2005 Cancer Report

Kidney/Renal Pelvis Cancer

Site Cases And Comparisons for 2004
Cancer Registry Data Summary For 2004
2004 Kidney/Renal Pelvis Cancer Study by G. Bino Rucker, M.D.

Our Cancer Program

The Oncology Committee of Manatee Memorial Hospital is pleased to present this brief overview of our cancer program. The annual report has been available online for five years.

Manatee Memorial Hospital is dedicated to serving our cancer patients and their families. We offer community outreach programs that include health fairs and cancer support groups.

Cancer Registry Data Summary for 2004

A total of 889 cancer patients were treated at Manatee Memorial Hospital during 2004. Of those, 624 were analytic cases (cases diagnosed and/or treated by our medical staff. The remaining 265 patients were non-analytic (diagnosed and treated elsewhere). (See below.)

Other areas that a registry reviews are the numbers of men and women diagnosed with cancer as well as their race. Our population demonstrates that 55% men and 45% women were diagnosed with cancer in 2004. The race distribution showed 92% were Caucasian, 7% were African-Americans and less than 1% were other races.

Age is an important factor and annual health exams should continue, as we grow older. The largest age group diagnosed with cancer was those persons from 70-79 years old; they represent over 49% of our 2004 population.

Staging cancer is one of the most important components from the physician’s viewpoint. Determining the stage of the disease or how far it has spread in the body helps him/her determine the type of treatment best suited for those diagnosed with cancer.

The stages run from Stage 0 to Stage IV. The higher the number, such as stage IV, means a more serious cancer. The stage breakdown at Manatee Memorial is:

Stage 0 – 7%
Stage I – 20%
Stage II - 17%
Stage III – 16%
Stage IV – 20%
Stage Unknown – 9%
Stage Not Applicable – 10%

Click to view 2004 Primary Cancer Sites chart.

The five most frequent sites of cancer seen at Manatee Memorial during 2004 are demonstrated below. A comparison is made to State, National and Florida statistics.

Lung cancer was our number one site with 24% at MMH, the State of Florida reported 19%. Our second most prominent site was Breast with 17% diagnosed at Manatee Memorial and 16% seen in Florida. Colorectal cancer, Prostate and Kidney cancers were our third, fourth and fifth most frequently registered sites at Manatee Memorial. Kidney cancer has significantly increased at MMH with 6% compared to National data of 3%.

Click to view Five Most Frequent Cancer Sites.

Below you will find a detailed presentation by G. Bino Rucker, M.D. regarding kidney cancer.

Kidney/Renal Pelvis Cancer Study Reviewed by: G. Bino Rucker, M.D.

The kidney and renal pelvis are part of the upper urinary tract system. The kidney filters about 200 quarts of blood daily and sifts out approximately two quarts of extra water and waste products which becomes urine. The urine is transported into the kidney’s collecting system know as the renal pelvis. Urine is then moved through the ureters to the bladder and exits the body through the urethra. This study will focus on the kidney and the kidney’s renal pelvis. The more common term kidney cancer will be used to represent both entities.

The American Cancer Society estimates 36,160 new cases of Kidney cancer will be diagnosed in 2005. This report will present the 2004 kidney malignancies diagnosed at Manatee Memorial Hospital (MMH) and compare this site of cancer to national statistics.

The most common type of kidney cancer is renal cell cancer. It accounts for greater than 90% of all malignant kidney tumors. There are subtypes of renal cell carcinoma, the more common include, clear cell, papillary, chromophobe cancer. About 80% of renal cell cancers are clear cell type. This is consistent with the cases at MMH.

There are risk factors that have been attributed to kidney cancer. These include smoking, obesity and job hazards. National studies have implicated exposure to asbestos, cadmium (a type of metal), benzene and organic solvents. These exposures may have been encountered at certain jobs types. Just because someone has had this exposure does not lead to kidney cancer. There are people who have not had this type of exposure or any of the above risk factors and still develop kidney cancer.

The following information is regarding kidney cancer, comparing MMH to the National Cancer Data Base (NCDB). The NCDB was designed by the American Cancer Society and the American College of Surgeons. The NCDB is a format that allows accumulation of standardized data of major cancer sites from hospital cancer registries. The NCDB data is taken from 2002 & 2003 statistics from over 1300 hospitals in the United States. The five year observed survival data for NCDB’s cases are from 1995 and 1996.

Incidence
During the year 2004 MMH registered 33 analytic cases of kidney cancer. This represents an increase of 14 cases from the previous year. As demonstrated below there has been a significant increase in kidney cancer in 2004, compared to previous kidney malignancies diagnosed at MMH.

Click to view Yearly Percentage of Kidney Cancer
Diagnosed at Manatee Memorial chart,

Age and Gender
The NCDB data demonstrates the greatest number of patients were diagnosed in the 70-79 age group. At MMH the 60-69 age group represented the greater number of patients. According to national data, kidney cancer is found approximately twice as often among men as among women.

Click to view Age at Which Cancer
Patients Were Diagnosed chart.

Stage
The stage at diagnosis is very important to the treatment plan. Staging is the process of finding out how the cancer has spread. The earlier the diagnosis is made the more favorable the prognosis. Staging in kidney cancer is based on the size of the tumor and the extension of tumor into tissues surrounding the kidney. Staging also considers if the tumor has spread to organs distant from the kidney. Stages are labeled using Roman numerals 0 through IV. The lower the number the less cancer has spread, the higher the number, such as Stage IV means the cancer has spread to other organs. The NCDB reports Stage I (early cancer) was diagnosed in 47% of the patients, Stage IV (cancer spread to other organs) in 19% of the patients. At MMH we demonstrate 42% at Stage I and 18% at Stage IV.

Click to view Stage At Time of Kidney Cancer Diagnosis chart.

Treatment
The most common type of treatment for kidney cancer is surgery. Surgery may include procedures which remove the entire kidney (radical nephrectomy). If not a radical nephrectomy patient may have a partial nephrectomy (part of kidney removed). The roles of radiation therapy, chemotherapy and immunotherapy are most often used if the cancer has spread beyond the kidney. Newer modalities such as laparoscopic cryoablation are emerging.

Click to view 2004 Kidney Surgery at Manatee Memorial chart.

Survival
As demonstrated below, MMH 5 year observed survival rates compares similarly to national statistics. There are several factors to keep in mind when reviewing survival statistics. The patients co-morbid conditions (other illnesses) must be considered as well as the stage (when the cancer was discovered).

Click to view Kidney Cancer Survival Rates chart.

Conclusions
Kidney cancer can involve the risk factors discussed above. As with any type of cancer a healthy lifestyle is one form of prevention. If you have had exposure to the environmental factors mentioned, share this information with your physician. If a family member has been diagnosed with renal cell carcinoma or von Hippel-Lindau disease, also share this information with your physician.

What is Cancer Registry?

The Cancer Registry is a data collection center for all cases of cancer diagnosed and treated at Manatee Memorial Hospital. The medical records of all oncology patients are analyzed by the Cancer Registrar to determine stage, treatment and survival. An important component of the Registry’s work is annual lifetime follow-up of all our former patients.

Manatee Memorial’s Cancer Program is an approved program by the American College of Surgeons' Commission on Cancer. This means our cancer program has met stringent requirements in the care of our cancer patients. We perform annual patient care evaluations, comparing ourselves to national statistics; we also assist in preparing the Cancer Management Conferences and the Oncology Committee meetings. We must follow Florida State Law by reporting malignancies to the Florida Cancer Data System. In addition, we work with the American Cancer Society on various projects throughout the year.

The success of our cancer program would not be possible without the support of administration, the medical staff and ancillary departments. Special thanks go to our volunteers, Florence Barstow and Donna Rose who give unselfishly of their time each week.

Physicians mentioned in this are independent contractors who are not agents or employees of Manatee Memorial Hospital or an affiliate agency. Manatee Memorial Hospital is not liable for any acts or omissions made by any physician, physician assistant nor in following an order of a physician.

2005 Cancer Program Annual Report was produced by the Cancer Registry and the Marketing Department at Manatee Memorial.

For further information, contact The Cancer Registry, (941) 745-7539.

Jamie Suarez, RHIT, CTR
Cancer Registrar

Accuracy of the Registry data contained in the 2005 Annual Report depends upon complete documentation in the medical record. If the treatment plan is not known upon discharge of the patient, the Cancer Registry contacts the appropriate physician's office to ascertain if the first course of treatment was given at another location. In some cases, patients initially refuse treatment or subsequently receive treatment after the first four months.

2004-2005 Oncology Committee

Thomas Farrell, M.D.
Cancer Liaison for Manatee Memorial

K. Telukuntla, M.D.
Chairperson, Medical Oncology

T. Farrell, M.D. (ACoS Liaison)
Pathology

A.S. Hassan, M.D.
Surgery

C. H. Inalsingh, M.D.
Radiation Oncology

Y. Nadiminti, M.D.
Medical Oncology

J. Pecoraro, M.D.
Surgery

P. Ray, M.D.
Radiation Oncology

G. B. Rucker, M.D.
Urology

M. Saunders, M.D.
Pathology

L. Silverman, M.D.
Radiology Oncology

M. Stoll, M.D.
Radiology

Non-Physician Members:

B. Chambliss
Director, Promotions/Marketing

G. Christine
Chief Financial Officer

N. Dugas, RN
Manager, Outpatient Services

G. Fisher, D. Min
Chaplain

C. Hardin, MS
MSA Coordinator
Performance Improvement

J. Hawkins, RN
Nurse Manager, Oncology Department

B. Heinz, RHIA
Director, Health Information Management

E. Honig, RN, OCN
Director, Care Management

P. Jefferson
Director, Imaging Services

K. Lowder, Pharm.D.
Pharmacy

D. Mann, RN
Director, Maternal Child Services/ Medical/Surgical

M. Theroux, Ed.D., MSN, RN
Director, Performance Improvement

Cancer Registrar:
J. Suarez, RHIT, CTR

Definition of Terms

American College of Surgeons – The ACoS, Commission on Cancer is referred to in this text in reference to breast cancer patient care evaluation. The ACoS is the organization that surveys and approves cancer programs.

Analytic – Pertains to those cases initially diagnosed and/or receiving their first course of treatment at Manatee Memorial Hospital.

Florida Cancer Data System – The FCDS is an incidence registry for the State of Florida. FCDS is a cancer registry administered by the Florida Department of Health and is operated and maintained by the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine.
Nonanalytic (N/A) - A case diagnosed and treated elsewhere prior to being seen at Manatee Memorial Hospital. Cases that were treated greater than four months after initial diagnosis. Cases that were initially diagnosed at autopsy are considered nonanalytic as well.

SEER – Surveillance, Epidemiology, End Results this program is a division of the National Cancer Institute. SEER publishes cancer incidence and survival data from 11 population-based registries.

Stage – The registry records stage using the AJCC (American Joint Committee on Cancer Manual) for staging guide. Stage 0, I, II, III, IV or Unknown.

Survival – The actuarial method of calculating survival provides a means for using all follow-up information accumulated up to the closing date of study.

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