When Ralph Auriemma, 71, found out he had a kidney stone in 2020, he didn’t expect it to lead to a cancer diagnosis.

“I was surprised. I knew there was something going on, but I didn't suspect cancer,” says Ralph, a retired tractor-trailer driver who lives in Ridgefield Park, New Jersey, with his wife of 45 years. “I'm in pretty good shape, and I never had any real problems besides crashing motorcycles and things like that.”

His general practitioner detected blood in his urine during a routine test—this, plus a slight difficulty in urinating, were Ralph’s only symptoms that something was amiss. He was referred to urologist Debra Fromer, M.D., at Hackensack University Medical Center, where he was diagnosed with a kidney stone.

“When they went in to remove the kidney stone, they found a tumor, and that started the whole thing rolling with kidney cancer,” he says.

Recurrence Again and Again

A CT scan and biopsy confirmed that Ralph had a low-grade upper tract urothelial carcinoma (UTUC) on his kidney. He was referred to Ravi Munver, M.D., a urologic oncologist and vice chair of the Department of Urology at Hackensack.

Low-grade cancers are less likely to grow quickly or spread and can sometimes be removed with a minimally invasive surgery depending on their size, number and location. Ralph was a good candidate for this approach, so Dr. Munver used a laser to remove the tumor surgically. Its large size required two surgeries, spread out by a few weeks, to remove it.

But in a follow-up appointment three months later, they discovered that the tumor had returned. Again, Dr. Munver removed it surgically—only for it to return again in another few months. “These tumors have a tendency to recur,” says Dr. Munver. “So many patients that have recurrent tumors may need their entire kidney and ureter removed surgically.”

Hoping to save Ralph’s kidney, Dr. Munver looked to an innovative new treatment that had recently received FDA approval. It’s a prescription medicine that’s endoscopically inserted into the kidney through a catheter, directly targeting the tumor.

A Cutting-edge Solution

Most kidney cancers grow from the outside of the kidney, but some, like Ralph’s, grow from the inside lining of the kidney. These urothelial carcinomas of the kidney are the same type of cancer as bladder cancer, but until recently, only bladder cancer could be successfully treated with a liquid chemotherapy called mitomycin.

“We haven't been able to effectively treat these tumors in the kidney with the same chemotherapy agent because the liquid form of the medication would not remain in contact with the tumor for the required extended period of time, as it would immediately pass down the ureter and into the bladder,” says Dr. Munver.

With this new treatment option, mitomycin is injected into the kidney as a liquid but turns into a gel once it is inside the body. This gel stays in contact with the kidney tumor for several hours before it turns back into a liquid and passes out of the body with urination.

“Mitomycin gel is a tremendous breakthrough that allows us to offer a treatment focused on preventing this type of cancerous tumor from coming back,” says Dr. Munver. “This therapy can help patients preserve their kidney, forgo or postpone major surgery and prevent the need for dialysis by maintaining kidney function. It is a true game changer.”

Ralph was treated once a week for six weeks. “The medication was no problem whatsoever. I was back up and around the same day and going about my normal activities,” says Ralph, who didn’t experience any side effects except a slight discomfort in his side.

This lack of side effects isn’t uncommon with topical chemotherapy like this. “No medication is completely without side effects, but in general, most patients do not experience debilitating side effects with this treatment,” says Dr. Munver. “In addition, patients do not develop the type of adverse side effects that can occur with an intravenous or oral form of chemotherapy.”

Outstanding Outcome

Ralph’s treatment has been incredibly successful. At a recent follow-up appointment, there were no signs of tumor recurrence—a big relief for him considering how quickly the tumor had recurred in the past.

“The results were tremendously gratifying,” says Dr. Munver. “The treatment worked as we had hoped, and he is doing great.” Ralph will be monitored every three months for the next year, and less frequently in the following years.

After more than a dozen procedures and surgeries to battle his recurring kidney cancer over the past two years, Ralph can now focus on enjoying his retirement with his wife, family and his beloved sports car. “We're never sitting still, my wife and I. We have grandkids and we're always out every day; we're always on the move,” says Ralph. “I feel good for a 71-year-old retired guy.”

Next Steps & Resources:

• Meet our source: Ravi Munver, M.D.
• To make an appointment with a doctor near you, call 800-822-8905 or visit our website.
• Learn more about Hackensack University Medical Center’s Urology Department, which has been ranked the #1 Urology Department in New Jersey for eight years in a row by U.S. News & World Report

The material provided through HealthU is intended to be used as general information only and should not replace the advice of your physician. Always consult your physician for individual care.