Healthcare Professional Perspectives on Diagnosing RCC

Healthcare professionals contextualize Terri Blalock’s experience by highlighting the typical presentation of RCC and elucidating workup procedures used to confirm a diagnosis.


Hans Hammers, MD, PhD: You presented with very advanced kidney cancer. Unfortunately, you had a large mass where the cancer came from and then had spread. In the abdomen, there were implants across the abdominal lining. You had innumerable lung nodules. There were so many that we couldn’t count them, and they probably contributed to your oxygen requirements. You were on oxygen, and you were in dire straits. There’s no doubt about it. It was a very challenging situation. You had a biopsy that was performed to confirm the diagnosis, and it from your kidney mass. I’m not sure if you remember that.

Terri Blalock: I do remember that. Yes, they performed a biopsy.

Hans Hammers, MD, PhD: Good. Let’s take a step back. Obviously, not everybody presents like Terri. In fact, her presentation went to the hospital, and that’s where we started things, and we can go into that in a few more minutes. I’m a medical oncologist, so I see patients with metastatic kidney cancer. What’s the spectrum of disease that you see over symptoms and signs of kidney cancer?

Laura Sanza, PhD, MPAS, PA-C: Patients can present in all sorts of ways. Most of the time, the presentation can represent the organ systems involved, such as in Ms Blalock’s case. There may be a shortness of breath, coughing, and new oxygen requirements because of the disease in her lungs. Patients can present with pain when they have metastatic disease to the bone. They can present with confusion, altered mental status, even seizures if there is disease to the brain. They can present with neurological deficits if the spinal cord is involved. They can present with physiological changes, weight loss, decreased appetite, and fatigue. But sometimes, patients can present without any symptoms, and a renal mass or metastatic disease is found incidentally because of imaging or work-up for something totally unrelated to the cancer. There are a wide variety of symptoms, and often they could be symptoms that don’t even make someone think of cancer. such as in Ms Blalock’s case. She presented with family thinking that this is pneumonia, or in the middle of the pandemic, thinking is it COVID-19? It turns out to be quite a surprise to learn that you have malignancy and it’s metastatic.

Hans Hammers, MD, PhD: Linie, anything from your perspective?

Linie Chi, NP: Usually, like Laura said, they can present like Ms Blalock. Sometimes, I walk into the clinic and you see they are generally pale and fatigued. They’ve been sleeping a lot of hours throughout the day. They’re not able to tell you why. Sometimes with men, they’ll tell you about retention, or blood in the urine. They’re like, “I thought it was a kidney stone. I thought it was gone, and then it came back again.” They go to their primary care and do an ultrasound. Usually, most of them are not thinking kidney cancer, and it ends up being kidney cancer.

Hans Hammers, MD, PhD: Kidney cancer is not the most common cancer. It’s not one of the big 4, if you will. It’s also one of the cancers we don’t screen for, we don’t have good screening tests. A lot of patients are surprised, quite frankly. It’s a big mass that grows in a pouch of fat. Patients are often disappointed because their primary care physician didn’t catch it, but the truth is, it’s really difficult to find. Laboratory [test results] are typically normal until it could be very advanced. The regular physical exam will not find a medium-sized mass. It’s a difficult thing to do with just a physical exam and regular lab work. It is true, most of the time, they will be diagnosed with imaging studies often done for a completely different reason, and the more free use of these agents.

Essentially, when she came to the hospital, she was fully staged, had some mental status changes. We also did an MRI of the brain. Fortunately, there was no cancer in the brain, but actually a series of mini strokes, probably from some hypercoagulability, meaning some clotting of the blood. We see this sometimes in advanced cancer. A biopsy was performed that showed clear cell kidney cancer, which allowed us to then think about therapies.

Transcript edited for clarity.

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