Michael Brandy, Deseret News
Given the choice of being "cut in half" or of having surgeons create four small holes for surgical instruments to do their work, it's hard to believe kidney cancer patients would choose the more radical option — particularly if the outcome was the same.
Yet because many Utahns don't know they have a choice, they opt for more radical surgery, according to Dr. Jay Bishoff, a urologist and medical director of the Intermountain Urological Institute at Intermountain Medical Center.
Bishoff and his fellow urologist at the institute, Dr. Scott Chidester, will answer questions about kidney cancer, prostate cancer, kidney stones and other related topics on Saturday from 10 a.m. to noon during the monthly Deseret News/Intermountain Healthcare Hotline. Callers can reach them toll free at 1-800-925-8177 or by e-mail on Saturday only at email@example.com.
The rate of kidney cancer in Americans has skyrocketed during the past 35 years, up 70 percent from 1973 to 1998, and up another 23 percent from 1998 to 2008. Why?
"We just simply don't know," Dr. Bishoff said.
There are approximately 235 cases of kidney cancer in Utah each year.
Yet the advent and prevalence of CT scanning has dramatically increased the rate of early detection, though it usually happens while doctors are examining patients for some other ailment, he said. The disease has no real symptoms in and of itself, and when patients learn they have the cancer, their family members become nervous, he said.
"I haven't treated a case of kidney cancer in the past several years where at least one family member didn't ask me if they should be screened as well."
The only sign that the cancer may be present is blood in the urine, but typically there is no pain associated with that condition, which is also present in a variety of other ailments.
Because chemotherapy and radiation are not effective against kidney cancer, surgery is the only option for treatment.
Though laparoscopic surgery for the disease was first done in 1990, "it's taken the urology community a long time to say this is a good idea," Bishoff said, noting many older urologists were never trained in the procedure.
In Utah, only 30 percent of surgeries are being done with laparoscipic techniques, yet 90 percent of those cancers can be treated this way, Bishoff said.
"Patients go home sooner and their recovery time is much shorter." Recovery time for surgery performed with a laparoscope is three to four weeks, while the "front to back" incision required by the traditional methods means three to four months of recovery time. "There's a huge difference in pain and morbidity" between the two, he said, noting if patients understand there is a choice, they can make the decision that best suits them.
But many patients aren't told they have an option, he said. "Older urologists don't want to give up cases to younger guys who do it this way. They keep cutting into people" and removing entire kidneys when laparoscopy often allows doctors to simply excise the tumor and leave the rest of the kidney in place.
Because so many patients will eventually deal with the kidney problems that accompany diabetes and high blood pressure, it's important to leave as much functional kidney in place to help avoid the need for dialysis later on, he said.
The older surgical technique requires "making a huge incision," where the 11th rib is removed and you "essentially cut the patient in half to get (the diseased kidney) out." Bischoff said he knows of at least two local clinics where one urologist can perform the procedure, but his partners don't tell their own patients about it.
"Several patients of mine stumbled into laparoscopy. They never knew it was available until they called me to find out."
In fact, one of his clinic's own rotating nurses had a kidney mass and was scheduled for major surgery the following week, he said. While taking care of a patient with four small holes on the abdomen, she asked why there was no incision. When the patient told her the holes were the only entry point, "she just about passed out, because the next week she was supposed to have that huge incision."
When she asked her physician why he didn't tell her about it, she was told, " "I don't do that, I'm not sure about cancer control."
Yet studies comparing the two procedures have shown that cancer control "is the same for both," Bishoff said. Patients need to ask "do you do (the less invasive surgery), and if not, who does."
On Saturday: treatment options for prostate cancer and kidney stones. Questions taken either by phone or via e-mail.
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