What is Kidney Cancer?

Kidney cancer is a type of cancer that starts in the kidney. Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, with one kidney on each side of your spine. The kidneys filter out waste from your blood and make urine. There are different types of cancer that can affect your kidneys. Kidney cancer is often discovered at an early stage, when the cancer is small and confined to the kidney.

About Iranian Surgery

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Before Kidney Cancer Treatment

Symptoms of kidney cancer

Kidney cancer doesn’t usually cause any symptoms in its early stages. As the cancer progresses, the symptoms may include:

. Persistent back pain, especially just below your ribs

. Blood in your urine

. Abdominal pain

. Abdominal swelling

. A lump in the abdomen

. Fatigue

. Flank pain

. Recurring fevers

. Unexplained weight loss

. Anemia

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

Causes

It’s not clear what causes most kidney cancers.

Doctors know that kidney cancer begins when some kidney cells develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The changes tell the cells to grow and divide rapidly. The accumulating abnormal cells form a tumor that can extend beyond the kidney. Some cells can break off and spread (metastasize) to distant parts of the body.

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Risk factors

Factors that can increase the risk of kidney cancer include:

. Older age. Your risk of kidney cancer increases as you age.

. Smoking. Smokers have a greater risk of kidney cancer than nonsmokers do. The risk decreases after you quit.

. Obesity. People who are obese have a higher risk of kidney cancer than people who are considered to have a healthy weight.

. High blood pressure (hypertension). High blood pressure increases your risk of kidney cancer.

. Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.

. Certain inherited syndromes. People who are born with certain inherited syndromes may have an increased risk of kidney cancer, such as those who have von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma or familial renal cancer.

. Family history of kidney cancer. The risk of kidney cancer is higher if close family members have had the disease.

Diagnosis

How kidney cancer is diagnosed

A diagnosis of kidney cancer requires a complete history and physical exam. Your doctor will look for an abdominal swelling or a lump in your abdomen. In men, the doctor may also look for an enlarged, twisted vein, or varicocele, in the scrotum.

Some tests that can be used to detect kidney cancer include:

. Complete blood count

The kidneys produce a hormone called erythropoietin that stimulates the production of red blood cells. A complete blood count can reveal if the red blood cell count is high, which would indicate polycythemia, or low, which would indicate anemia.

. Blood chemistry tests

Blood chemistry tests can help show how well your kidneys are functioning. Kidney cancer can also influence the levels of some types of chemicals in your blood, such as liver enzymes and calcium.

. Urinalysis

A urinalysis can allow your doctor to determine if there’s blood present in your urine. It may also reveal other signs of an infection.

. Ultrasound of the abdomen and kidneys

An abdominal ultrasound can measure the size and shape of your kidneys. If a tumor is present, it may reveal its size and consistency.

. Renal angiography

In this test, your doctor threads a catheter up a large artery in your leg or groin, to the renal artery. They’ll inject a special dye into the artery. After the dye is injected, they’ll take a series of X-rays. This helps your doctor see the blood supply to your kidneys in detail. If a tumor is present, the blood supply to the tumor can be seen.

. Intravenous pyelogram

In this test, a healthcare provider will inject a special dye into one of your veins. The dye allows your kidneys to be seen more clearly with X-rays. This test can help your doctor find a tumor or obstruction.

. CT scan of the abdomen

A CT scan is a noninvasive test that uses X-rays to create cross-sectional images of your body. It allows the following to be viewed:

. Bones

. Muscles

. Fat

. Organs

. Blood vessels

It can be used to find out if cancer has spread beyond the kidney.

The following tests can also be used to find out if kidney cancer has spread:

. An MRI scan of the abdomen

. A bone scan

. A chest X-ray

. A PET scan

. A chest or abdominal CT scan

. Removing a sample of kidney tissue (biopsy).

In some situations, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer. This procedure isn’t always needed.

Prevention

Taking steps to improve your health may help reduce your risk of kidney cancer. To reduce your risk, try to:

. Quit smoking. If you smoke, quit. Many options for quitting exist, including support programs, medications and nicotine replacement products. Tell your doctor you want to quit, and discuss your options together.

. Maintain a healthy weight. Work to maintain a healthy weight. If you’re overweight or obese, reduce the number of calories you consume each day and try to be physically active most days of the week. Ask your doctor about other healthy strategies to help you lose weight.

. Protecting yourself from chemical toxins at work.

. Control high blood pressure. Ask your doctor to check your blood pressure at your next appointment. If your blood pressure is high, you can discuss options for lowering your numbers. Lifestyle measures such as exercise, weight loss and diet changes can help. Some people may need to add medications to lower their blood pressure. Discuss your options with your doctor.

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During Kidney Cancer Treatment

Kidney cancer staging

Once your doctor identifies a kidney lesion that might be kidney cancer, the next step is to determine the extent (stage) of the cancer. Staging tests for kidney cancer may include additional CT scans or other imaging tests your doctor feels are appropriate.

The stages of kidney cancer are indicated by Roman numerals that range from I to IV, with the lowest stages indicating cancer that is confined to the kidney. By stage IV, the cancer is considered advanced and may have spread to the lymph nodes or to other areas of the body.

There are 4 number stages of 1 to 4.

. Stage 1. The cancer is less than 7cm across and is completely inside the kidney.

. Stage 2. The cancer is more than 7cm across but is still completely inside the kidney.

. Stage 3. 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.

. Stage 4. 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.

Grades of kidney cancer

Grade means how much the cancer cells look like normal cells. A specialist (pathologist) looks at the cells under a microscope. The pathologist will look at the centre of the cell (nucleus) and the size and shape of the cells.

The more the cancer cells look like normal cells, the lower the grade. They tend to grow more slowly and are less likely to spread to another part of the body (metastasise).

The less the cancer cells look like normal cells, the higher the grade. They tend to grow more quickly and are more likely to spread to another part of the body.

Kidney cancers are graded 1-4. This is called the Fuhrman system. Grade 1 is the lowest grade, and grade 4 is the highest grade.

The grade tells your doctor how the cancer might behave and what treatment you need. The main factor for deciding on the best treatment is whether your cancer has spread away from the kidney or not.

Types of kidney cancer

Several types of cancer can affect the kidneys. Adenocarcinoma of the kidney is also known as renal cell carcinoma. It’s the most common type of kidney cancer in adults and starts in the part of the kidney that filters blood. Renal pelvis carcinoma starts in the part of the kidney where urine is collected.

Wilms’ tumor is the most common type of kidney cancer in children under the age of 5.

There are other types of kidney cancer, but they’re rare.

Treatment

Kidney cancer treatment usually begins with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney, additional treatments may be recommended.

Together, you and your treatment team can discuss your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment.

Surgery

For most kidney cancers, surgery is the initial treatment. The goal of surgery is to remove the cancer while preserving normal kidney function, when possible. Operations used to treat kidney cancer include:

. Removing the affected kidney (nephrectomy). A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures.

The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy).

. Removing the tumor from the kidney (partial nephrectomy). Also called kidney-sparing or nephron-sparing surgery, the surgeon removes the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. It can be done as an open procedure, or laparoscopically or with robotic assistance.

Kidney-sparing surgery is a common treatment for small kidney cancers and it may be an option if you have only one kidney. When possible, kidney-sparing surgery is generally preferred over a complete nephrectomy to preserve kidney function and reduce the risk of later complications, such as kidney disease and the need for dialysis.

The type of surgery your doctor recommends will be based on your cancer and its stage, as well as your overall health.

Nonsurgical treatments

Small kidney cancers are sometimes destroyed using nonsurgical treatments, such as heat and cold. These procedures may be an option in certain situations, such as in people with other health problems that make surgery risky.

Options may include:

. Treatment to freeze cancer cells (cryoablation). During cryoablation, a special hollow needle is inserted through your skin and into the kidney tumor using ultrasound or other image guidance. Cold gas in the needle is used to freeze the cancer cells.

. Treatment to heat cancer cells (radiofrequency ablation). During radiofrequency ablation, a special probe is inserted through your skin and into the kidney tumor using ultrasound or other imaging to guide placement of the probe. An electrical current is run through the needle and into the cancer cells, causing the cells to heat up or burn.

Treatments for advanced and recurrent kidney cancer

Kidney cancer that comes back after treatment and kidney cancer that spreads to other parts of the body may not be curable. Treatments may help control the cancer and keep you comfortable. In these situations, treatments may include:

. Surgery to remove as much of the kidney cancer as possible. If the cancer can’t be removed completely during an operation, surgeons may work to remove as much of the cancer as possible. Surgery may also be used to remove cancer that has spread to another area of the body.

. Targeted therapy. Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die. Your doctor may recommend testing your cancer cells to see which targeted drugs may be most likely to be effective.

. Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

. Radiation therapy. Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain.

. Clinical trials. Clinical trials are research studies that give you a chance to try the latest innovations in kidney cancer treatment. Some clinical trials assess the safety and effectiveness of potential treatments. Other clinical trials try to find new ways to prevent or detect disease. If you’re interested in trying a clinical trial, discuss the benefits and risks with your doctor.

Alternative medicine

No alternative medicine therapies have been proved to cure kidney cancer. But some integrative treatments can be combined with standard medical therapies to help you cope with side effects of cancer and its treatment, such as distress.

People with cancer often experience distress. If you’re distressed, you may have difficulty sleeping and find yourself constantly thinking about your cancer. You may feel angry or sad.

Discuss your feelings with your doctor. Specialists can help you sort through your feelings and help you devise strategies for coping. In some cases, medications may help.

Integrative medicine treatments may also help you feel better, including:

. Art therapy

. Exercise

. Massage therapy

. Meditation

. Music therapy

. Relaxation exercises

. Spirituality

Talk with your doctor if you’re interested in these treatment options.

After Kidney Cancer Treatment

Long-term outlook for people with kidney cancer

The outlook for people with kidney cancer varies. It depends on how quickly the cancer is caught and how it responds to treatment.

Approximately 65 percent of kidney and renal pelvis cancers are diagnosed before they have spread. The cancer can or spread, or metastasize, to the other kidney, but it’s most likely to spread to the lungs. Metastatic cancer is harder to treat.

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Kidney cancer can also be complicated by:

. High blood pressure

. High levels of calcium in the blood

. Overproduction of red blood cells

. Liver problems

Survival rates for kidney cancer are higher when the condition is treated in its earlier stages. For example, the American Cancer Society reports that the observed five-year survival rate for stage 1 kidney cancer is 81 percent. Keep in mind that observed survival rates are estimates.

Can kidney cancer be found early?

Many kidney cancers are found fairly early, while they are still limited to the kidney, but others are found at a more advanced stage. There are a few reasons for this:

. These cancers can sometimes grow quite large without causing any pain or other problems.

. Because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical exam.

. There are no recommended screening tests for kidney cancer in people who are not at increased risk. This is because no test has been shown to lower the overall risk of dying from kidney cancer.

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