Kidney Cancer
Kidney
The kidneys are a pair of bean-shaped organs, about 4 or 5 inches long, located in the back of the abdomen, protected by the lower rib cage.
Functions:
- They filter the blood.
- The kidney is responsible for removing wastes, controlling body’s fluid balance, and regulating the balance of electrolytes.
- The kidneys create urine.
- They help control blood pressure by synthesizing a hormone called renin.
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Kidney Cancer
Cancer that originates in the kidneys is called Kidney Cancer. Cancer is a serious health condition caused by an uncontrolled division of abnormal cells in any part of the body. These abnormal cells grow to form a lump called tumor.
The tumor is said to be benign i.e. non-cancerous if it lacks the ability to grow and spread to other parts of the body. Whereas, if the tumor continues to multiply uncontrollably, and spread to various parts of the body then it is called malignant or cancerous tumors.
Benign tumors respond well to treatment and the prognosis is usually favorable but in some rare scenarios, they may grow to become malignant tumors. Malignant tumors are innately dangerous and the chances of recovery declines with each passing stage.
Types of Kidney Cancer
- Renal cell carcinoma
This is the most common type of kidney cancer accounting 90% of occurrence. Although RCC usually grows as a single tumor within a kidney, sometimes multiple tumors may be spotted in one or both kidneys at the same time.- Clear cell renal cell carcinoma: Cancer cells that first appear in the lining of tiny tubes in the kidney are called clear cell renal cell carcinoma. This is the most common form of renal cell carcinoma amounting to 70% of occurrences.
- Papillary Renal Cell Carcinoma: This is the second most common sub type amounting to 10% of occurrences. These cancers form little finger-like projections (called papillae).
- Chromophobe renal cell carcinoma: This sub type accounts for about 5% of RCCs.
- Rare types of renal cell carcinoma: These sub types are very rare, each making up less than 1% of RCCs:
- Collecting duct RCC
- Multilocular cystic RCC
- Medullary carcinoma
- Mucinous tubular and spindle cell carcinoma
- Neuroblastoma-associated RCC
- Transitional cell carcinoma:
Also called urothelial carcinomas, transitional cell carcinomas generally initiate in the lining of the renal pelvis. This lining is made up of cells called transitional cells. - Wilms tumor:
It is also known as nephroblastoma and occurs mostly in children. This type of cancer is very rare among adults.
Occurrence Rate of Kidney Cancer in India
In India, renal cell carcinoma is more frequent in younger people. One-third of the patients are less than 50 yrs of age and only 10.4% patients had tumor of less than 4 cm (T1a). Younger patients less than 39 years of age have relatively lower survival rates.
Symptoms for Kidney Cancer may not appear until it’s too late. However, some of the common signs and symptoms are as follows:
- Blood in the urine.
- Persistent low back pain on one side.
- A mass on the side or lower back.
- Fatigue.
- Loss of appetite.
- Weight loss not caused by dieting.
- Fever that is not caused by an infection and that doesn’t go away.
- Anaemia.
- Fever.
However, some of these symptoms may be caused due to less serious ailments as well. Do visit the doctor if you have any of the symptoms.
The chances of occurrence of kidney cancer increases with certain factors. These risk factors for Kidney Cancer include:
- Smoking: Smoking increases the risk of developing renal cell carcinoma (RCC).
- Obesity: Obesity may cause changes in certain hormones that can lead to RCC.
- Gender: It is more common in man than woman.
- Family history of Kidney Cancer: People with a strong family history of renal cell cancer have a higher chance of developing this Cancer.
- High Blood Pressure: The risk of kidney cancer is higher in people with high blood pressure.
- Medicines: Certain medicines like Phenacetin and Diuretics increase the risk of developing Kidney Cancer.
- Genetic and hereditary risk factors: Some rare inherited conditions may increase the risk of kidney Cancer. Some genetic and hereditary conditions that are thought to increase the risk are listed below:
- von Hippel-Lindau disease
- Hereditary papillary renal cell carcinoma
- Hereditary leiomyoma-renal cell carcinoma
- Birt-Hogg-Dube (BHD) syndrome
- Familial renal Cancer
- Hereditary renal oncocytoma
The exact cause of a particular case of Kidney Cancer cannot be traced accurately, and hence there is no clarity to the preventive measures of this Cancer. However, being alert and taking a few precautions’ comes as a life savior. Here are a few precautions:
- Quit Smoking.
- Weight Control.
- Avoiding being exposed to harmful chemicals.
- Eating healthy and exercising regularly.
- Managing Blood Pressure
- Consulting your doctor before taking medications.
Kidney Cancer is staged by measuring the size of the tumor, the location of the Cancer cells either confined to the kidney, locally spread or widespread beyond the fibrous tissue surrounding the kidney
Stage I (T1, N0, M0)
- Stage 1 is the least aggressive stage and has the highest survival and recovery rate.
- The tumor only appears in one kidney and there’s no evidence that it has spread to lymph nodes or other organs.
- Stage 1 tumor can be further classified into:
- T1a: The tumor is 4 cm or smaller.
- T1b: The tumor is larger than 4 cm but not larger than 7 cm.
- In this stage generally, the cancerous kidney is removed through surgery.
Stage II (T2, N0, M0)
- The growth of cancerous cells is restricted within the Kidney.
- There’s no evidence that it has spread to nearby lymph nodes or other organs.
- Cancerous kidney will probably be removed, and follow-up therapy might not be necessary.
- Stage 2 cancer can be further classified into:
- T2a: The tumor size ranges between 7 cm to10 cm.
- T2b: The tumor is larger than 10 cm but not more than 12 cm.
Stage III(T3, M0, N0)
- The tumor may be of any size and has grown into a major vein and into tissues surrounding the kidney.
- The tumor has not spread into the adrenal gland or beyond Gerota’s fascia.
- The tumor has not spread to lymph nodes or distant organs.
- In this stage, treatment is aggressive.
Stage IV
- Cancer has spread beyond the fatty layer of tissue around the kidney, and it may also be in nearby lymph nodes
- Cancer may have spread to other organs, such as the bowel, pancreas, or lungs
- Cancer has spread beyond Gerota’s fascia (including contiguous extension into the ipsilateral adrenal gland)
Survival rates indicate an average outcome of a large number of people who had the disease, but they cannot precisely predict the expectancy of any particular case. The survival rate of Kidney Cancer when detected at an early stage is quite high. People with Kidney Cancer tend to be older and may have other serious health conditions. Therefore, the percentage of people surviving the Cancer itself is likely to be higher.
| Stage | 5 year Survival Rate |
| I | 81% |
| II | 74% |
| III | 53% |
| IV | 8% |
Kidney cancer might be indicated by several symptoms like pain, weight loss, fatigue or a lump. In case any of these signs are visible it is recommended to visit a doctor and go for an examination.
- Physical exam and history: In this, the doctor conducts an examination of the body to check general signs of health, including health habits, any past illnesses, and types of treatment. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Urine and Blood Test: A urine or blood test is conducted to check for any signs of the disease.
- Intravenous pyelogram (IVP): In this procedure a dye is injected that travels to the urinary tract, highlighting any tumors and an X-ray of the kidney is taken.
- Ultrasound: In this procedure, sound waves are implemented to create a picture of the kidneys that helps to tell if a tumor is solid or fluid-filled.
- CT Scan: In this procedure, X-rays and a computer are used to create a series of detailed pictures of the kidneys. This may also require an injection of dye. CT scans have virtually replaced pyelogram and ultrasound as a tool for diagnosing Kidney Cancer.
- Magnetic resonance imaging: In this strong magnets and radio waves are used to create detailed images of soft tissues in the body.
- Renal arteriogram: This test is used to evaluate the blood supply to the tumor.
Once the stage of cancer and its spread is located then the treatment can be planned. Today owing to the advancement in science and technology, there are several treatment options for Kidney Cancer. Treatments available are dependent on the stages of Cancer; however, surgery to remove the kidney is the most preferred treatment for Kidney Cancer as most of the people can survive well with just 1 kidney or a part of the kidney. Primary treatments available are as follows:
- Surgery for Kidney Cancer
Depending on the stage of advancement of cancer, one of the following types of surgery is recommended.- Radical nephrectomy It is the most common surgery for kidney cancer, done through a small incision with a laparoscope. In this surgery, the surgeon removes the kidney, adrenal gland, surrounding tissue and sometimes the nearby lymph nodes.
- Simple nephrectomy In this surgery only the kidney is removed.
- Partial nephrectomy This surgery is done to remove Cancer in the kidney along with some tissue around it. This procedure is used for patients with smaller tumors (less than 4 cm) or in those patients in which a radical nephrectomy might hurt the other kidney.
- Cryotherapy: In this procedure, extreme cold temperature is used to kill the Cancer.
- Radiofrequency ablation: It uses high-energy radio waves to “cook” the tumor.
- Arterial embolization: This procedure involves inserting material into an artery that leads to the kidney. This blocks blood flow to the tumor. This procedure may be done to help shrink the tumor before surgery.
- Targeted Therapy: This therapy uses drugs or other substances to find and target cancer cells with less toxicity to normal cells. One type of targeted therapy is anti-angiogenic agents. These keep blood vessels from feeding a tumor, causing it to shrink or stop growing. Another type of targeted agent is known as multikinase inhibitors or tyrosine kinase inhibitors. These are oral drugs that block an enzyme pathway which allows cancer cells to grow. The third type of targeted therapy is known as m-TOR inhibitors.
- Radiation Therapy for Kidney Cancer: This treatment uses high-energy X-rays or other types of radiation to kill cancer cells or halt their growth. External radiation therapy sends radiation to the Cancer from a machine outside the body.
- Chemotherapy for Kidney Cancer: This therapy uses drugs to kill cancer cells or stop them from multiplying.
Most of the Kidney Cancers are found before they spread (metastasize) to distant organs. And Cancers caught early are easier to treat successfully. However, when Kidney Cancer spreads, or metastasizes, to other parts of the body, it goes from being one of the most curable types of Cancer to one of the least.
In case of experiencing any of the mentioned symptoms or having a prior or familial history, a physical examination by a specialist is recommended once in a year.
The Kidneys are so deep inside the body; it’s harder to find Kidney Cancer just by looking or feeling for growths. Kidney Cancer often doesn’t cause symptoms until the tumor has already grown. The most common symptom of Kidney Cancer is blood in the urine or hematuria. Being aware of the symptoms and going for regular urine and blood test once a year is highly recommended.
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