Kidney (Renal) Cancer
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 Harrisonâ��s reports bluntly, â��Investigational therapy is first-line treatment for metastatic disease as no immune approach or chemotherapeutic agent has shown significant antitumor activity.â�� (3) Interleukin-II, once heralded as a miracle cure in the mid 1980â��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 â��Adenocarcinoma, consistent with metastatic renal tubular carcinoma.â��
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 â��a large focal area of increased radiopharmaceutical uptake with a photopenic center consistent with metastatic disease in the left occipital region of the skull.â�� A CT scan of the chest indicated â��Small nodule at the left lung baseâ�¦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.â�� 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 â��No evidence of bony metastatic disease.â�� 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, DQâ��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 physicianâ��s notes, this time â��urine cytology showed atypical cells on 2 occasions and malignant cells in one specimen. Repeat IVP showed a defect in the right renal pelvis.â��
When repeat cystoscopy in June 1991 revealed a normal bladder mucosa, but significant blood in the right ureter, her urologist suspected she â��most likely has a right renal pelvis tumor and have advised her family that she will most likely need nephro-ureterectomy.â�� 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 â�� 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 â�� 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 â�� 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: â��No solid tumor mass seen. The left kidney and the remainder of the abdominal organs were normal in appearance.â��
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 urologistâ��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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1. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo, DL, Jameson JL. Harrisonâ��s Principles of Internal Medicine, 16th Edition. New York: McGraw-Hill; 2005:541.
2. DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles and practice of oncology, 6th Edition. Philadelphia: Lippincott Williams & Wilkins; 2001:1364.
3. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo, DL, Jameson JL. Harrisonâ��s Principles of Internal Medicine, 16th Edition. New York: McGraw-Hill; 2005:542.
4. DeVita VT, Hellman S, Rosenberg SA. Cancer: Principles and practice of oncology, 6th Edition. Philadelphia: Lippincott Williams & Wilkins; 2001:1369.