Kidney Cancer

Renal cell cancer (also called kidney cancer or renal cell adenocarcinoma) is a disease in which malignant cancer cells form in tubules of the kidney. Approximately 54,000 Americans are diagnosed with kidney cancer each year, according to the National Cancer Institute. Although anyone can get kidney cancer, it usually strikes people over age 50. And the risk goes up with age.

Risk Factors

  • Genetic conditions, such as von Hippel-Lindau disease, Tuberous Sclerosis or hereditary papillary renal cell carcinoma
  • Long-term dialysis
  • High-fat diet
  • Obesity
  • Smoking
  • Exposure to asbestos
  • Cadmium exposure

Symptoms

In early stages there are usually no symptoms. As the disease progresses symptoms may include:

  • Blood in the urine
  • A mass or lump in the abdomen
  • A pain in the side or lower back that doesn't go away
  • Loss of appetite
  • Weight loss for no known reason
  • Anemia
  • Chronic fatigue
  • Leg and ankle swelling
  • Fever
  • Hypertension (high blood pressure)

Staging

Doctors describe kidney cancer by the following stages:

  • Stage I is an early stage of kidney cancer. The tumor measures up to 2 ¾ inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.
  • Stage II also is an early stage of kidney cancer, but the tumor measures more than 2 ¾ inches (7 centimeters). The cancer cells are found only in the kidney.
  • Stage III is one of the following:
    • The tumor does not extend beyond the kidney, but cancer cells have spread through the lymphatic system to one nearby lymph node; or
    • The tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue. Cancer cells may be found in one nearby lymph node; or
    • The cancer cells have spread from the kidney to a nearby large blood vessel. Cancer cells may be found in one nearby lymph node.
  • Stage IV is one of the following:
    • The tumor extends beyond the fibrous tissue that surrounds the kidney; or
    • Cancer cells are found in more than one nearby lymph node; or
    • The cancer has spread to other places in the body such as the lungs.

Recurrent cancer is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.

Detection and Diagnosis

Intravenous Pyleogram (IVP): In this test, the doctor injects dye into a vein in the arm. The dye then travels through the body and collects in the kidneys. The dye makes the kidneys show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems. This test has largely been replaced by more advanced imaging studies.

Computed Tomography Scan (CT Scan): In this test, an x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys and surrounding structures show up clearly in the pictures. A CT scan can help show a kidney tumor in more detail as well as surrounding organs. Most renal cancers today are detected as accidental or incidental findings on CT scans done for other reasons.

Magnetic Resonance Imaging (MRI Scan): With this test, the patient is placed in a large magnet and multiple views of the kidneys and surrounding structures are taken. Intravenous contrast usually is used to help enhance the visualization of the kidneys and surrounding structures.

Ultrasound Test: In this test, the ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram, helping the physician to evaluate the size of the tumor.

Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. Once completed, a pathologist then uses a microscope to look for cancer cells in the sample tissue.

Treatment Options

Surgery: Surgery is the most common treatment for kidney cancer. It is a type of local therapy that treats the cancer in the kidney and the area close to the tumor. Surgical options for treatment include:

  • Radical Nephrectomy: Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed. This type of surgery can be done via traditional open surgical,  laparoscopic and robotic-assisted approaches. Laparoscopic and robotic approaches minimize the recovery time and are possible for most patients.
  • Partial Nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the tumor is small (less than 1.5 inches), if the patient has only one kidney, or when the cancer affects both kidneys. This type of surgery can be done via traditional open surgical, aparoscopic and robotic-assisted approaches. Laparoscopic and robotic approaches minimize the recovery time and are possible for most patients.
  • Ablation Therapy: Rather than removing the tumor, a probe is placed into the tumor that destroys the tumor by either very high heat (radiofrequency ablation) or low temperatures (cryoablation). These probes are placed under direct visualization or with the assistance of x-ray images such as an ultrasound or CT scan.
  • Arterial Embolization: This is a type of local therapy that shrinks the tumor. When surgery is not possible, embolization may be used to help relieve the symptoms of renal cell cancer such as bleeding. The doctor inserts a narrow tube (catheter) into a blood vessel in the leg. The tube is passed up to the main blood vessel (renal artery) that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.

Radiation Therapy: Also known as radiotherapy, radiation therapy is another type of local therapy. Although it has proven effective with other cancers, it has limited use for the treatment of renal cell carcinoma except in extreme cases.

Biological Therapy: This is a type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer. For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 or aldesleukin). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

Chemotherapy: This is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer.

Targeted Therapies: This is a new class of therapy that is directed at more advanced diseases. It does not kill the tumor cells but prevents them from growing or progressing.

Prevention

Some risk factors for developing kidney cancer are hereditary, but you can reduce your risk for developing this form of cancer if you:

  • Avoid tobacco products
  • Avoid exposure to asbestos and cadmium
  • Try to achieve and maintain a healthy weight

Insurance

Although insurance plans vary, medications and surgeries due to kidney cancer are usually covered by insurance. Check with your insurance plan in advance to make sure.

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