KIDNEY CANCER
A.Introduction
- Kidney cancer otherwise known as Renal cancer .As we know that kidney is made up of cellular tissue ,like every other organ
- The reason behind why does the cancer occurs is , Sometimes these cells functions irregularly due to altering of DNA in it and thus starts to proliferates profusely with no control resulting in tumors and then it grows into cancer
- Out of all other carcinomas renal cell carcinoma is one of the most commonest
B.Who gets it?
- Average age is to diagnose the kidney cancer is between the age of 65-70 or more
- Men are more prone to be affected as twice as women
- Patients with underlying kidney diseases such as tumors can become malignant
C.Etiology
The main cause behind the cancer is unknown
But ,few factors can contribute to this which may increase the risk of getting disease or spread of the existing disease
1.Age
As mentioned earlier,the older age group are most vulnerable to the renal cancer
2 Gender
Males are at the highest chances of affecting when compared to females and children
3.Smoking or drinking habits
The more the cigarette smoking the more is the the disease, also drinking alcohol and other relative habits can definitely increase the risk cancer and also affects the survival and overall quality of life twice that of the non smokers
4.Obesity,Overweight
Being fit is certainly one of the most important factors to consider ,if not the weight builds up causing pressure over the abdomen and kidney region causing further symptoms which cannot be relieved until the pressure is lifted .Moreover,the hormonal changes are also noticed .
5.Hypertension
People with high Blood pressure exert pressure over the arteries makes them work much harder than normally which inturn reduces blood supply and flow to the organ .This might be a reason but there is no known reason .
6.Long term survival over dialysis
Survival over dialysis itself indicates that the patient may have a failed or improper functioning of the kidney .
7.Positive family history
Positive family history with any kidney related diseases have higher chances to get inherited in siblings.
8.Exposure to radiation
Frequent exposure to radiation can be a high level risk for patients with known history of cancer , thyroid & pregnant women with kidney diseases .The needed care should be provided
9.Underlying kidney or other related systemic diseases
Underlying kidney diseases like CKD, at advanced stages can cause risk and other diseases such as lymphoma etc.
10.Certain medications
Medications such as acetaminophen and Non-aspirin,NSAIDS, were associated with renal cancer.
11.Inherited Genetic diseases /Mutated genetic diseases
Inherited renal conditions such as papillary renal carcinoma ,von hippel Lindau can be a contributing factor
12 Diabetes mellitus
There are certain reasons that confirm that type 1 diabetes mellitus is significantly associated with a higher risk of renal cancer.
D.Signs and symptoms
Kidney cancer doesn’t get diagnosed until it spreads,so early evaluation is hard
- Hematuria-red or cola colored urine
- Pain in side or back
- Loss of appetite
- Unexplained Weight loss
- Fever
- Fatigue
- Anemia
- Edema
- Shortness of breath
- Bone pain
- Blood while cough
- Persistent tiredness
E.How is it diagnosed?
In order to reveal the disease a person must undergo a thorough physical examination ,health history ,family history,drug history and also certain basic to advanced tests
1.Urine tests
To check any signs of disease such as blood in urine,color of urine ,any protein in urine etc
2.Blood tests
To know whether the kidneys are functioning properly by filtering the waste products from blood or not
3.Imaging tests such as ultrasound,X-rays,CT scan,MRI
These tests helps to visualize the tumor abnormality in regards to its size,shape,contents,texture etc
4.Intravenous pyelogram or IVP
One of the x ray imaging technique where a dye is injected to differentiate tumor cells
5.Renal arteriogram
Use to evaluate the blood supply through arteries to kidneys is enough or not
6.Biopsy
Not many times or condition but at some point of the disease the biopsy is recommended if patient isn’t responded to the treatment ,also when the doctor couldn’t get enough information to rule out the stage of damage
7.bone scan
To check whether cancer spread involved in bone
8.chest x ray
Whether in lungs
Based on these tests the decision is made to perform few other relative tests,which helps to determine the stage of the cancer
F.Staging
The lower the stage ,the earlier the condition ,lesser the risk .The higher the stage,the more advanced the cancer is .
Kidney cancer is of 4 stages
Stage 1
Tumor is of <= 7 cms ,only involving kidneys
Stage 2
Tumor is of >7 cms ,only involving kidneys
Stage 3
- Tumor involving kidney and at least 1 lymph node involvement
- Tumor involving fatty tissue around kidneys or kidneys blood vessel,major veins ,perinephric tissues along with involving one nearby lymph node
- But not involving ipsilateral adrenal gland and not beyond gerota’s fascia
Stage 4
- Cancer involving kidneys and its spread to other organs such as lungs,pancreas,bowel etc
- Involving beyond gerota’s fascia ,fatty tissue around the kidney with involvement of nearby lymph nodes.
G.Types of kidney cancer
1.Renal cell carcinoma
- The disease starts at the cells in tubules of kidneys
- Signs include blood in urine and lump in the abdominal region
- Also known as kidney cancer or hypernephroma/renal adenocarcinoma.
a.Clear cell renal cell carcinoma
- It is a subtype of renal cell carcinoma, also known as conventional kidney cell carcinoma
- The cancer starts from cells in tubules and look as clear bubbles in microscope
b.Non – clear cell renal cell carcinoma
- This type of renal cell carcinoma has different histological appearance
- It has a biologically diverse entity
- Papillary renal carcinoma
- 2nd most encountered type of malignancy
- Subtypes include type 1 and 2
- Origin of derivation is from the tubular epithelial cells
- May be inherent or genetic
- The distinguished feature shows a characteristic papillary architecture in microscopic view
d.Chromophobe renal cell carcinoma
- Rare type of kidney cancer with less malignant potential
- Two subtypes include typical and eosinophilic variant
- Others include
e.Transitional cell carcinoma
- Also known as urothelial carcinoma
- This cancer origins from the transitional cells present as lining over the organs
- It is usually rare ,either low or high grade.
f . Nephroblastoma
- One of the most common cancer in children of age 3& 4
- Also known as wilms tumor
- It occurs as a part of other syndromes
- Cannot be treated
- Renal sarcoma
- This is the type of cancer which affects the surrounding soft tissues of kidney
- One of the rare type
- Among renal sarcomas common one includes fibrosarcoma ,has poor prognostic value
- Non cancerous benign tumors are listed down
- Angiomyolipoma
- Benign tumor which has no symptoms but sometimes, present with fever ,pain, hypertension and anemia
- Can be treated through surgical intervention or by embolization to remove the tumor mass .
- Oncocytoma
- Common benign form of kidney cancer
- Usually discovered accidentally while performing any diagnostic tests
- As this doesn’t not present with any symptoms it’s hard to evaluate and rule out
- If present,it affects adults mostly.
H.Treatment options for kidney cancer
- Once the diagnosis is made and the stage of the kidney cancer is known the treatment plan is made .There is involvement of all the experts especially oncologists,urologist, nephrologist or a surgeon .Just to make it helpful the second opinion is advised about the diagnosis and alternative treatment options
- There are a myriad of standard type treatment options available. But still, the first choice remains is the surgery
- Depending upon the type and stage of kidney disease the procedure is performed
- Surgical removal by
1.Nephrectomy/radical nephrectomy
In Radical nephrectomy the removal of kidneys ,adrenal glands and the surrounding tissue along with nearby involved lymph nodes is done
Have to do this procedure on general anesthesia with minimal surgical incision with the help of laparoscopy
2.Partial /kidney sparing
In partial or kidney sparing nephrectomy the cancer tissue along with some part of surrounding tissue is also removed
Usually performed in tumors which are in size less than or 4cms
In cases ,where the radical nephrectomy might harm both the kidney
- Sometimes non surgical procedures are also considered If patient is not willing for surgical procedures or even after surgical removal still the cancer evidence existed
- These methods of elimination will destroy the cancer cells by freezing them.
1.Cryoablation
Uses extreme cold to freeze the cancer cells to prevent further spread from damaging and kill them
2.Radiofrequency
Uses high frequency radiation waves to burn the tumors
3.interferon alpha or interleukin -2
The procedure in which this substance is used is known as biological therapy where it initiates the immune system to boost the natural defense .
4.m-TOR inhibitors
Sometimes the targeted drugs are given orally or through blood vessels to prevent growth of the tumors
Similar to this some other drugs used are anti-angiogenic drugs ,multikinase inhibitors and so on.
5.Radiation /Chemotherapy
In radiation therapy the high energy rays are used to treat the cancer cells and also to relieve the symptoms
In chemotherapy, certain medications are used which halts the growth of tumors cells
You may have these chemical drugs through orally or intravenous routes
Procedure usually takes for a period of 3months – 6months
Considered less effective in kidney cancer management.
6.Other lymph nodal ablation
Affected nearby lymph nodes are ablated with the following above mentioned methods.
I.Prevention
You will only manage the condition without further spreading and getting worse .Managing to eat healthy food,diet control,track on body weight,quitting smoking and alcohol consumption,being physically,mentally and emotionally fit can improve .
J.Frequently asked questions
1.what are early signs of kidney cancer?
The earliest signs and symptoms includes
- Fever
- Hematuria
- Blood pressure is high
- Lump over abdomen or side
- Pain in abdominal region or side
- Loss of appetite
- Extreme tiredness
- Anemia
- Unexplained body weight
2.How curable is kidney cancer?
- The kidney cancer is often curable and preventable with appropriate diagnosis and treatment plan when it’s still localized to the kidney area before it’s spread
- Also curability depends on the stage and patients overall general health.
3 Can you survive with kidney cancer?
- Yes,can survive with kidney cancer .However,it depends on the type,stage ,time of diagnosis.An average of 5 year survival rate is estimated
4.What is kidney cancer caused by?
The reason for the cause is unknown but have several factors which influences the disease to spread
- smoking
- Overweight
- Exposure to radiation frequently
- Underlying medical conditions
- Blood pressure
- Diabetes
5.Do kidney cancer affect eyes?
- Yes,there are certain cases where the patient with kidney cancer has a metastasis of eyes and orbits
- A high level of detection and management is required before it affects .
6.What age kidney cancer is common
- It is common in adults ,mostly in older age groups
- The average age of people is between 65-74 years
7.will blood tests show kidney cancer?
- Complete blood picture doesn’t show the kidney cancer directly but helps to evaluate the substances which are involved in causing cancer or the byproduct in the blood
8.where does kidney cancer usually start?
- Kidney cancer usually starts at the lining of the tubules in kidneys then spreads to surrounding areas and further more into other organs
9.where is the first place kidney cancer spreads to ?
- The place it spread to was lymph nodes which are near to the cancer tissue and then has potential to metastasize to lungs and bone ,brain ,liver etc
- The presence & spread is unpredictable before it is diagnosed
10.How fast does kidney cancer progress ?
- The order of aggressiveness is papillary >chromophobe>medullary>oncocytic renal cell carcinoma
- If the type of cancer is low grade then it has slow growth ,high grade type has rapid spread
11.Is stage 1 kidney cancer curable ?
- Yes,it is curable. A surgical removal with /without need of regular follow up can make the disease curable .An average of 5-8 years of survival rate is seen.
12.Does the kidney need chemo?
- Even Though it’s not a standard therapy in a few cases ,it is considered .
- Cisplatin,5-fluorouracil are used
13.What is kidney cancer pain like
- The nature of the pain is persistent type in the abdomen region or lower back region or side just below your ribs
- Often times it is severe and sometimes is moderate to mild
14.What happens in the final stage of renal cancer ?
- Swelling in ankles or feet ,hands which is as a result of fluid retention
- Hypertension
- Fluid in lungs
- Anemia (severe)
- Sudden elevated levels of potassium in blood can be life threatening and death
15.Can you have kidney cancer?
Most kidney cancers either benign or malignant, have an option to operate surgically or through some non surgical procedures.
The most common surgical procedure is nephrectomy which may be radical or partial .
The different approaches include open incision, laparoscopic surgery
16.How does kidney cancer affect the body?
In early stages there is no inconvenience faced but as it progresses the symptoms are more evident .Extreme pain,tiredness,eating habits ,loss of appetite and unexplained body loss can create insecurity to the patient
17.What are the chances of spreading?
There is possibility of 65-70% of chance of spreading .Mostly to the nearby tissues ,lymph nodes only when the cancer is localized
18.Can you live without kidneys
No,at least a single kidney is needed to fulfill our body functional requirements or needs to manage the waste buildup in the body.
19.What is the most accurate test for kidney cancer ?
The CT scan provides precise description and detail of the organ regarding it size ,shape and location of any abnormalities .Also used as an investigative material for any further spread of the tumors
20.How long do you have to live if your kidneys are failing?
Maybe for weeks or months ,there is no alternative or possibility to live a healthy life when the kidney starts failing . Temporary survival is possible if patient responds to dialysis which is an artificial filtration process or else through Transplantation which is very challenging