Vitaly Margulis, M.D. Answers Questions On: Kidney Cancer

My primary clinical focus is on patients with kidney cancer. I also see a fair share of patients with prostate cancer because it is so common, as well as those with bladder, testicular, urethral, penile, and adrenal cancers.

Twenty to 30 years ago, removal of the kidney was the standard treatment. Back then, patients would generally see a doctor only after they’d developed symptoms of kidney cancer. Now, however, we find a lot of kidney tumors by accident and in the very early stages. When a patient is being treated for something else, we often find the tumor on his or her CT scan. These days, we remove only the tumor and save the rest of the kidney, if the situation warrants that.

We have a dedicated team of experts who deal with advanced kidney tumors. This includes a medical oncologist, radiation oncologist, a surgeon like myself, a heart surgeon, and other specialists. We all work together to individualize treatment – drugs, chemotherapy, or surgery – according to the patient’s specific circumstances.

Men are three times as likely as women to develop kidney cancer, and one of the easiest ways to decrease the risk of developing it is to stop smoking. In fact, smoking causes most urologic cancers. Genetics can also be a factor, but that occurs in a minority of the population.

We evaluate the patient as a whole – age, socioeconomic factors, their support system, and, obviously, their tumor status. Also, some of our patients travel quite far to be treated at UT Southwestern. For example, a prostate cancer patient from Oklahoma may not be the best candidate for radiation therapy because it requires a daily visit to the medical center. He may benefit most from surgery because he can typically be in and out of the hospital in two days. Another patient may not need treatment at all but just careful monitoring. We take everything into consideration before making a recommendation.

We’re on the leading edge of surgical expertise, and we see a large volume of genitourinary malignancies at various stages. Also, we don’t work as individuals; we have in place teams that address various genitourinary cancers. That multidisciplinary care translates into better outcomes.

There will be more improvements in drug treatments and surgical techniques. For advanced kidney cancer, we have drugs that will specifically target the cancer on a molecular level. Surgically, we’ll use focal therapy a lot more. Focal therapy means treating only the area that is diseased or cancerous. We use this approach quite often with prostate cancer and will continue to use it with other cancers, as well. Another aspect of focal therapy is the use of active surveillance for urologic cancers. We’ve learned that many cancers can be safely observed and that we should intervene only when necessary.