Renal Cancer

renal cancer

Kidney cancers are generally seen in people over 60 years of age, although young people may also be affected. The most common early symptom is blood in the urine and if cancer is diagnosed at an early stage, there is a good chance of a cure. The two kidneys lie to the sides of the upper abdomen (the loins). Each kidney is about the size of a large orange, but bean-shaped. The are supplied by the renal artery. The functional tiny units of kidneys are called as nephrons, which filter the blood and take out waste material and water from the body in the form of urine.Urine passes down from the kidneys to the tubes called as ureter, which goes from each kidney to the bladder, where urine is stored until it is passed out through the urethra when we go to the toilet. The cleaned (filtered) blood from each kidney gets collected into a large renal vein where it takes the blood back towards the heart. Though normally we have two kidneys, but a person can live normally with a single kidney as well.

Kidneys are also known to produce certain hormones like:

  • Renn - which helps to regulate blood pressure.
  • Erythropoietin - which helps to stimulate the bone marrow to make red blood cells.
  • Calcitriol - which helps to regulate the calcium level in the blood.

Cancer is a disease of the cells in the body where the abnormal cells multiply out of control. A malignant tumour is a lump or growth of tissue made up from cancer cells, which continue to multiply. Malignant tumours invade into nearby tissues and organs, which can cause damage. Also by invading blood vessels these cancerous cells can be deposited to other parts of the body, leading to secondary tumors (metastasis) in different areas of the body. Some cancers are more serious than others; some are more easily treated than others; some have a better outlook (prognosis) than others. Therefore, one has to know exactly what type of cancer one is treating before recommending any treatment.

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.This type of cancer develops from a cell in a kidney tubule, which becomes cancerous. As the tumour grows: The affected kidney tends to become larger. In time the tumour 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 (metastasise). Renal cell cancers can be divided into several subtypes by looking at certain features of the cells under a microscope. For example, most are clear cell renal cell cancers, but some other types occur such as sarcomatoid, or granular renal cell cancers. Knowing the subtype of the cancer can be important, as some respond to treatment better than others.

Other types of kidney cancer

  • Transitional cell (urothelial) cancers are cancers which arise from transitional cells. These are cells which line the renal pelvis, ureters and bladder. Transitional cell cancer is common in the bladder, but in some cases it develops in the renal pelvis.
  • Wilms' tumour and clear cell sarcoma of the kidney are types of kidney cancer which develop only in children.

The exact cause why a cell becomes cancerous is unclear. It is thought that something damages or alters certain genes in the cell. This makes the cell abnormal, and multiply out of control.Many people develop kidney cancer for no apparent reason. 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. It is uncommon in people aged under 50. It is also more common in men.
  • Smoking. About a third of kidney cancers are thought to be caused by smoking.
  • Other chemical carcinogens. Some workplace chemicals have been linked to an increased risk of kidney cancer. For example, asbestos, cadmium and some organic solvents.
  • Obesity. About a quarter of kidney cancer cases are due to being overweight.
  • Kidney dialysis. People on long-term dialysis have an increased risk.
  • Hypertension. There is a greater risk in people who have high blood pressure.
  • Genetic factors may play a role in some cases. (A faulty gene that runs in some families may sometimes trigger kidney cancer.

The main symptoms of kidney cancer include:

  • Blood in urine- this is usually painless it may come and go as the tumour bleeds from time to time. (There are many causes of blood in the urine, which have to be ruled out, example, bladder or kidney infections, inflammation of the kidney, kidney stones, etc.)
  • Pain or discomfort in the side or back of the abdomen (loin pain).
  • Fever (high temperatures) and sweats.
  • A swelling in the area over a kidney.
  • Anemia, which can cause tiredness. You may also look pale.
  • Hormonal problems, like, polycythemia (increased red blood cells), high blood pressure, etc.

Tests advised by doctors to diagnose tumors include

  • An ultrasound scan of the kidney ,is often the first tests done if your doctor suspects that you may have kidney cancer. It is a safe and painless test which uses sound waves to create images of organs and structures inside your body
  • A more sophisticated scan called a computed tomography (CT) scan may be used if there is doubt about the diagnosis.
  • If you are found to have a kidney cancer, then other tests done would be, magnetic resonance imaging (MRI) scan of the abdomen and chest, a chest X-ray, blood tests, and sometimes other tests.

These tests are also required to find out the extent of the disease also called as staging the 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.) The treatment advised for each case depends on various factors, such as the stage of the cancer (how large the cancer is and whether it has spread), the exact subtype or grade of the cancer, and your general health.

  • Surgery includes an operation to remove all (or sometimes part) of the affected kidney. This is usually done as an open operation but it can also be done as a keyhole operation for some cases. It is curative if cancer is at an early stage. If the cancer has spread to other parts of the body, surgery is still advised, often in addition to other treatments.
  • In some cases, surgery is done to remove a secondary kidney tumour which has spread to another part of the body. For example, some secondary tumours which develop in the liver or lung can be removed.

  • 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. It may be advised in addition to surgery, which aims to kill any cancerous cells which may have been left behind following an operation.Radiotherapy may be used to treat the primary cancer instead of surgery if your general health is poor. It is also commonly used to treat kidney cancer which has spread to other sites, such as secondary tumours which develop in a bone or the brain.
  • Arterial embolisationis 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. (A catheter is a long thin, flexible, hollow tube.) 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 (sometimes called biological therapy) is the treatment which uses medicines to stimulate the immune system to attack cancerous cells. Two medicines are commonly used to treat kidney cancer - interferon and aldesleukin (sometimes called interleukin 2).Other immune therapies, such as using vaccines to stimulate your immune system to fight cancer cells and using monoclonal antibodies to attack cancer cells, are being investigated as possible new treatments for kidney cancer.Recently, new targeted treatments have been introduced including sunitinib, sorafenib, pazopanib and temsirolimus. They are types of medicines called multikinaseinhibitors which interfere with the growth of cancer cells. They also work by slowing the growth of new blood vessels within the tumour. They can shrink the cancer or slow its growth.
  • Other treatments include, 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. Radiofrequency is delivered via an electrode to destroy the tumour tissue in the target area. Cryotherapy involves using a coolant at subfreezing temperatures to create an ice ball around the probe's tip, which then destroys surrounding tissue.

The prognosis (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. However, many people with kidney cancer are diagnosed when the cancer has already spread. In this situation a cure is less likely. However, treatment can often slow down the progression of the cancer. The response to treatment can also vary from case to case. This may be partly related to the exact subtype or grade of the cancer. Some kidney cancers, even some which are advanced and have spread, respond much better to immunotherapy than others.The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type and stage of cancer is likely to respond to treatment.

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