Kidney cancer: Improving survival in Nigeria

Kidney

March is the awareness month for Kidney Cancer, Colorectal Cancer and Multiple Myeloma. Last year, this writer focused on colorectal cancer (article available at www.cecpng.org blog page). This article will focus on kidney cancer.

Kidney cancer is also known as renal cancer. It is a cancer that starts in the kidneys. The kidneys are a pair of bean-shaped organs, each about the size of a fist. They are attached to the upper back wall of the abdomen, with one on either side of the backbone. The kidneys’ main function is to remove excess water, salt, and waste products from the blood in form of urine. The kidneys also help control blood pressure and ensure that the body has enough red blood cells.

Although, the survival rate for kidney cancer is very high if found at an early stage, kidney cancer is among the most fatal cancers in Nigeria, with over 900 new cases and about 800 deaths yearly, according to WHO. This implies that two Nigerians die every day of this disease, with a death rate of over 80%, compared to the much lower global mortality rate of 40%. In the United States of America, the death rate of kidney cancer is about 25% with more than 200,000 kidney cancer survivors currently living in USA.

Risk factors that could make an individual more likely to develop kidney cancer, include: lifestyle-related and job-related risk factors such as smoking, obesity, workplace exposure to certain substances, including certain herbicides, and organic solvents. Genetic and hereditary conditions, such as Sickle cell disease can also increase the tendency to develop certain types of kidney cancer. However, genetic factors account for only a small portion of cases overall.

Age and gender are also risk factors of kidney cancer. Globally, kidney cancer is more common in men than women. However, in Nigeria, the reverse is the case. The risk of kidney cancer increases with age. The average age at diagnosis is 64 in whites, in whom kidney cancer is rare under age 45. However, in Nigeria, kidney cancer tends to occur earlier, with the average age of occurrence being in the forties.

Other risk factors include: high blood pressure and advanced kidney disease especially those needing dialysis as well as family history of kidney cancer. The long-term, regular use of certain drugs, such as non-aspirin anti-inflammatory pain killers and diuretics (water pills) also increase the risk. Therefore, long-term use should only be undertaken after consultation with a doctor, who can appropriately evaluate benefits / risks and monitor treatment closely. Individuals placed on these medications should not panic but should observe the other preventive measures stated below.

It is important to note that having a risk factor, or even several risk factors, does not mean that one will get the disease. Conversely, some people who get the disease may have few or no known risk factors. This is illustrated by the case of Mrs. Vera Williams (not her real name) who was recently diagnosed with stage III kidney cancer at the age of thirty (30). This young nursing mother had none of the risk factors outlined above.

The risk of kidney cancer can be reduced by life-style modification. These include quitting smoking, maintaining a healthy weight, exercising, choosing a diet high in fruits and vegetables, as well as getting treatment for high blood pressure. Avoiding workplace exposure to harmful substances such as cadmium and organic solvents may also reduce the risk for renal cancer.

Early kidney cancers do not usually cause any signs or symptoms, but larger ones might. Kidney cancers can sometimes grow quite large without causing any problems. In addition, because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical examination. The most common symptom of kidney cancer is painless urination of blood, a condition known as haematuria. Other possible signs and symptoms of kidney cancer include: low back or flank pain or pressure on one side (not caused by injury), presence of a mass, a hard lump or a thickening or bulging under the skin that can be seen or felt on the side or lower back. Tiredness, loss of appetite, weight loss not caused by dieting, and unexplained fever are also symptoms of kidney cancer.

It is noteworthy, that these signs and symptoms can also be caused by other diseases apart from kidney cancer. For example, blood in the urine is most often caused by a bladder or urinary tract infection or a kidney stone. Still, presence of any of these symptoms should prompt evaluation by a doctor so that the cause can be found and treated.

Although, there are no universal screening tests for kidney cancer risk, a urine test which should be part of routine medical checkup, may find small amounts of blood in the urine of some people with early kidney cancer. This is known as microscopic haematuria. Imaging tests such as Ultrasound Scan, Computed Tomography (CT) Scans and Magnetic Resonance Imaging (MRI) scans can often find small kidney cancers. With increasing use of these imaging test in the evaluation of nonspecific abdominal complaints in developed countries, most cases of kidney cancers are often found accidentally when they are causing no symptoms.

People at increased risk of kidney cancer should get regular imaging tests (CT, MRI, or ultrasound scans) to look for kidney tumors. Kidney cancers that are found early with these tests can often be cured. In addition, it is expedient that any one that passes blood in the urine, even if it occurs only once, should have an imaging test done to determine the cause before instituting treatment. Health practitioners should not merely prescribe antibiotics or anti-schistosomal drugs for patients with haematuria, without fully evaluating them.

Treatment options for kidney cancer include: surgery, ablation (e.g. cryotherapy) and other local therapies, radiation therapy, targeted therapy, immunotherapy (biologic therapy) and chemotherapy. In some cases, a combination of more than one type of treatment might be used. However, surgery which could be partial or total, is the main treatment for most kidney cancers. The chances of surviving kidney cancer without having surgery are small.

Unfortunately, Nigerians are often afraid of surgery. Those that present with early stage disease, often default after being informed of the need for surgery. They then opt for traditional / spiritual / alternative treatment, only to present much later with incurable disease.

At this point, we must note that the kidneys are important, but a person actually needs less than one complete kidney to function. Many people in the United States are living normal, healthy lives with just one kidney. So people should not be afraid of undertaking surgery.

Clearly, the key to improved kidney cancer survival is prevention and early detection. Regrettably, the diagnostic imaging tests are expensive, not widely available and out of the reach of most people in Nigeria.

The good news is that with a routine urine test, kidney cancer could be picked up early. However, most Nigerians do not have the culture of carrying out routine medical screening. Some elderly Nigerians pride themselves in never having any need to visit the hospital. Often such people’s first visit to hospital would be when they are rushed there, moribund. This culture is fueled by the absence of a national system of health promotion and the dearth of preventive medical facilities, especially in the rural areas.

One way of ensuring early detection of kidney cancer is by taking advantage of existing opportunities for routine screening, for instance during pregnancy. Mrs. Vera Williams had regular urine test during Antenatal Care (ANC). However, the form of urine testing carried out at ANC is often limited to checking for glucose and protein. Her case calls for a review of the current practice. Routine urine test should be more comprehensive so as to include test for blood. If this had been done for Vera, she could have been diagnosed at a curable stage.

There remains an urgent need for an accessible and organised system of cancer prevention and health promotion. A mobile system of preventive health care is the best solution. The Collaborative Research-USA Network of Mobile Clinics, posits that “The mobile clinic sector is an untapped resource for helping the nation reduce health disparities while improving care, improving health and saving healthcare costs.”

This is why the current focus of Committee Encouraging Corporate Philanthropy (CECP-Nigeria) is to acquire and deploy Mobile Cancer Centres (MCC) across the country. Because the MCC contains facilities for imaging (ultrasonography) and comprehensive urine test, it would greatly facilitate the early diagnosis of kidney cancer in Nigeria. The operational partner of CECP is the National Cancer Prevention Programme (NCPP), a non-governmental initiative. NCPP has been at the forefront of efforts towards the establishment of effective system of nation-wide cancer control in Nigeria. The MCC would make holistic preventive health care accessible at the grassroots.

CECP hereby uses this opportunity to appreciate all the Nigerian philanthropists who have identified with this cause, by pledging to contribute towards the MCC. CECP invites every person of goodwill to support this initiative as we work towards deploying the first set of MCCs by the October Cancer Awareness Month.

According to the Union for International Cancer Control, ‘Together we can take action to make a difference’. We can! I can!

• Dr. Nzelu (Executive Secretary, CECP-Nigeria) can be reached via info@cecpng.org