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Cancer

Renal Cell Carcinoma

02/27/2008

Question:

My father is 64 years old and has undergone nephrectomy for Renal Cell Carcinoma in the right kidney. The right kidney was removed along with the tumor. It was performed on 26th of November. The CECT scan report and the Whole Body Bone Scan report was normal after the operation. After this he was undergoing an immunotherapy with Interferon. At this time his haemoglobin percentage was 11.4%. However, presently his haemoglobin percentage has dropped to 10.5%. He is also getting the symptoms of fatigue, heavy face, and irritation on hands and feet. My question is that whether my father is facing a recurrence of the disease. What shall I have to do? Also please tell me the survival period after the recurrence of the disease.

Answer:

It would help to know if the cancer had spread outside of the kidney when the kidney was taken out. If the cancer was confined to the kidney, then booster interferon is NOT indicated at all. His symptoms sound related to the interferon treatment.

Regarding prognosis, there are many schemas reviewing a patient’s life span. The most frequently quoted is by Dr Robert J Motzer in his study published in the Journal of Clinical Oncology 17:2530-2540, 1999.

"The median survival time was 10 months (95% confidence interval [CI], 9 to 11 months). Fifty-seven of 670 patients remain alive, and the median follow-up time for survivors was 33 months. Pretreatment features associated with a shorter survival in the multivariate analysis were low Karnofsky performance status (<80%), high serum lactate dehydrogenase (> 1.5 times upper limit of normal), low hemoglobin (< lower limit of normal), high "corrected" serum calcium (> 10 mg/dL), and absence of prior nephrectomy. These were used as risk factors to categorize patients into three different groups. The median time to death in the 25% of patients with zero risk factors (favorable-risk) was 20 months. Fifty-three percent of the patients had one or two risk factors (intermediate-risk), and the median survival time in this group was 10 months. Patients with three or more risk factors (poor-risk), who comprised 22% of the patients, had a median survival time of 4 months."

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Response by:

Thomas  Olencki, DO Thomas Olencki, DO
Clinical Professor of Medical Oncology
College of Medicine
The Ohio State University