CancerGuide: Special Kidney Cancer Section
Tumors On Ice
Tumors can be preserved at very low temperature by freezing in liquid nitrogen. This preserves the internal and molecular structure of the cells for years. It may even be possible to retrieve viable cells when the tumor is thawed. Freezing your tumor is definitely not standard practice, and if you want to do it you'll probably have to arrange it yourself with cooperation from your doctors, but I am recommending it because I think there are likely to be major benefits in the foreseeable future.
Why Freeze Your Tumor?
Some years ago the Kidney Cancer Association advocated freezing your tumor in case a vaccine was developed that could be made from the frozen tumor in the future. I was never enthusiastic about this approach because all the vaccine protocols I knew of required fresh tissue, and no vaccines were close to being commercially available.
But a talk at the 2003 Kidney Cancer Association Convention by Dr. Bin Teh of the Van Andel Research Institute on gene expression profiling of kidney cancer convinced me that it is well worth consider arranging to have your tumor preserved but the reason is quite different from saving it for a vaccine.
Gene Chips and Gene Expression Profiling
It turns out that a revolution in "Genomics" is making it possible to profile the gene expression of tumors. This means finding out which genes are active in the tumor compared to normal cells and which genes are not. The character of a cell is largely determined by what genes are turned on.
The technique for determining your tumor's gene expression profile involves what are known as "gene chips" or more formally "DNA Microarrays". Gene chips are clever marriage between microelectronics and molecular biology which permit one to determine the amount of Messenger RNA (mRNA) for tens of thousands of genes at once in a single experiment. mRNA is produced when a gene is turned on. mRNA codes for and specifies the amino acids that make the protein specified by that gene and allows the gene's DNA to be translated into its protein.
What Gene Expression Profiling Might Be Able Do For You
What You Can Do Today
Gene expression profiling isn't available now...
Right now, this is strictly a research technique, not a standard test, and it isn't available. Also, research on gene expression profiling for kidney cancer is only in its infancy and it's too early to reliably fulfill any of the promises of this technique.
...but I predict it will be in the not too distant future
A tremendous amount of effort is being put into this area in cancer research because of its huge potential. In addition, the cost of gene chips is constantly falling. At the meeting the cost of a gene chip was said to be about $1000.00. Although this doesn't include the costs related to setting up a lab, quality control and running and interpreting the test, it's clear to me that with falling prices, increased automation, and increased knowledge of what gene expression profiles tell us, these tests will probably become both economical and useful some time in the next several years. I do have to tell you that most of the doctors at the conference were skeptical due to the costs and the difficulty of convincing insurance companies to pay, but anyone who's had a CT scan, an MRI, or a PET scan knows that several thousand dollars for an important test is far from out of the question.
I predict that gene expression analysis will first be available from small "boutique" labs and may not be routinely paid for by insurance companies. If your case has difficult to understand pathology, or if early information from gene expression analysis research begins to show how it can guide treatment decisions, you may find it useful even before it is in general use.
... and it can be done with frozen tissue
One of the other patients at the KCA conference (a physician) asked Dr. Bin Teh some very smart questions and we all learned that although this test can't be done with pathology slides or paraffin blocks (the standard method of preserving your pathology), it can be done with frozen tissue. And it turns out it's possible to have your surgical specimen frozen if you arrange it before surgery. If you have your tumor preserved today, then when the technology becomes available your tumor can be tested. From the discussion at the conference, it sounded as though freezing can preserve the tissue for many years.
Which Tumors Can Be Preserved?
The most common surgery for kidney cancer patients is a nephrectomy and the primary tumor is usually the biggest tumor mass. This then is the obvious choice. But patients having surgery for metastatic tumors might also be able to have the tumor preserved if the tumors are big enough.
The initial cost to have your tumor preserved will probably be in the range of a few hundred to a few thousand dollars. After an initial storage period, there may be a yearly storage charge which should be reasonable. The cost won't be covered by insurance and you should inquire carefully before signing up for anything.
How To Get Your Tumor Preserved
Important: You must arrange for tumor preservation before your surgery!
I am not yet sure of the best way to have your tumor frozen. Since the diagnostics I am talking about aren't yet standard, and there are different ways to handle and freeze tissue it's hard to know which is best. I am still looking into it.
Some References on Gene Expression Profiling in Renal Cell Cancer
Identification and classification of differentially expressed genes in renal cell carcinoma by expression profiling on a global human 31,500-element cDNA array.
Genome Res. 2001 Nov;11(11):1861-70.
Gene expression patterns in renal cell carcinoma assessed by complementary DNA microarray.
Am J Pathol. 2003 Mar;162(3):925-32.
Transcription profiling of renal cell carcinoma.
Verh Dtsch Ges Pathol. 2002 ;86:153-64.
Differential gene expression in renal-cell cancer.
J Lab Clin Med. 2002 Jul;140(1):52-64.
Gene expression profiling of clear cell renal cell carcinoma: gene identification and prognostic classification.
Proc Natl Acad Sci U S A. 2001 Aug 14;98(17):9754-9.
Predicting survival in patients with metastatic kidney cancer by gene-expression profiling in the primary tumor.
Proc Natl Acad Sci U S A. 2003 Jun 10;100(12):6958-63.
This CancerGuide Page By Steve Dunn. © Steve Dunn
Page Created: August 6, 2003, Last Updated: June 12, 2004