‘Doctor, I’m only 32. How can I have cancer?’

It was a usual Monday morning in my OPD this Sept when a young man in his early 30s walked in for what he believed would be a routine check-up. He was fit, cheerful and entirely asymptomatic. He only wanted an ultrasound because his company offered it as part of an annual health plan. Little did he know that this harmless screening test would alter the course of his life forever. The radiologist performing his abdominal scan paused a little longer than usual, his eyes narrowing at the monitor. He called me in. There it was, faint yet unmistakable: an irregular mass in the upper pole of the right kidney, large enough to be concerning yet small enough to fall in the early detection category. We ordered a contrast CT to confirm. The diagnosis arrived with the weight of a hammer: renal cell carcinoma (RCC). “Doctor…. I don’t even feel unwell. I don’t smoke much. I’m only 32. How can I have cancer?” His voice was unsteady. It’s a question I hear more often each year. Kidney cancer is typically seen in men above 50. I explained that many kidney tumours are silent and only discovered incidentally. The scan placed his tumour in the T1a category (less than 4 cm), which, if caught early, offers an excellent chance of cure. The priority in someone his age is to remove the cancer and preserve as much healthy kidney as possible. I recommended a robotic partial nephrectomy, a precision surgery through keyhole incisions to remove only the tumour with a slim rim of normal tissue, saving the rest of the kidney. He agreed. Within a few days, we prepped him for surgery, carefully mapped the tumour, temporarily controlled the blood flow to the kidney, excised the mass, reconstructed the defect, and restored circulation. The surgery was done within three hours and by evening, he could sit up straight. He started walking the next day and went home on day three. Pathology confirmed clear cell RCC confined to the kidney, with negative margins, no spread, no residual disease, which meant he did not require chemotherapy or radiotherapy. During counselling after surgery, while we revisited his family history, we got to know his grandmother also had a kidney tumour in her 40s. This information completely changed the picture. We recommended genetic testing. His blood test came back positive for a change in the VHL (von Hippel–Lindau) gene, a hereditary condition that raises the risk of kidney tumours and certain other tumours over one’s lifetime. Each child of a person affected with the VHL gene change has a 50% chance of inheriting the variant. Not everyone is affected the same way or at the same age, but the lifetime risks are significant. With structured surveillance, most problems can be detected early. While surgery cured his current cancer, modern targeted therapies give us additional tools. Belzutifan (HIF-2α inhibitor) can shrink VHL-related kidney tumours and other VHL tumours, helping delay or avoid repeat operations. VEGF/tyrosine kinase inhibitors (TKIs) such as sunitinib, pazopanib and axitinib are used mainly in advanced RCC to cut off the tumour’s blood supply. Immunotherapy (checkpoint inhibitors like nivolumab or pembrolizumab) is effective in advanced RCC and adjuvant use may be considered in select higher-risk post-operative cases. Dr Suryavanshi is head of uro-oncology at Amrita Hospital, Faridabad. He spoke to Steffy Thevar