Kidney cancer is among the 10 most common cancers in both men and women in the United States, claiming more than 63,990 new people in 2017. Seattle Cancer Care Alliance’s Dr. John L. Gore, a surgeon, researcher, and educator who specializes in urologic oncology, took time to share the latest in the field.
SCCA: Tell us what’s happening with kidney cancer today?
Gore: Our kidney cancer program at SCCA is growing. It had been the fastest growing area across the organization for three consecutive years. We believe this could be happening for a number of reasons.
We know that the rate of kidney cancer in the community is increasing because of two risk factors: Smoking and obesity.
We have better capacity to deliver better kidney cancer treatment at SCCA and beyond.
We have the increased use of imaging in the medical community and we’re finding a lot of tumors that weren’t previously detected. For example, in 2017, most kidney cancers are detected incidentally, meaning that most patients were found to have a kidney tumor when they were getting a CT scan for something else, like appendicitis.
SCCA: We're better at detecting and treating?
Gore: Kidney cancer is an ever-changing domain. Since 2005, there has been an explosion of potential therapies for kidney cancer. Kidney cancer has always been one of the diseases treated with immune therapies. In the past, interferon and interleukin-2 were used. But the emergence of new immune therapies, like checkpoint inhibitors, has changed the number of options for kidney cancer and the treatment algorithms we use for kidney cancer.
We have a dedicated Kidney Cancer Multispecialty Clinic at SCCA, which opened in April 2017. Our multispecialty approach allows people to have the opportunity to discuss all aspects of kidney cancer care.
SCCA: How does the multi-disciplinary approach work?
Gore: Our multi-disciplinary team convenes twice a month and is a way for our patients to see their entire team in one visit: a medical oncologist, urologist, radiation oncologist and representatives from nursing, nutrition and social work, if needed.
We try to make it so patients can gather all of the opinions relevant to their kidney cancer diagnosis so that we can help them make the best decision going forward.
SCCA: Is it for all kidney cancer patients?
Gore: Candidates for the Kidney Cancer Multispecialty Clinic are patients with newly diagnosed kidney cancer that has spread to other parts of the body, because that’s the situation that involves decision-making from all different specialties. If someone has a new tumor and there’s no evidence that it has spread outside of the kidney, that patient should be treated by their urologist.
SCCA: How about advances in technology?
Gore: We have always tried to use state-of-the-art surgical techniques for localized kidney cancer care. We offer robotic surgeries and we personalize our treatment to each patient. Firefly is one of the newer technologies that we have available. The Firefly technology uses near-infrared imaging to detect an injected tracer dye of indocyanine green (ICG) in the blood.
SCCA: How frequently is Firefly used?
Gore: I would say I use it in maybe a third of cases.
SCCA: When is Firefly used?
Gore: We use it for a couple of different purposes: for patients who have complicated anatomy or to identify the locations of blood vessels. It either helps me identify the location of important blood vessels or helps me delineate that outline of the kidney tumor before we cut it out.
One of our goals is to provide safe, good cancer care, but we also want to provide high value care. We don’t want to use it just to use it.