain. In any event, the response was negligible.
While some radiation oncologists report that at times, the benefit
of radiation therapy might continue for up to two months, DQ showed
significant response only after his third month on his nutritional
program. Furthermore, although his radiologists initially downplayed
the new findings on the chest CT in late 1991, in retrospect these
lesions may have indicated the beginnings of explosive spread.
Patient UB: A 6.5-Plus Year Survivor of Renal Pelvic
Cancer
In July of 1989, Patient UB, at the time a 66-year old Caribbean
woman, first developed hematuria. Cystoscopy revealed only a benign
urethrocoele, and a right retrograde pyelogram showed no abnormalities.
Subsequent urine cytology in January 1990 was negative but in May
1991 she consulted her urologist again after noticing blood in her
urine. According to the physician’s notes, this time “urine cytology
showed atypical cells on 2 occasions and malignant cells in one
specimen. Repeat IVP showed a defect in the right renal pelvis.”
When repeat cystoscopy in June 1991 revealed a normal bladder mucosa,
but significant blood in the right ureter, her urologist suspected
she “most likely has a right renal pelvis tumor and have advised
her family that she will most likely need nephro-ureterectomy.”
The patient then agreed to a needle biopsy of the right renal tumor,
which showed, according to the patient and her family, renal pelvic
cancer – though we do not have the actual pathology report of this
test in our possession.
When UB learned of our approach from her daughter who lives in
the United States, she cancelled surgery despite the urgings of
her urologist and decided to proceed with our treatment. During
our first session in July 1991, she reported intermittent right
flank pain and urethral burning on urination, but no other symptoms.
I urged her to reconsider surgery, which I explained could be curative
if the disease proved localized. She adamantly held her course,
stating that she had had enough surgery in her life – she had years
early undergone hysterectomy - and would not allow any more, whether
I would accept her as a patient or not. So, with her point well
made, we agreed to proceed.
She proved to be a very compliant patient and did well clinically,
with rapid resolution of her flank pain and no further episodes
of hematuria. On her home island, she studiously avoided contact
with all other doctors despite my wish she consult with them at
least on occasion. Since she had no insurance, frequent testing
to monitor her progress was simply out of the question – not that
she would have agreed to it anyway. But in October 1995, after she
completed four years on our treatment, she did allow an abdominal
ultrasound, which revealed a normal right kidney except for a 2.3
cm simple cyst in the pole. Otherwise, the report states: “No solid
tumor mass seen. The left kidney and the remainder of the abdominal
organs were normal in appearance.”
During the first four years on therapy, UB did return periodically
to New York for re-evaluations. After 1995, she could not afford
the expense of the trips, so I agreed to follow her by phone. My
last contact with her was in 1998, after she had been on the program
for 6.5 years. At that time she was feeling well, with no complaints.
In this patient, her resolution of signs and symptoms, her lack
of disease spread and her long survival all indicate a good response
to treatment, particularly since she refused all orthodox interventions
including surgery. Furthermore, ultrasound studies after four years
on treatment confirmed the previously documented renal pelvis tumor
had resolved completely. Unfortunately, we never received the actual
pathology report of the needle biopsy, so her records are in that
sense incomplete. But the patient and family members carefully described
the procedure and the results that had been reported to her. And,
we do have the urologist’s discussion of the positive cytology and
IVP findings to confirm the diagnosis of cancer. Despite the one
missing document, I included her because she did so well following
only our nutritional regimen.
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