Kidney Cancer

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Overview

Kidney cancer, also known as renal cancer, is a disease wherein the kidney cells start growing uncontrollably and become cancerous or malignant.

The incidence of kidney cancers is relatively higher in developed countries. It is less common in eastern countries, according to the reports. Kidney cancer is one of the cancers that can be easily treated. They also have excellent survival rates, and patients can lead a normal and healthy life after the treatment.

Types

1. Renal Cell Carcinoma (RCC): Renal cell carcinoma accounts for 85% of kidney cancers. RCCs originate from the proximal renal tubules, which are responsible for filtration.
2. Urothelial Carcinoma: Also known as transitional cell carcinoma, urothelial carcinoma accounts for 5% to 10% of all adult kidney malignancies detected. This kind of cancer begins in the renal pelvis, where urine is collected just before it rushes to the bladder. It can sometimes be treated like bladder cancer.
3. Sarcoma: Sarcomas of the kidney develop in the soft tissues of the kidney, the capsule (a thin layer of connective tissue that surrounds the kidney), and the fat tissue. These are, however, rare. Kidney sarcomas frequently recur and therefore, necessitate a strict post-treatment follow-up plan.
4. Wilms Tumour: Wilms tumour is more common among youngsters, and it is handled differently than adult kidney cancers. Wilms tumours account for around 1% of all kidney malignancies.
5. Lymphoma: Lymphoma can cause both kidneys to enlarge and is linked to enlarged lymph nodes.

Symptoms

In the early stages of kidney cancer, signs and symptoms are not noticeable. The following are some of the most common signs of kidney cancer:

Blood in urine; the colour of urine may be pink, red or brown (just like cola)
Formation of a lump in the side of the abdominal region
Chronic back pain, right below the ribs
Persistent abdominal discomfort
Extreme weakness
Loss of appetite
Unintentional weight loss
Profuse sweating
Anaemia
Swelling in the lower limbs
Persistent fever without cold or infection

Kidney cancer that has metastasised to other organs might show the following symptoms:

Bone pain
Coughing up blood
Shortness of breath

Many of these symptoms listed above, however, can be caused by other disorders, and someone with kidney cancer may not have any signs or symptoms at all. It is important to not ignore any symptoms and immediately meet a doctor if any symptom lasts for more than two weeks.

Courses

Although the exact cause of kidney cancer is not known, a few risk factors have been identified, and these risk factors are found to increase one’s chances of developing kidney cancer:

Smoking: Smoking doubles kidney cancer risk.
Obesity: Obese individuals are prone to developing kidney cancers.
Family History of Kidney Cancer: Having a positive family history of kidney cancer is a risk factor for kidney cancer.
Regular Usage of NSAIDs: Consumption of ibuprofen and naproxen for a long time is associated with an increased risk of kidney cancer.
Underlying Kidney Diseases: Being diagnosed with kidney disorders that need dialysis increases one’s risk of developing kidney cancer.
Infection: Hepatitis C infection increases kidney cancer risk.
Age: The risk of kidney cancer increases with age.
Hypertension: Those with hypertension or high blood pressure are at a higher risk of developing kidney cancer.
Von Hippel-Lindau Disease: Individuals with this genetic disorder are at a higher risk of getting kidney cancer.
Previous Treatments for Cervical Cancer or Testicular Cancer: Those who have received treatment for cervical cancer and testicular cancer are more prone to develop kidney cancer.
Exposure to Harmful Chemicals: Exposure to hazardous chemicals, such as cadmium and certain herbicides increases one’s risk of getting kidney cancer.

Diagnosis

There are multiple tests recommended by doctors for the detection and diagnosis of kidney cancers. Before any test, a thorough physical examination and medical history assessment are done in order to understand the cause of the signs of symptoms that a patient has presented oneself with. If kidney cancer is suspected, the doctor may recommend the following tests:

a. Blood Tests: Blood tests do not help with a definitive diagnosis, but they can hint at an underlying kidney problem that needs medical attention. Blood tests may also help in knowing if the disease has spread to nearby organs.

b. Urine Cytology/Urine Tests: Urine tests are also recommended to check for traces of blood, which are only visible under a microscope. Many patients with kidney cancers tend to have blood in their urine and this makes urine cytology a reliable testing method.

c. Imaging Tests: Imaging tests, such as MRI scan, PET/CT scan, etc., provide detailed structures of the kidneys, and if the tumour is present, these tests can provide comprehensive data, such as the size, shape, exact location, grade, etc.

These imaging tests are also used for disease staging, treatment planning, monitoring the treatment given and restaging the disease amidst the treatment.

d. Biopsy: Biopsy is the best way to receive a definitive diagnosis of all solid tumours, including kidney cancer. During this procedure, a small sample of tissue is collected and examined under a microscope for the presence of cancerous cells.

If bone metastasis is suspected, a bone scan may also be recommended.

Treatment

The treatment suggested by the doctor depends on the stage of kidney cancer. It may also depend on other factors, such as the size of the tumour, exact location, underlying medical conditions, the patient’s age and overall condition of the patient. Following are the treatment options available for kidney cancer:

a. Active Surveillance: For patients who are too old to undergo aggressive treatment or have a smaller tumour or are diagnosed with other serious medical conditions like heart disease, lung disease or kidney disease, active surveillance may be recommended. During active surveillance, the doctor will closely monitor the tumour through regular tests and appointments.

b. Surgery: Surgery is the main line of treatment for kidney cancers. Kidney tumours can either be operated through open surgery or minimally invasive surgery. Minimally invasive procedures include robotic surgery and laparoscopic surgery; both these procedures use tiny incisions to insert the instruments and operate the tumour. Reduced blood loss, fewer treatment-related complications, lesser pain and faster recovery are some of the advantages of minimally-invasive procedures.

The different types of surgical methods used by the doctors are as below:

Nephrectomy: Nephrectomy is a surgical procedure recommended for kidney cancer. This procedure removes the kidney, a margin of healthy tissues surrounding the tumour and the lymph nodes close to the tumour. In some cases, the adrenal gland may also be removed. Open nephrectomy is one in which the tumour is accessed through a single big incision. Minimally invasive nephrectomy, on the other hand, uses smaller incisions to operate the tumour. A video camera and small surgical equipment are inserted through these incisions. The surgeon performs this procedure with the help of a video monitor.
Nephron-sparing Surgery (Partial Nephrectomy): During this procedure, the surgeon removes only the tumour and a small portion of normal tissues that surround the tumour. The entire kidney is not removed. This procedure is ideal for early-stage kidney cancers. Partial nephrectomy may also be considered if the patient has only one kidney.

In cases where complete removal of the tumour is not possible, surgery may be performed to remove as much tumour as possible. Doctors may also recommend surgery for the tumours that have spread to other organs from the kidney.

c. Radiation Therapy: It is a non-invasive medical procedure that uses high-energy radiation beams, such as X-rays to destroy cancer cells. Radiation therapy may be combined with other treatment modalities, such as surgery and chemotherapy in order to enhance the overall effectiveness of the treatment.

In the case of advanced-stage kidney cancers, radiation therapy may be recommended to ease symptoms, such as pain, especially in cases where the disease has spread to bones.

d. Immunotherapy: Immunotherapy is a novel treatment approach that strengthens the patient’s own immune system. When cancer cells create unique proteins that help them hide from immune system cells, the body’s disease-fighting abilities may be hampered. In such cases, immunotherapy may help the immune cells regain their ability to identify cancer cells and destroy them. Immunotherapy may be recommended along with other treatments as a part of the multimodal treatment plan.

e. Chemotherapy: Chemotherapy is not the main line of treatment for kidney cancers. However, in a small percentage of cases, chemotherapy is recommended for kidney cancer management. This treatment method uses strong medications that are able to destroy the cancer cells throughout the body. Chemotherapy drugs may be administered orally or intravenously.

In most cases, kidney cancers are treated with a multimodal approach; chemotherapy may be combined with other treatment modalities, such as surgery and radiation therapy for successful clinical outcomes and better survival rates.

f. Targeted therapy: Targeted therapy is a type of cancer treatment that focuses on specific vulnerabilities or indicators found in cancer cells. Targeted therapy may be able to inhibit these vulnerabilities and hence kill cancer cells through a variety of mechanisms. Targeted therapy is a personalised treatment approach, and not all patients are eligible for this.

Frequently Asked Questions

1. Is kidney cancer treatable if caught early?

Kidney cancer can usually be treated successfully if it is found early. Today, new therapies and techniques have resulted in significantly higher overall survival rates for advanced-stage kidney cancers.

2. Can smoking cause kidney cancer?

Yes, smoking is one of the risk factors for kidney cancers, and it may cause kidney cancer. Therefore, it is important to consider quitting tobacco.

3. If I have one kidney removed after cancer, can I live normally?

When one of the kidneys is removed due to cancer, the other kidney starts to function for both. Most people who have one kidney can live a normal life without any major health problems. However, you should keep yourself healthy and be mindful about the activities that may cause harm to your other kidney.

4. Can I prevent kidney cancer?

The exact cause of kidney cancer is unknown, and therefore, there are no known ways to prevent kidney cancers completely. However, there are a few ways to reduce your risk of developing kidney cancers:

Quitting Smoking: Quitting the habit of smoking can reduce your kidney cancer risk.
Maintaining a Healthy Body Weight: Healthy weight management plays a significant role in reducing your kidney cancer risk.
Eating Nutritious Food: A diet rich in fruits and vegetables also plays an important role in bringing your kidney cancer risk down. Also, you may consider reducing your animal fat intake.