Professor Grant Stewart has led the development of the first national guideline on improving the diagnosis and management of kidney cancer.
By offering more patients with a kidney lump a biopsy, clinicians can tell patients if the lesion is cancer or benign and if they need to consider a treatment like surgery, or if they can avoid these treatments
Grant Stewart
The guideline, published today by the National Institute for Health and Care Excellence (NICE), promotes the gold standard approach to the management of kidney cancer across all stages of the disease.
The new recommendations aim to improve kidney cancer care across the NHS by helping healthcare professionals offer people the right treatments and support, while considering individual preferences.
Professor Grant Stewart, who co-directs the Urological Malignancies Virtual Institute at the University of Cambridge and is Director of Studies in Clinical Medicine at Selwyn College has been the clinical lead for developing the guideline on kidney cancer.
The guideline covers all stages of diagnosing and managing patients with renal cell carcinoma, the most common type of kidney cancer. It includes recommendations on imaging, biopsy, active surveillance, risk prediction, surgical and non-surgical treatments, and drug therapy.
One of the key recommendations in the guideline is to offer biopsies to more people with suspected kidney cancer. This would mean more people with a small kidney lump - which is a mass measuring 4 centimetres or less - are offered a biopsy to confirm their diagnosis.
A biopsy is when a sample of abnormal cells is collected using a needle through the skin into the tumour in the kidney during a CT or ultrasound scan. The cells are then tested to confirm whether or not the lump is cancer, or in fact benign. The results help clinicians offer the best treatment options, possibly avoiding unnecessary surgery in people with benign or low-risk tumours.
This recommendation could double the number of biopsies undertaken on suspected kidney cancer patients. The committee acknowledged that some hospitals would need to adapt their clinical pathways to offer biopsies to more patients, but that reducing unnecessary surgeries would benefit patients and save surgical costs.
Professor Stewart, who is also Consultant Urological Surgeon at Addenbrooke's Hospital, said: "By offering more patients with a kidney lump a biopsy, clinicians can tell patients if the lesion is cancer or benign and if they need to consider a treatment like surgery, or if they can avoid these treatments which do have some risks associated with them."
Another important recommendation is that patients should have access to a clinical nurse specialist with training and experience in kidney cancer to provide support and information, from their initial diagnosis through their treatment and follow-up.
The committee acknowledged that more clinical nurse specialists may need to be recruited, and specialist training provided, to be able to offer this support to all kidney cancer patients.
Professor Stewart added: "Access to a clinical nurse specialist, with training and experience in kidney cancer care, will ensure that patients have a single point of contact for all the questions at any time that arise during their care journey."
Professor Stewart has long been championing practice-changing initiatives to improve the management and outcomes of kidney cancer patients.
He has already introduced a new kidney clinic at Addenbrooke's Hospital where patients with suspected kidney cancer receive their diagnosis on the same day, reducing the anxiety of waiting days or weeks for test results.
Professor Stewart explained: "In Cambridge, we have developed a one-stop biopsy clinic for kidney cancer, so we can biopsy more patients while reducing the time patients wait between presentation and diagnosis to half the time for the traditional multi-appointment route."
Adapted from a story from the Cancer Research UK Cambridge Centre
