kidney Cancer

Kidney cancer – is also called Renal Cancer – Almost all kidney cancers first appear in the lining of tubules in the kidney. This type of kidney cancer is called renal cell carcinoma and occurs in 4 out of 5 cases of kidney cancer and is also called renal adenocarcinoma or hypernephroma. Other types of kidney cancer include- transitional cell cancers of the renal pelvis and Wilms tumor of the kidney occurring in children.

The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully. However, these tumors can grow to be quite large before they are detected.

We don’t know the causes of kidney cancer. But certain factors appear to increase the risk of getting kidney cancer. For example, kidney cancer occurs most often in people older than age 40.

These are some other risk factors for kidney cancer:

  • Smoking. This applies to cigars or cigarettes
  • Being male. However, several case reports on renal cancer in Nigeria report a higher female preponderance.
  • Being obese. Extra weight may cause changes to sex hormones that increase risk.
  • Using non-aspirin, non steroidal anti-inflammatory drugs (NSAIDS) for a long time. 
  • Having advanced kidney disease or being on long-term dialysis.
  • Having certain genetic conditions, such as von Hippel-Lindau (VHL) disease, Birt-Hogg-Dube syndrome or inherited papillary renal cell carcinoma. In rare cases long standing sickle cell nephropathy is a risk.
  • Having a family history of kidney cancer. The risk is especially high in siblings.
  • Being exposed to certain chemicals, such as asbestos, cadmium, benzene, organic solvents, or certain herbicides
  • Having high blood pressure. Doctors don’t know whether high blood pressure or medication used to treat it is the source of the increased risk.
  • Being black. 
  • Having lymphoma. For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.

What Are the Symptoms of Kidney Cancer?

  • Hematuria (Blood in the urine)
  • Abdominal mass
  • Abdominal pain
  • A loss of appetite
  • Weight loss
  • Fever
  • Extreme fatigue
  • Anemia
  • Leg swelling

Symptoms of metastasis include;

  • Shortness of breath
  • Coughing up blood
  • Bone pain

Sometimes the presentation of kidney cancer includes what is called paraneoplastic syndromes. This means that signs, symptoms and complications are not directly attributable to the kidney cancer but are associated with it. For instance

  • Hypercalcemia and its complications
  • Increased prolactin production and in men breast growth and in some cases, milk letdown.
  • Increased production of red blood cells presenting with a PCV >54% due to abnormally increased production of erythropoietin by the kidney.
  • In rarer cases there is new onset impaired glucose tolerance or worsening of existing diabetes mellitus

Diagnosis

To confirm a diagnosis of kidney cancer, a thorough physical exam, health history, and tests are required.

Testing required includes:

  • Urinalysis
  • Renal function tests.
  • Intravenous pyelogram (IVP) highlighting any tumors.
  • Ultrasound to identify simple versus solid or complex masses.
  • A CT scan with and without contrast. CT scans have replaced IVP and ultrasound as a tool for diagnosing kidney cancer.
  • Magnetic resonance imaging (MRI) with or without contrast.

Most of the time a diagnosis can be made without a biopsy. Sometimes, a biopsy will be done to confirm the diagnosis. A doctor may use a needle biopsy to remove a sample of tissue, which is then examined under a microscope for cancer cells. The biopsy may also tell the grade of the cancer. Often the surgeon will simply remove the entire tumor and then have a sample of tissue examined.

Once a diagnosis is made additional testing is required to assess the stage of the cancer. For this, a CT scan or MRI, chest X-ray or a bone scan can see if the cancer has spread to other organs like the liver, brain, bones or surrounding tissues.

Stages of Kidney Cancer

Prognosis depends on the patients general health, as well as the grade and stage of kidney cancer.


Stage I

  • A tumor 7 centimeters or smaller, limited to the kidney

Stage II

  • A tumor larger than 7 centimeters, limited to the kidney

Stage III

  • A tumor that is in the kidney and in at least one nearby lymph node
  • A tumor that is in the main renal vessel(s) and may also be in nearby lymph node
  • A tumor that is in perinephric fat and may also involve nearby lymph nodes
  • A tumor that extends into major veins or perinephric tissues, but not into the ipsilateral adrenal gland and not beyond Gerota’s fascia

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)

Treatments for Kidney Cancer?

Kidney cancer is one of the more common cancers to undergo spontaneous remission. However, the incidence is quite low (approximately 0.5%).

There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, residual disease may be addressed with non-surgical approaches.

Surgery for kidney cancer

The type you have depends on how advanced the cancer is.

  • Radical nephrectomy removes the kidney, adrenal gland, and surrounding tissue. It also often removes nearby lymph nodes. It is the most common surgery for kidney cancer and can now be done through a small incision with a laparoscope.
  • Simple nephrectomy removes the kidney only.
  • Partial nephrectomy removes the 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.

If surgery can’t remove the kidney cancer, other options to help destroy the tumor include;

  • Cryotherapy.
  • Radiofrequency ablation.
  • Arterial embolization 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.

Biologic therapy for kidney cancer

This therapy uses the immune system to fight cancer by boosting, directing, or restoring the body’s natural defenses. Substances for biologic therapy are made by the body or in a lab. Examples of biologic therapy for metastatic kidney cancer include interferon alpha or interleukin-2. Other biologics that have been used in treatment of renal cancer include Bevacizumab, Sorafenib and Sunitnib. More recently, Nivolumab is approved as a biologic for treating renal cancer. There are many other new immunotherapies being actively studied for kidney cancer.

Targeted therapy for kidney cancer

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. A third type of targeted therapy is known as m-TOR inhibitors such as Everolimus and Temsirolimus. There are two of these drugs available, one oral and one by IV. They block a pathway which allows blood vessels to help tumor cells grow. Each of these drugs has a unique place in the management of advanced kidney cancer.

Radiation therapy for kidney cancer

Often used to help with symptoms of kidney cancer or in patients who cannot have surgery, 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. Less effective for kidney cancer than for other types of cancer, chemotherapy is mostly used for a certain type of kidney cancer in which there spindle cells (sarcomatoid variant).

This article was written by Dr Egbuna of Kidney Solutions Center, Nigeria www.kidney-solutions.com

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