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Kidney Cancer

kidney cancer


What is kidney cancer?

There are several types of kidney cancer, but most cases are renal cell cancer. This is sometimes called renal adenocarcinoma or renal cell carcinoma or hypernephroma.

Renal cell cancer

This type of cancer develops from a cell in a kidney tubule, which becomes cancerous. The cancer grows and forms into a tumor within the kidney. As the tumor grows:
The affected kidney tends to become larger. In time the tumor may grow through the wall of the kidney and invade nearby tissues and organs, such as the muscles around the spine, the liver, the nearby large blood vessels, etc.

Some cells may break off into the lymph channels or bloodstream. The cancer may then spread to nearby lymph nodes or to other areas of the body (metastasize).
Some rare types of cancer arise from other types of cell within the kidney. For example:

  • Transitional cell (urothelial) cancers are cancers which arise from transitional cells. These are cells which line the renal pelvis, ureters and bladder.
  • Wilms' tumor and clear cell sarcoma of the kidney are types of kidney cancer which develop only in children.

What causes kidney cancer?

A cancerous tumor starts from one abnormal cell. The exact reason why a cell becomes cancerous is unclear. However, certain risk factors increase the chance that kidney cancer may develop. These include:

  • Age. Most cases develop in people over the age of 60.
  • Smoking. About a third of kidney cancers are thought to be caused by smoking.
  • Other chemical carcinogens. For example, asbestos, cadmium and some organic solvents.
  • Obesity
  • Kidney dialysis.
  • Hypertension.
  • Genetic factors may play a role in some cases.

What are the symptoms of kidney cancer?

  • Blood in urine
  • Pain or discomfort in the side or back of the abdomen (loin pain).
  • Fever and sweats.
  • A swelling in the area over a kidney.
  • Anemia, which can cause tiredness.
  • A high blood calcium level.
  • High blood pressure.

How is kidney cancer diagnosed and assessed?

A doctor may suspect that you have kidney cancer from the symptoms and signs listed above, and then arrange tests to confirm the diagnosis
Tests to confirm the diagnosis.

An ultrasound scan of the kidney can usually detect a kidney cancer. A more sophisticated scan called a computed tomography (CT) scan may be used if there is doubt about the diagnosis.

Assessing the extent and spread

A CT scan or magnetic resonance imaging (MRI) scans of the abdomen and chest, a chest X-ray, blood tests, and sometimes other tests. This assessment is called staging of the cancer.

The aim of staging is to find out:

  • How much the tumour in the kidney has grown, and whether it has grown to the edge, or through the outer part of the kidney.
  • Whether the cancer has spread to local lymph glands (nodes).
  • Whether the cancer has spread to other areas of the body (metastasized).

What are the treatments for kidney cancer (renal cell cancer)?

Treatment options which may be considered include surgery, radiotherapy, arterial embolisation and immunotherapy. In general, chemotherapy does not work as well for renal cell cancer as for some other types of cancer. Therefore, it is not often used as a treatment.

In some cases, the treatment aims to cure the cancer. In some cases, the treatment aims to control the cancer. This may keep you free of symptoms for some time. In some cases, treatment aims to ease symptoms. Some treatments may be used to reduce the size of a cancer, which may ease symptoms such as pain.

Surgery

An operation to remove all (or sometimes part) of the affected kidney is the most common treatment. This is usually done as an open operation but it can also be done as a keyhole operation for some cases. If the cancer is at an early stage and not spread then surgery alone may be curative. In some cases, surgery is done to remove a secondary kidney tumor which has spread to another part of the body.

Radiotherapy

Radiotherapy is a treatment which uses high-energy beams of radiation which are focused on cancerous tissue. This kills cancer cells, or stops cancer cells from multiplying. Radiotherapy may be advised in addition to surgery, which aims to kill any cancerous cells which may have been left behind following an operation.

Arterial embolisation

This may be used instead of surgery (for example, if you are not well enough for surgery). The aim of this treatment is to block off the blood vessel (artery) which is supplying a kidney tumour with blood. To do this, a catheter is inserted into a blood vessel in the groin. Using X-ray pictures for guidance, the catheter is pushed up into the blood vessel in the affected kidney. When it is in the correct place, a substance is injected down the catheter into the blood vessel to block the blood vessel. The tumour is then deprived of its blood supply and so dies.

Immunotherapy

Two medicines are commonly used to treat kidney cancer - interferon and aldesleukin (sometimes called interleukin 2).

Recently, new targeted treatments have been introduced including sunitinib, sorafenib, pazopanib and temsirolimus. They are types of medicines called multikinase inhibitors which interfere with the growth of cancer cells. They also work by slowing the growth of new blood vessels within the tumour.

Other treatments

Using local anaesthetic with sedation or a general anaesthetic, radiofrequency (using electrodes inserted through the skin) or cryotherapy (using probes inserted through the skin or in a laparoscope) may be used as an option in the treatment of kidney cancer.

What is the prognosis?

The outlook is best in those who are diagnosed when the cancer is confined within a kidney, has not spread, and who are otherwise in general good health. Surgical removal of an affected kidney in this situation gives a good chance of cure.

The response to treatment can also vary from case to case.


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