The Diagnosis of a Patient with Stage 4 Renal Cell Cancer
Karl J. D’Silva, M.D., and Steven Gallant discuss the process of being diagnosed with stage 4 renal cell cancer.
PUBLISHED June 24, 2019
Karl J. D’Silva, M.D.: Hi. Welcome to this CURE Expert Connections® for oncology. I’m Dr. Karl D’Silva. I’m a medical oncologist and a hematologist and a medical director for the Lahey Cancer Center in Peabody, Massachusetts.
Hi Steve, welcome to the meeting.
Steven Gallant: Thank you.
Karl J. D’Silva, M.D.: Can you share with us the story about your diagnosis of renal cell cancer?
Steven Gallant: Absolutely. January. 13th, 2018, I was working in Boston and I was up on a lift and I went right to my knees in pain, and the pain was in the back. I said to my partner, “Mac, I’m not doing too good.” And he was like, “What’s going on?” And I said, “I got a pain in my back. It feels like what my buddy always talked about when he had kidney stones.” And he said, “Gee, Steve, come on down, why don’t you take a break.” So I took a break, I went up back of the jobsite and I lay down and I started drinking water. And after like 20 minutes I went to the bathroom and I urinated straight red. So I went out front and said, “I gotta go to the hospital.” My buddy said he knew somebody at Burlington Lahey Clinic. He said, “Steve, they’re the best kidney people.” And I said, “I’ll go try there.” Because here I was in Boston, I figured I’d go to Mass General maybe. And he was like, “No, go to Lahey Clinic in Burlington.”
So I went to Lahey Clinic and got admitted right away. When I told them what was going on they brought me right in and started blood tests right away. And they had a CT [computed tomography] scan done and within a couple of hours my team of doctors came in and told me what the diagnosis was.
Karl J. D’Silva, M.D.: Wow, that’s a very impressive story. So you presented with some blood in the urine. You had back pain, and you hardly could even walk down the lift, wow. Then when they told you about your diagnosis that there was a mass in the belly, what was your decision at that time?
Steven Gallant: Right away, Dr. Harras Zaid, M.D., who ran the team is the one who approached me and said that there was a mass in my kidney. And he said it was stage 4 renal cell carcinoma. And believe it or not, you know me now after a year, and so you know what I’m like, I didn’t even blink. Right away I put my hand up and I said, “Wait a second.” I thought about what it meant to me. And I’ve come to believe over the last 20 years that any physical injury manifests from the spiritual world.
I know a lot of people don’t believe in that, but I figured that the blood stream represents the flow of life. And the kidneys being a part of that and filtering out the blood flow meant that I was possibly neglecting my flow of life, and that’s exactly what went through my mind right after he told me. So once I figured out why it manifested physically like that from the spiritual world, I looked at him and I really smiled and I said, “All right, I understand, I got it, what can we do? What’s next?”
Karl J. D’Silva, M.D.: Steve basically represented one of the standard presentations of a stage 4 renal cell cancer. The tests that were done on him were basically, he came to the emergency department and presented with flank pain, hematuria, and the first thing we do is imaging studies of the abdomen and the pelvis, and you see a huge mass there. And that’s how we were able to come to a diagnosis of renal cell cancer.
So NCCN guidelines that we use today, called the National Comprehensive Cancer Network guidelines, are used to determine whether the patient is in the good risk, intermediate risk or the high risk category. And this criteria have been devised because of the presence of new novel therapies that have been used in the treatment of renal cell cancer.