Kidney cancer

Kidney cancer is mostly common among people who are above 40 years of age. Renal cell cancer, also known as adenocarcinoma or hypernephroma, is the most common type of kidney cancer that occurs in adults. When kidney cancer spreads beyond the kidney, the lymph nodes get affected by the cancer cells. Kidney cancer can also spread to various other organs such as lungs, bones, or liver.

While transitional cell carcinoma affects the renal pelvis, Wilms tumor is a type of kidney cancer that commonly occurs in children.

Causes:

  • Cigarette smoking
  • Obesity
  • High blood pressure
  • Being on long-term dialysis is a prominent risk factor for kidney cancer.
  • Von Hippel-Lindau (VHL) syndrome: VHL is a very rare genetic disease. It is mainly caused by alterations or abnormalities in the VHL gene. Besides increasing the risk of kidney cancer, it can also result in cysts or tumors in the eyes, brain, and other regions in the body.
  • Occupation: People involved in certain occupations which constantly expose them to hazardous chemicals or substances such as asbestos or cadmium are at a greater risk of getting affected by kidney cancer.
  • Gender: When compared to females, males are more likely to be diagnosed with kidney cancer.

Symptoms:

Some of the common symptoms of kidney cancer include:

  • Blood in the urine
  • Severe pain on the sides
  • The presence of a lump or mass on the side or the abdomen
  • Weight loss
  • Fever
  • Feeling extremely tired or poor health

Diagnosis:

Your doctor may perform one or more of these procedures for diagnosis:

  • Physical examination: The doctor conducts physical examination and various tests to check and confirm if you have fever, high blood pressure or tumor.
  • Urine tests: Urine test is conducted to confirm if there is blood in urine or symptoms of other diseases.
  • Blood tests: Your blood is checked to see if your kidneys are functioning properly and to verify the level of substances, such as creatinine. If you have an extremely high level of creatinine, it may mean that the kidneys are not functioning well.
  • Intravenous Pyelogram (IVP): In this procedure, the doctor injects a special dye into a vein in your arm. The dye, which passes through the body, gets collected in the kidneys. This will be revealed in the series of x-rays which tracks the dye as it travels through the kidneys to the ureters and bladder. This test helps to confirm if you have a kidney tumor or other problems.
  • CT scan: A CT scan is often recommended as it helps to confirm if the person is affected by kidney tumor.
  • Ultrasound test: An ultrasound test helps to diagnose if there is a solid tumor or cyst.
  • Biopsy: A biopsy refers to the removal of a small amount of tissue in the kidney to confirm the presence of cancer cells. In some cases, the doctor might recommend a biopsy to the patient.
  • Surgery: On the basis of the results of the CT scan, ultrasound, and X-rays, the doctor may or may not recommend surgery to remove either a part or the entire kidney. The final diagnosis is made by a pathologist who examines the tissue under a microscope.

Various stages in Cancer

In order to plan the treatment that is appropriate for the patient, the doctor must know the extent or severity of the disease. The various stages of cancer are essentially based on two factors; the size of the tumor and whether the cancer has spread to other regions of the body. This will involve various imaging tests such as an ultrasound, a CT scan or an MRI.
The various stages of cancer include:

Stage I: Cancer is less than 7cm in size and is completely within kidney.

Prostate-Cancer

Stage II: The cancer is more than 7cm across but is still completely inside the kidney.

Prostate-Cancer

Stage III: The cancer has grown into surrounding tissues or a major vein nearby. It is still inside the layer of connective tissue called Gerota's fascia. There might or might not be any cancer cells in the lymph nodes, but the cancer has not spread to another part of the body.

Prostate-Cancer

Stage IV: Stage 4 means one of the following:

  • The cancer has grown into surrounding tissues outside the connective tissue called Gerota's fascia, or into the adrenal gland. It may or may not have spread to the lymph nodes or other parts of the body
  • The cancer has spread to another part of the body
Prostate-Cancer

Kidney cancer treatment

Treatment of kidney cancer is mainly decided on the stage of cancer one has. However it also depends on:

  • type of cancer (the type of cells the cancer started in)
  • where the cancer is
  • other health conditions that you have

If cancer hasn't spread to other parts of body

Surgery is the main treatment.

If the cancer is smaller than 3cm and patient is older or unwell, doctor might suggest having no treatment at first. They will monitor the patient closely. They might call this active surveillance.

If one can't have surgery, he/she might have:

  • freezing therapy (cryotherapy)
  • radio wave treatment (RFA)
  • radiotherapy
  • blocking the blood supply to the cancer (arterial embolisation)

If cancer has spread away from the kidney (advanced cancer)

One might have surgery to remove your kidney if he/she is well enough to recover from the operation. The surgeon might also remove cancer that has spread (secondary cancer).

Patient also might have targeted cancer drugs to stop or slow the growth of the cancer.

Other possible treatments include:

  • radiotherapy
  • freezing therapy (cryotherapy)
  • radio wave treatment (RFA)
  • blocking the blood supply to the cancer (arterial embolisation)

Surgery

Surgery is the most commonly recommended treatment for kidney cancer. The surgery or operation performed for removing the kidney is called a Nephrectomy. There are different types of nephrectomies, which essentially depends on the stage of the tumor.

Radical nephrectomy: Kidney cancer is generally treated with Radical nephrectomy. In this process, the surgeon removes the whole kidney with or without the adrenal gland and some portions of the tissue surrounding the kidney. Some of the lymph nodes in the region also may be removed.

Prostate-Cancer

Simple nephrectomy: In this process, the surgeon removes only the kidney.

Partial nephrectomy: This operation is used for small kidney cancers that have not spread. Wherever possible, it’s used to treat stage 1 kidney cancer (less than 7cm across). The surgeon removes the part of the kidney containing the cancer. Remaining kidney is left behind. Doctors call this nephron sparing surgery. The nephron is the filtering unit of the kidney – so you have some working kidney left after the operation.

Prostate-Cancer

Conventionally these surgeries are performed by open technique resulting in big scars and delayed recovery. However with advanced techniques we perform these surgeries as laparoscopic or robotic involving vary small cuts, minimising the blood loss, ealy recovery and early return to normal activities and no compramise in oncological outcome.

Arterial embolization

Arterial embolization is a type of local therapy that is used to shrink or reduce the tumor. Embolization is usually used to alleviate the symptoms of kidney cancer.

In this procedure, the doctor inserts a catheter into one of the blood vessels in the leg. The catheter is then passed up to the renal artery that transports blood to the kidney. The doctor injects a special substance into the blood vessel to interrupt the flow of blood into the kidney. This blockage inhibits the flow of oxygen to the tumour and prevents it from growing and developing further.

This treatment is not a cure because the doctors have not removed the cancer. There is still a chance that cancer cells will spread to other parts of the body in the future.

Prostate-Cancer

Immunotherapy

This is a type of systemic therapy which uses the natural ability or immune system of the body to fight cancer. The body generally produces interferon alpha or interleukin-2 in small amounts in response to certain infections or diseases. For the treatment of cancer, they are created in the laboratory in large amounts.

Chemotherapy

Chemotherapy, a type of systemic therapy where anti-cancer drugs travel through the bloodstream in to different part of the body to prevent or control the spread of the disease. This is not very effective in common variety of kidney cancer

Follow-up care

Follow-up care following the treatment for kidney cancer is extremely important. The doctor regularly monitors the recovery of the person who has undergone the treatment for kidney cancer and to check if there is any probability for the recurrence of cancer. The patient may also have to undergo lab tests, chest x-rays, CT scans, or other tests.