Managing Stage III Renal Pelvis Cancer: Treatment Options for Elderly Patients

Q: Managing Stage III Renal Pelvis Cancer: Treatment Options for Elderly Patients

Hello： Your father should undergo examination and treatment at a major hospital, as he is already in stage 3. <br>The 5-year survival rate is approximately 50-60%. <br>If his physical condition is good, aggressive treatment can be pursued. <br>However, if his health status is poo

Stage III renal pelvis cancer

Director Du: My father underwent a CT scan that revealed a tumor in the renal pelvis, which was confirmed as renal pelvis cancer through a biopsy.
He subsequently had a left nephrectomy and lymphadenectomy near the ureter, and the pathology report indicated stage III renal pelvis cancer.
The doctor has suggested three options for postoperative treatment: chemotherapy, immunotherapy, or regular monitoring.
However, my father is already 84 years old.
Which option would be the most suitable? Chemotherapy may adversely affect his remaining right kidney, and immunotherapy is quite expensive with uncertain immune responses.
Would it be too late to initiate treatment if we only monitor for recurrence? I would appreciate your advice.
Thank you!

Liao Xiansheng, 50~59 year old female. Ask Date: 2023/02/25

Dr. Du Shixi reply Urology

Hello: Your father should undergo examination and treatment at a major hospital, as he is already in stage 3.
The 5-year survival rate is approximately 50-60%.
If his physical condition is good, aggressive treatment can be pursued.
However, if his health status is poor, such as low activity levels, low compliance, or the presence of other chronic diseases, especially two or more, a more conservative approach may be advisable.
Major hospitals will provide ample information, and it is essential for the family and the patient to reach a consensus.
Otherwise, whether opting for aggressive or conservative treatment, a decision must be made.
As you mentioned, it would not be ideal to wait until a recurrence occurs to take action.
Wishing you good health.

Reply Date: 2023/02/25

More Info

Managing Stage III renal pelvis cancer in elderly patients, particularly those who are 84 years old, requires a careful and individualized approach. The treatment options available typically include chemotherapy, immunotherapy, and active surveillance (or regular follow-up). Each of these options has its own benefits and risks, especially in the context of an older patient with potentially limited renal function.

1. Chemotherapy: This is a standard treatment for advanced renal pelvis cancer. However, in elderly patients, especially those with only one functioning kidney, the risks associated with chemotherapy can be significant. Chemotherapy can lead to nephrotoxicity, which may further compromise renal function. Additionally, older patients may have a different tolerance to chemotherapy, experiencing more severe side effects compared to younger patients. Therefore, if chemotherapy is considered, it is crucial to monitor kidney function closely and adjust the treatment regimen accordingly.

2. Immunotherapy: This treatment option has gained traction in recent years for various cancers, including renal pelvis cancer. Immunotherapy can be effective and may offer a different side effect profile compared to traditional chemotherapy. However, the cost can be a significant barrier, and the potential for immune-related adverse effects must be considered. In elderly patients, the immune system may not respond as robustly as in younger individuals, which could affect the efficacy of immunotherapy. A thorough discussion with the oncologist about the potential benefits and risks, as well as the financial implications, is essential.

3. Active Surveillance: Given the patient's age and the potential risks associated with aggressive treatment, active surveillance may be a reasonable option. This approach involves closely monitoring the patient’s condition without immediate treatment, intervening only if there are signs of disease progression. This strategy can be particularly appealing for elderly patients who may have other comorbidities or who may not tolerate aggressive treatments well. However, the concern with this approach is that if the cancer progresses, it may limit future treatment options and potentially lead to a more complicated clinical situation.

4. Quality of Life Considerations: At 84 years old, the patient's quality of life should be a primary consideration in treatment decisions. It is important to weigh the potential benefits of aggressive treatment against the likelihood of side effects and the impact on the patient's overall well-being. Engaging in a shared decision-making process with the patient (if possible) and their family can help align treatment choices with the patient's values and preferences.

5. Multidisciplinary Approach: Involving a multidisciplinary team, including oncologists, nephrologists, geriatricians, and palliative care specialists, can provide a comprehensive evaluation of the patient's condition and treatment options. This team can help tailor the treatment plan to the patient's specific needs, taking into account their overall health status, kidney function, and personal preferences.

In conclusion, managing Stage III renal pelvis cancer in an elderly patient requires a nuanced approach that balances the potential benefits of treatment with the risks and the patient's quality of life. Chemotherapy and immunotherapy are viable options, but careful consideration of the patient's renal function and overall health is critical. Active surveillance may also be appropriate, depending on the individual circumstances. Ultimately, a collaborative approach involving the patient and a multidisciplinary team will yield the best outcomes.

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