Advice for Patients with RCC Choosing a Treatment Option



Karl J. D’Silva, M.D.: So Steve, once you were told that you would need to go for treatment, what was the treatment that was offered to you?

Steven Gallant: Well, they pretty much offered me three right off the top. He said, “You can go home and just take what comes.” I kind of laughed at that. And he said, “We could operate, take out as much as we can and get what we can.” And he said third, “You could start treatment right away, maybe chemotherapy or radiation or something.” I jumped right away. I said, “Listen, if you can take out as much as you can, I’ll take care of the rest.” I said, “I’ll work on the rest. I’ll do the medication after that and we’ll see what happens.” So I was ready for the operation right away.

Karl J. D’Silva, M.D.: Good. So, when I look at renal cell cancer we always think, can the outcome and prognosis differ depending upon the stage of the disease? Oh, definitely. Because usually we look at if they are stage 3, which means T3, 7 centimeters or above, as well as presence of lymph node involvement, that falls into the high-risk category. So we know that Steve had stage 4 disease, and it had gone to the liver as well as the lung. At that point we needed to do something to prevent the cancer from progressing very rapidly. So he elected to go for surgery because we know that kidney cancer has a lot of the immunological factors and angiogenic factors that drive the cancer. And if we can cut off that supply of these factors into the circulation, at least thereafter we could treat them with some of the novel agents.

So your outlook at that time pretty much changed when you came to know you were stage 4 disease. And basically, since you have gone through this and now you’re looking really good, do you have any practical advice for patients who are undergoing a diagnosis of renal cell cancer?

Steven Gallant: That’s a tough question because there’s so many different areas you can touch on. But whenever you go to the hospital you should be positive, never feel like a victim. That victim mentality just creates a negative flow in the body. So I went thinking I had kidney stones, I didn’t think it was a big deal. And when they diagnosed me, as they did, I still really didn’t blink because I’m such a positive person. I just stayed positive and I believed that whatever was going to happen was the way it was supposed to be. And as it happened, it was synchronistic because of how I ended up with you as a doctor.

Karl J. D’Silva, M.D.: Yes.

Steven Gallant: For one thing I had a different doctor that was on my team who got called away for an emergency because of his wife. And they ended up having me with Dr. D’Silva, who part of what he does is research, and the other doctor was more old-school. So I probably would have been pushed into a different venue.

Kind of jumping ahead because the operation was pretty radical. It was a lot longer than they thought it was going to be, more involved, and more damage was done. They not only took the kidney, part of my liver, lymph nodes, other tissue; they went into the inferior vena cava, which ended up only being at 30% working order right now, which is a side effect from the operation. Nothing to do with the cure of the cancer itself other than it’s something I’m going to have to live with. And then after the operation is when I was introduced to you, and that was within a couple of weeks after the operation, correct?

Karl J. D’Silva, M.D.: Yes, it was basically one week after the surgery, Steve comes to my office.

Steven Gallant: In a wheelchair.

Karl J. D’Silva, M.D.: In a wheelchair, and he was really sick, and I had to help him up to get on to the examination table, and he had also developed a large clot, so it was not easy. And I said, wow, this is not going to be easy to treat him. I said to him, “You need to recover from the surgery, and we’ll see how that happens.” Usually we wait about four weeks to start the treatment and decide what the frontline therapy is going to be.

Transcript Edited for Clarity

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