Author: lindseyhemonc

Weighty Matters: The Kidney Cancer-Obesity Connection

By Shayne Robinson, R.D., C.S.O, C.D.N

In March, we celebrate both National Nutrition Month and Kidney Cancer Awareness Month. This makes it the perfect time to talk about whether what we eat can play a role in preventing kidney cancer.

So is there a connection between diet, exercise and kidney cancer?

The World Cancer Research Fund International Continuous Update Project seeks to find out. They analyze global cancer prevention and survival research linked to diet, nutrition, physical activity and weight to determine whether certain lifestyle factors affect cancer risk. They then release reports based on the evaluation of this worldwide data.

Map Kidney Cancer Obesity
Image credit: American Institute for Cancer Research, aicr.org

When it comes to the kidneys, there is strong evidence that being overweight or obese increases the risk of developing kidney cancer. In fact, the latest findings showed that maintaining a healthy weight could prevent 24% of all kidney cancers in the United States. The report also found that there was an association between body fatness and kidney cancer, such that the more overweight people were, the greater their risk of developing kidney cancer. Being overweight or obese was assessed by body mass index (BMI), waist circumference and waist-to-hip ratio.

The good news is that this means that we can make healthy lifestyle changes to lose weight and reduce our risk of developing kidney cancer.

Wondering if you should lose weight?

See where you stack up on a BMI chart and measure your waist circumference. To measure waist circumference, place a tape measure around your waist above the tip of your hipbone. Measure your waist after exhaling. For women, a waist measurement of 31.5 inches or more indicates high risk for obesity. For men, a waist measurement of 37 inches or more indicates high risk for obesity. If your BMI is over 25 or your waist circumference is above these numbers, talk to your physician or Registered Dietitian about starting a weight loss program.

Here are 6 tips to get started with a weight loss plan:

  1. Lose pounds the healthy way. Move more and eat less. Avoid fad diets.
  2. Avoid high calorie, energy-dense beverages. This includes fruit juice, soda, sweetened coffee beverages, lemonade and sweetened tea. These beverages don’t provide the satiety you will get from eating solid foods.
  3. Eat your veggies! Cut back on energy-dense, high-calorie foods by making half your plate raw or steamed, non-starchy vegetables. These high-fiber vegetables will fill you up without weighing you down.
  4. Portion control is key. Scale back on portion sizes, except the non-starchy vegetables. Using smaller plates can help.
  5. Get movin’ — Increase your physical activity. For some people, this may mean starting by walking to the mailbox and back. Aim for 30 minutes of physical activity a day. If you can’t do 30 minutes, start small and increase as your fitness improves.
  6. See a professional. Nothing replaces the individualized counseling you will receive from working with a registered dietitian (RD). To see a dietitian at the NewYork-Presbyterian Outpatient Nutrition Practice call (212) 746-0838. A physician referral is required.

Living with One Kidney? 5 Things to Know

Dr. Molina and Dan R.
With many types of kidney cancer, surgical removal of the cancerous part of the kidney is part of treatment. This is also known as a “nephrectomy.” Depending on the size and location of your tumor, you may have had all or part of the kidney removed. People only need one kidney, but it’s very important to protect your remaining kidney function since the kidneys are responsible for filtering your blood and removing wastes from your body.

March is Kidney Cancer Awareness Month and the second Thursday in March is World Kidney Day. After you’ve had all or part of your kidney resected in order to remove a tumor, there are certain things to keep in mind in order to preserve your remaining kidney function. Here are five things you should know:

  1. Certain medications may need to be adjusted or avoided. Medications should be dosed according to your level of remaining kidney function. This is called “renal dosing” and pertains to all medications filtered by the kidneys (which covers a diverse group ranging from certain medications for cholesterol, heart disease, blood pressure, diabetes, infections and pain). A medical oncologist who specializes in kidney cancer should take this into account when prescribing medications, including dosing for cancer treatments. Some over-the-counter drugs are also “nephro-toxic” or harmful to the kidneys. These include non-steroidal anti-inflammatory drugs (NSAIDs), a type of pain medication that includes ibuprofen (Advil®), aspirin and naproxen (Aleve®).
  2. Speak up before imaging tests. Certain imaging tests that might be necessary to see what’s going on in your body and determine whether your cancer has spread, require the injection of contrast dyes. It’s critical to tell the imaging technician that you only have one kidney before undergoing these tests or any procedures. You should also hydrate before and after the test, and you may need to stop taking certain medications beforehand, such as metformin for diabetes. It’s important to discuss your specific situation with your healthcare team before you undergo any procedures.
  3. Drink up! Drinking plenty of water and staying hydrated is important on an ongoing basis, not just when undergoing imaging tests. Being hydrated helps your kidneys filter the wastes and toxins out of your blood so that they can leave your body as urine. Aim for your urine to be clear or pale yellow. Staying hydrated also helps prevent kidney stones.
  4. Watch the sugar and hold the salt. Diabetes and high blood pressure can damage the kidneys, so it’s important to monitor your sugar and salt/sodium intake. People with only one kidney should consume less than 2300mg sodium each day. This is approximately one teaspoon of salt. Those with diabetes should regularly check blood sugar levels. Additionally, maintaining a healthy weight and incorporating physical activity can help prevent developing type II diabetes.
  5. Know your numbers. There are certain blood and urine tests that you’ll want to monitor for changes in your level of kidney function over time. These include your estimated glomerular filtration rate (eGFR) which indicates how well your kidneys are filtering the wastes from your blood, the albumin to creatinine (A:C) ratio which indicates the level of protein in your urine, as well as tests for blood and infection. Work with your primary care physician to make sure you’re receiving these tests on an annual basis and you should see a nephrologist (kidney function specialist) if your eGFR is less than 30 milliliters per minute (ml/min) or if you have large amounts of blood or protein in the urine.

What are Cancer Neoantigens? The Link Between Neoantigens and Immunotherapy

By Bishoy Faltas, M.D.

Our immune system has evolved over time to enable us to fight infections. Our bodies need to differentiate between our own cells (self) and cells from bacteria and viruses (non-self) in order to mount an effective attack to eliminate the invaders. In order to do that, our immune system has learned to recognize fragments of foreign proteins, which carry a specific sequence that marks them as “targets” for the immune system. We call these antigens.

Cancer cells thrive because they hide from the immune system, but their disguise is not perfect. Cells typically become cancerous because of changes in their genetic makeup. These same changes can result in proteins that the immune system is able to recognize as foreign. These are called neoantigens, and refer to new cancer antigens that cue the immune system to attack the cancer and eliminate it.

neoantigen[2]
New sequencing technologies enable us to detect new cancer antigens unique to each patient.
The immune system just needs a little help to make this happen. To tip the balance in favor of the immune system, we now use drugs called immune checkpoint inhibitors. These unleash the power of the immune system to attack the tumor. A good way to think about it is as “releasing the brakes” off the immune response. This approach to treatment is very promising for bladder cancer, especially when other treatments have failed to stop the cancer from progressing or metastasizing to other organs.

To understand which patients are most likely to respond to these immune checkpoint inhibitors, we conducted a study examining the neoantigens in bladder cancer patients at Weill Cornell Medicine. Our analyses found many differences in the neoantigens between untreated tumors and advanced tumors that had previously been treated with chemotherapy from advanced chemotherapy-resistant bladder cancers. More details on our findings can be found here:

In the future, we are hoping to use neoantigens as biomarkers that tell us which patients are most likely to respond to specific immunotherapies. A form of precision medicine, this will help us to narrowly tailor our treatment approach to each patient.

Some of our current immunotherapy treatments for people with bladder cancers include: