Kidney Cancer - MITR
Kidney Cancer
Kidney cancer, or cancer of the kidney
Description
The most common types of kidney cancer include renal cell carcinoma and urothelial cell carcinoma of the renal pelvis. Renal cell carcinoma accounts for approximately 90% of all kidney cancers. Urothelial cell carcinoma is a type of cancer that occurs in the urinary system, specifically the urinary bladder, ureter, urethra and urachus.
Alternative nomenclature – clear cell adenocarcinoma, transitional cell carcinoma of pelvi-calyceal system.
Epidemiology:
Worldwide, approximately 208,000 cases of kidney cancer are diagnosed annually, accounting for nearly 2% of all cancers. Regions in Asia and Africa have the lowest rates of kidney cancer. Adults aged between 50 and 80 years are more likely to develop kidney cancer compared to other people. This type of cancer affects men more than women. The incidence of kidney cancer in the developed world has been steadily increasing over the last three decades. Some experts believe there is a close link between this increase and a parallel rise in rates of adult obesity.
Risk factors for renal cell carcinoma (90% of all kidney cancers)
➾ Age – There is a significant increase in risk for people aged 60 or more.
➾ Sex – The ratio between men and women is 1.5 to 1.
Obesity
Hypertension (high blood pressure) – Nobody is sure why there is an increased risk. Some say it is the hypertension itself, while others blame anti-hypertensive medications.
* Experts estimate that smoking, obesity and hypertension account for approximately 50% of all renal cell carcinomas.
Chemicals at work – Workers who are exposed to specific chemicals, such as asbestos, trichloroethylene and cadmium are more likely to develop renal cell carcinoma than other people. Asbestos, a mineral, is widely used in construction. Cadmium, a metal, is used in the manufacture of batteries. Trichloroethylene, an industrial solvent, is used to strip paint from metals.
Kidney failure treatment – Patients on long-term dialysis for chronic kidney failure treatment are more likely to develop renal cell carcinoma.
Kidney transplant recipients – Patients who have received a kidney transplant and have to take immunosuppressant medications have a higher risk of developing renal cell carcinoma.
Von Hippel-Lindau disease – A genetic disease which raises the patient’s risk of developing several kinds of tumors, including renal cell carcinoma.
Hereditary papillary renal cell carcinoma – Characterized by the development of multiple papillary tumors in both kidneys (a papillary tumor is shaped like a small mushroom with its stem attached to the inner lining of an organ).
Symptoms
➾ Early stages of kidney cancer do not usually show any symptoms.
➾ During the advanced stages, the following signs and symptoms may appear:
➾ Blood in the urine
➾ A continuous pain below the ribs
➾ A lump in the abdomen
If the cancer is spread
➾ Tiredness (fatigue)
➾ Weight loss
➾ Bone pain
➾ Night sweats
➾ Evaluation of patient
➾ Blood and urine tests
Ultrasound scan – This scan helps in identifying any changes in the shape of the kidney which could be caused by a tumor.
A CT (computerized tomography (CT) scan – It is the diagnostic test and it is used to know how much it has spread.
A biopsy – This is not required routinely to diagnose the cancer. A needle is guided through the skin into the kidney – the guidance system is either ultrasound or CT. A small sample of kidney tissue is removed and examined under a microscope to check for the presence of cancer cells.
A biopsy procedure increases the risk of infection and bleeding. There is also a chance that a biopsy could help the cancer spread to the area where the needle is inserted. Usually a biopsy is not needed, if things are fairly sure that cancer is present, and proceed straight to surgery, thus avoiding the additional risks of a biopsy. Kidney biopsies are more commonly done on patients who are not thought to have cancer, or those who cannot be operated on.
Transitional cell cancer – additional tests
Excretory urogram.
Cystoscopy
Treatment:
Treatment options depend on several factors, including the patient’s general health, the type of kidney cancer, and whether it has spread – plus the patient’s own preferences.
Surgery – most kidney cancers have surgery as the initial treatment:
Nephrectomy (removing a kidney) – A radical nephrectomy means removing the kidney and the adrenal gland that is just above it, a border of healthy tissue and the adjacent lymph nodes. The adjacent lymph nodes will be checked in order to make sure the cancer has not spread beyond the kidney. The surgery can be done laparoscopically – small incisions are made in the abdomen into which a video camera and surgical tools go in. The surgeon watches a video monitor. If the tumor is less than 1.5 inches (4cm) in diameter the surgeon may only have to remove part of the kidney (partial nephrectomy).
It is possible to live a normal life with just one kidney – the other kidney will make up for the loss.
Some patients, especially those who are unwell or frail, may not be able to undergo surgery.
Even if the cancer has spread outside the kidney the patient may still benefit from having the kidney removed. Removing the kidney may ease pain, and make other types of non-surgical treatments more effective.
Nephron-sparing surgery – The tumor is surgically removed, but not the kidney. This may be an option during the early stage of kidney cancer, or if the patient has only one kidney.
When surgery is not possible – For patients who cannot undergo surgery because the risks are too high, the following treatment options are possible (some of these treatments may also form part of a treatment program that includes surgery):
Embolization – The aim here is to block the flow of blood to the tumor. The surgeon inserts acatheter, a small tube, into the groin. X-ray images guide the catheter into the blood supply for the kidney. A special material passes through the catheter into the blood vessel that blocks the blood supply to the kidney, and thus starving the tumor of oxygen and nutrients, causing it to shrink.
Cryoablation – One or more cryoprobes (special needles) are inserted through small incisions into the tumor. A gas in the needles freezes the cells around the tip of each needle. The needles are guided with a CT scan. The doctor freezes the cancer cells. Another gas warms the tissue up again (thawing them), and then the cells are refrozen. This freeze-thaw cycle kills the cancer cells. Patients may experience some pain after the procedure, and on very rare occasions some bleeding, infection and damage to tissue close to the tumor.
Advanced or recurrent kidney cancer treatment – Treatments for kidney cancer that comes back, or kidney cancer that has spread out of the kidney include:
Surgery – The aim here is to surgically remove as much of the tumor as possible.
Biological therapy (immunotherapy) – This involves drugs that use the body’s own immune system to fight cancer. Examples are interferon and interleukin-2 .Side effects include nausea, vomiting, chills, elevated body temperature and loss of appetite.
Targeted therapy – These are medicines which are designed to target and interrupt (destroy) the functions that cancer needs in order to thrive, such as the blood supply. They include:
Radiotherapy – Although radiotherapy cannot usually cure kidney cancer, it may help reduce its spread, as well as helping reduce pain. Patients undergoing radiation therapy (radiotherapy) typically have a few minutes treatment daily for a number of days. When radiotherapy is used to control rather than to cure a cancer, the side effects tend to be less severe.