Overview
The kidneys - most people have two - are fist-sized organs that filter waste and excess fluid from the blood. They produce urine and hormones that help regulate blood pressure and help maintain the correct amount of minerals in the bloodstream.
Kidney cancer is among the 10 most prevalent cancers in men and women, with nearly 63,000 new cases diagnosed annually. Renal cell carcinoma, which has several subsets including clear cell, papillary, sarcomatoid, transitional cell and others, is the most common form of kidney cancer. Other types of kidney cancer are transitional cell carcinomas, Wilms tumors and renal sarcomas.
Symptoms
Frequently, kidney cancer causes few, if any, symptoms early in the disease. When symptoms do appear they may include:
- Painless urination of blood that may occur one day and not the next
- Abdominal mass, hard lump, thickening or hardening under the skin that can be seen or felt
- Back pain or pressure
Once cancer has spread beyond the kidneys to different organs, symptoms become more varied:
- Fever
- Weight loss
- Low blood counts
- Anemia
- High blood pressure
Risk Factors
Researchers have found genetic factors as well as environmental conditions are linked to an increased risk of developing kidney cancer.
Genetic factors:
- Von Hippel-Lindau disease
- Hereditary papillary renal cell carcinoma
- Hereditary leiomyoma-renal cell carcinoma
- Birt-Hogg-Dube syndrome
- Hereditary renal oncocytoma
- Familial renal cancer
Other factors:
- High blood pressure
- Smoking
- Obesity
- Advanced kidney disease
- Use of diuretics
Tests and Diagnostic
A CT scan, MRI or a kidney ultrasound are routinely employed to diagnose suspicious masses that may be kidney cancer.
Treatment
Surgery
A nephrectomy is a procedure to remove all or part of the kidney. The decision to take out the entire kidney or only a section is based on the size and number of tumors, whether a tumor is confined to the kidney, how much of the organ and nearby tissue are affected and how well the kidney is functioning.
A partial nephrectomy, also called kidney-sparing surgery, is performed when only a section of the kidney is diseased. The remaining healthy part of the kidney is left intact. Experienced surgeons prefer this procedure to treat kidney cancer.
A radical nephrectomy involves removing the entire kidney and the ureter - the tube that carries urine from the kidney - several lymph nodes and the adrenal gland if it is affected. This is the most common type of treatment for advanced cancer or when it has spread throughout and beyond the kidneys.
Physicians use one of the following surgical procedures to perform a partial or radical nephrectomy:
Robotic surgery
Robotic-assisted surgery is now the most commonly used procedure for a nephrectomy. The surgeon sits at a computer that controls the robot and tiny surgical tools to make small incisions and then remove the kidney. Robotic surgery provides the physician better imaging and more precise removal of diseased tissue. It results in less pain and bleeding as well as a shorter hospital stay, usually about two days. All patients are not eligible for robotic surgery - surgeons select patients based on their age and overall health as well as the type and stage of the disease.
Laparoscopic surgery
During this minimally invasive procedure a surgeon uses a laparoscope - a long, thin tube with a bright light and a high-resolution camera to see inside the abdomen. Several small incisions are made to insert the laparoscope and tiny surgical instruments are used to remove the kidney and diseased tissues through one of the incisions. The procedure usually takes a few hours and patients remain in the hospital from one to three days.
Open surgery
The surgeon makes an incision on the abdomen or on the side of the affected kidney under the lower ribs and removes the kidney and other diseased tissues. The procedure typically takes two hours and the patient stays in the hospital between three and five days. Surgeons prefer this type of procedure for advanced cancer or when it has spread throughout and beyond the kidneys.
Radiofrequency Ablation (RFA)
When surgery isn't an option for treating kidney cancer, physicians may use a non-surgical minimally invasive treatment called Radiofrequency Ablation (RFA). It kills the abnormal tissue in cancer patients while sparing healthy tissue. RFA is performed by an interventional radiologist, who uses X-ray imaging to guide a needle into the tumor. Radiofrequency energy is transmitted from the needle into the target tissues, creating heat and killing the tumor.
Many patients feel some mild to moderate discomfort during the procedure, but it typically does not cause side effects. Most patients can resume their daily activities within a few days.
Benefits
- May be done under local sedation or general anesthesia.
- Is well tolerated - patients may be a bit more tired but they can resume regular activities rather quickly.
- The treatment can be repeated if necessary and combined with other types of treatments.
- May relieve pain and suffering for many cancer patients.
Disadvantages
The long-term effectiveness of RFA is still unknown so surgery is typically the best option.
Targeted Therapy
Targeted therapy focuses on the cancer's specific genes, proteins or the tissue makeup that allows cancer to survive and grow. It blocks the growth and spread of these cancer cells while limiting the damage to healthy cells. This type of treatment is becoming more widespread against kidney cancer.
There are different targeted therapies, each using varying medications that affect assorted areas of the cancer-growing process:
- Anti-angiogenesis therapy focuses on preventing angiogenesis, which is the development of new blood vessels that feed the tumor. Cutting off the blood supply to the tumor starves it and slows its growth and spread.
- Tyrosine kinase inhibitors (TKIs) is a form of treatment that uses medications to target the process of growing new blood vessels. It is used in patients that have a mutation of the VHL gene, which plays a pivotal role in the development of vessels. Side effects of this type of treatment may include diarrhea, high blood pressure and tenderness and sensitivity in the hands and feet.
- mTOR inhibitors are drugs that target a specific protein that helps kidney cancer cells grow.
Immunotherapy
Immunotherapy, also known as biologic therapy, boosts the body's natural defenses to fight cancer. It uses biologics made either in the body or a laboratory to ramp up the body's immune system. There are a number of different types of immunotherapy treatments, used to target particular kidney cancer cells and stages of the disease.
Chemotherapy and radiation are not typically used to treat kidney cancer.
