David Brownlees Experienced Few Symptoms of Kidney Cancer
- David Brownlees, 44, learned he had kidney cancer after first being misdiagnosed with gallstones. The father-of-four experienced no symptoms in the years prior to his diagnosis, and the cancer had spread to his lung by the time doctors caught the disease.
- He had his kidney and lung removed but is grateful for the fact that his diagnosis came at a time when a new combo of drugs has improved overall survival rates for individuals with advanced-stage kidney cancer like himself.
- Kidney cancer is difficult to detect in the early stages because so few patients experience symptoms, Dr. Geoffrey Sonn told SurvivorNet. That is why it can be easy for people like Brownlees to not learn they have the disease until it has spread to other organs.
David Brownlees tells Edinburgh Live that he visited his doctor after experiencing frequent fatigue and headaches in January 2020.Read More
Brownlees barely had time to digest this new diagnosis before being booked for surgery to remove part of his kidney. That surgery occurred just one week before the entire country went into lockdown because of the COVID pandemic.
Battling Kidney Cancer During COVID Lockdown
“I had my operation March 2, 2020, and my first scan was in lockdown, so there was no contact, and most communication was over the phone – nothing face to face,” explains Brownlees. “I had advanced cancer, so they basically cut me in half to remove the massive tumor on my kidney. I had 67 staples in total.”
A few months later, a scan revealed that the cancer had metastasized to other organs.
“They then found I had [metastasis] on my lung so I was transferred to the oncology department for further treatment in August 2020,” reveals Brownlees.
He struggled with the constant moving around and explaining his situation anew each time to a different group of oncologists and doctors. Brownlees said that the protocols during COVID also made treatment a very solitary journey.
“I had a COVID-19 test when I was taken by ambulance to the Western General. I had to wait alone in a ward for three days waiting for the result,” he noted by way of example.
The side effects he experienced from the disease were similar to those associated with COVID, which put Brownlees on edge throughout his treatment.
Kidney Cancer Scare
There was also a moment when doctors thought the cancer had spread to his brain, with Brownlees experiencing “really bad headaches” in October.
“The doctor asked if I wanted my wife to come in and on Halloween weekend told us it looks like a brain tumor,” recalled Brownlees.
“After a scan we found out that it wasn’t but the scare was the worst time followed by the best news that I didn’t have it which was really scary.”
Despite being misdiagnosed, Brownlees is nothing but grateful.
“The cancer was growing slowly over five years and I had no symptoms and no idea I had cancer,” he explained.
He noted that he remained active and unaware while the cancer grew and spread inside his body.
Benefits of New Drug Combo
“I was lucky to get it two years ago rather than five years ago as treatment is much better now,” said Brownlees.
The treatment is notably better for Brownlees, who is currently taking the immunotherapy drug nivolumab and cabozantinib, a targeted therapy that inhibits the growth of tumors.
In March, the New England Journal of Medicine published the results of a phase III trial of the two drugs. That trial showed that the combination had “significant benefits to progression-free survival, overall survival, and likelihood of response in patients” compared with other treatments in individuals battling advanced-stage kidney cancer.
This combo blocks the growth of blood vessels in any cancerous tumors while harnessing the immune system to start attacking the weakened growths.
Why Kidney Cancer Is Difficult To Diagnose
Kidney cancer is tough to detect in the early stages because so few patients experience symptoms. That is why it can be easy for people like David Brownlees not to notice the disease until the late stages, especially if they do not exhibit the few symptoms of kidney cancer.
“Traditionally, kidney cancer was, was diagnosed in people coming in with blood in the urine, a mass in the belly that was big enough that you could feel, or pain on that side,” Dr. Geoffrey Sonn, a urologic oncologist at Stanford Hospital and Clinics, told SurvivorNet in a previous interview. “More recently, because of the great increase in the use of imaging with ultrasound, CT scans, and MRI, most kidney cancer is diagnosed incidentally.”
Dr. Sonn explained that patients often learn they have kidney cancer while doctors are performing a scan for some other reason or trying to confirm a different diagnosis.
“Somebody has abdominal pain and undergoes a CT scan, and by chance, they’re found to have a mass in the kidney that’s kidney cancer,” cited Dr. Sonn. “So that’s the most common presentation now, is an incidental mass seen on imaging done for another reason.”
However, even that is rare because so many people are like Brownlees and experience no real symptoms until the cancer has started to metastasize in the body.
“For localized kidney cancer, for relatively small masses that have not metastasized, most often patients feel nothing,” explained Dr. Sonn. “For larger masses of the kidney, they may have pain on that side, they may see blood in the urine, or a routine urine test may show a microscopic amount of blood in the urine that’s not enough to be seen visually, but still will prompt further testing.”
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Early Detection of Kidney Cancer
Individuals who detect kidney cancer before the disease has spread can often beat the disease with just surgery.
“If there’s no indication of metastasis or spread to other organs, most patients we will just monitor with follow-up scans done typically initially at six-month intervals,” said Dr. Sonn. “If nothing else arises, patients are usually able to get away with surgery alone. Most do not end up needing radiation; most do not need chemotherapy or other types of medications.”
Dr. Sonn said that those patients can return to “a completely normal life with no changes in activity level, with no changes in diet.”
He did add there could be “some decrease in their overall kidney function, but not enough in most cases to require dialysis.”
Other patients who have no spread but a larger mass may require surgery to remove the entire kidney, though, as Dr. Sonn notes, it is one of the few organs which humans can spare.
“For masses that are too large for partial nephrectomy or ones in a location where that’s not possible, then the surgery is removing the entire kidney,” explained Dr. Sonn. “Fortunately, we have two kidneys, and a single kidney in most patients is enough to get by with not needing to be on dialysis, not having any sort of change that they need in their life.”
He did note that he would discuss the importance of diet, exercise, and other lifestyle choices in these cases.
“After surgery for a partial nephrectomy or a small renal mass, patients are typically in the hospital for a day or two and then go home,” said Dr. Sonn. “If it turns out that it is kidney cancer, which is the most common, most likely event, then we will typically see patients back in three to four weeks just as a post-operative checkup to make sure that the wounds are healing up appropriately, to go over any questions. After that, my follow-up protocol is usually in-person visits and imaging with a CAT scan of the abdomen, with a chest x-ray every six months for a couple of years, and then once a year thereafter.”
The recovery is slightly longer for patients who have a kidney removed, but the outlook is just as good.
“For men with localized kidney cancer that’s completely removed with surgery, I will tell them that there’s approximately 90% chance that the kidney cancer will not come back or they will not go on to die of kidney cancer,” said Dr. Sonn. “So the outcomes of localized kidney cancer are quite good.”
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