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The kidneys are two organs that filter waste products from the blood and form urine, as well as secrete vital hormones for proper body functioning. Kidney cancer, also referred to as renal cancer, occurs when cancer develops in normal kidney tissue.
To better understand kidney cancer, let’s take a quick look at how the kidneys function. Our kidneys—each the size of a fist—are a pair of bean-shaped organs that are attached to the upper back part of the abdominal wall—one on either side of the spine. Above each kidney sit the adrenal glands. The main job of the kidneys is to filter the blood coming in via the renal arteries to remove excess water, salt, and waste products—which collectively become urine. Urine leaves the kidneys via long slender tubes called ureters, which connect to the bladder. Urine is stored in the bladder until you urinate (or, more colloquially, pee). The place where the ureters meet the kidneys is called the renal pelvis. The kidneys also perform several other functions—they help:
While our kidneys are important, it’s interesting to note that we actually need less than one complete kidney to function. Many people are living normal, healthy lives with just one kidney. Some people, however, do not have any working kidneys, and they survive with the help of dialysis, a medical procedure that uses a special machine to filer the blood much the way a real kidney would. More than 1 million cases of cancer will be diagnosed this year. Kidney cancers only comprise 3% of these new cancers. Although nearly 13,000 people died from kidney cancer in the US in 2005, it is estimated that there are more than 100,000 kidney cancer survivors living in the US currently.
According to the National Cancer Institute, there are three main forms of renal cancer:
Renal cell cancer (RCC). RCC is the most common type of renal cancer in adults—accounting for 9 out of 10 kidney cancers—and stems from the cells that comprise the kidneys themselves. It is now understood that many subtypes of RCC exist. For example, there are the following subtypes:
Wilms tumor. Wilms tumors—or nephroblastomas—are the most common type of kidney cancer found in children, and are rarely found in adults.
Transitional cell cancer. Transitional cell cancer forms from tissues comprising the renal pelvis, or part of the urine collection system of the kidney, and the ureter, which carries urine from the kidneys to the bladder. Of every 100 cancers in the kidney, about 5 to 10 are transitional cell carcinomas (TCCs), also known as urothelial carcinomas. Transitional cell carcinoma is a more rare, but potentially very aggressive type of kidney or renal cancer. About 9 out of 10 TCCs of the kidney are cured if they are found at an early stage. The chances for cure are lower if the tumor has grown into the ureter wall or main part of the kidney or if it looks more aggressive (high grade) when seen under a microscope.
Benign (non-cancerous) kidney tumors
There are also a number of benign—non-cancerous—kidney tumors, which means that they do not metastasize or spread throughout the body, but can nonetheless still grow and cause considerable trouble. Benign kidney tumors can be treated by either removing or destroying them, using many of the same treatments utilized for kidney cancers, like surgery, radiofrequency ablation, and arterial embolization. Choice of treatment hinges on many factors, like the size of the tumor and if it is causing any symptoms, number of tumors, whether tumors are in one or both kidneys, and the person’s overall health. These are the main types of benign kidney tumors:
The specific cause of kidney cancer remains unknown. However, certain risk factors associated with developing the disease have been identified. These are outlined below in the Risk Factors section.
It is known that kidney cancer, as well as all other cancers, are a disease characterized uncontrolled cellular growth. Normally, specific genes within the DNA (genetic material) of cells have functions to regulate cell division. Genes involved in cell replication, cell division, cellular growth, and cellular survival are called oncogenes, while those involved in limiting cell growth and division and induce cell death when necessary are called tumor suppressor genes (such as TP53 and RB1 genes).
When cell DNA is damaged, these genes may be altered and the oncogenes are turned on and the tumor suppressor genes are turned off. As a result, there is uncontrollable cell growth and possible cancer. While these changes to the DNA of cells are caused by the environment, changes or mutations to DNA can also be inherited. If these mutations in the DNA correspond to genes that are involved with effective and correct cell replication, a person’s risk for developing kidney cancers and other cancers may be increased.
Although the cause of kidney cancer is still largely unknown, there are some genetic conditions and environmental factors, which may contribute to the development of this disease.
According to the Mayo Clinic, risk factors for developing kidney cancer are:
A diagnosis of kidney cancer will likely start with a visit to your primary care physician, who will obtain a thorough medical history and then perform a physical examination. In addition, he or she will then utilize any of the following tools to arrive at a diagnosis:
CT scans use x-rays to generate an image, but have several advantages compared to the chest x-ray. It will show the precise location, shape, and size of masses. In order to obtain even sharper images, some patients are asked to drink or receive IV contrast. This contrast makes some tissues appear brighter, which makes the images and the structures more apparent and easier to discern. Allergies to contrast medium may cause hives, flushing, shortness of breath, and low blood pressure. If you have had a reaction to contrast before, you should inform your physician. In addition to masses (such as cancers), it can show enlarged lymph nodes, which may have cancer cells. Many patients will have CT scans of the chest, as well as the abdomen to look for cancer spread, which may involve the liver, adrenal glands, or other internal organs. The CT scan may also involve the brain to look for cancer metastasis. A CT scan may also be used to obtain biopsies of masses or cancers that lie deep within or nearby other vital structures, which is termed CT guided needle biopsy.
Magnetic resonance imaging (MRI) studies also provide detailed soft tissue “pictures.” As opposed to CT scans, which utilizes x-rays, MRIs use magnetic radio waves to generate images. MRIs are particularly useful for imaging the brain and spinal cord. Gadolinium, a contrast, is often used to produce even better MRI images.
PET scans, also known as positron emission tomography, are especially useful to look for cancer spread. This study involves injecting a special radioactive sugar (flurodeoxyglucose, or FDP) into the vein. The amount of radioactivity is very low and will not cause you harm. After the injection, a special scanner will pick up areas in your body where the sugar has accumulated. As cancer cells are very active and require a great amount of energy (sugar), the FDP will concentrate in these areas. The PET scan does not produce extremely detailed images, but rather indicates spread of cancer throughout the body.
Bone scans can also be performed to detect spread of cancer to bones. During this procedure, a radioactive dye is injected in the vein, where is it transported to areas of bone with abundant activity, which may occur in cancerous and non-cancerous states.
Simple chest x-rays or radiographs will usually be performed as it is convenient, cheap, and will reveal if the cancer has progressed to the lungs
An intravenous pyelogram, or IVP, is an x-ray test that provides pictures of the kidneys, bladder, ureters, and urethra, and can evaluate the collecting system within the kidneys. During this procedure a specialized dye called contrast material is injected into a vein in your arm, where it is carried throughout the body, including the kidneys. X-rays are then taken at timed intervals. These images can demonstrate abnormalities within the kidneys.
Ureteroscopy is a procedure that utilizes a small camera placed through the urethra, bladder, and into the ureter to assess for areas of possible damage and cancer.
Angiography, which utilizes a specialized intravenous dye to visualize the arteries of the body, may also be used to help demonstrate the blood supply of the tumor and to help the surgeon plan his or her surgery.
If a suspicious mass is identified via the aforementioned tests, a biopsy may need to be performed to ensure proper diagnosis. During a biopsy, a small amount of tissue is removed from the suspicious mass and then assessed under the microscope. A biopsy is commonly performed as a fine needle aspiration, or FNA, which utilizes CT imaging and a long, thin needle to pierce the skin and to obtain a small tissue sample of the mass. A pathologist will then study the biopsy to determine if the mass is benign or malignant and will then identify the exact type of malignancy.
Possible lab tests used to diagnosis kidney cancer include:
Symptoms of renal cancer are usually absent until the disease is advanced. Unfortunately, prognosis declines as the disease progresses.
The most common symptom of renal cancer is painless bleeding in the urine, which is known as hematuria. Hematuria occurs in almost half of all patients with renal cancer . Although this is a common sign of kidney cancer, hematuria can occur in other medical conditions, such as kidney stones, or nephrolithiasis.
Other common signs and symptoms include:
Prognosis refers to the likely course of a disease or ailment. To determine the prognosis of kidney cancer, many factors must be considered. For example, the age of the patient and his or her functional status, or level of functioning, also plays a vital role in prognosis. Generally, younger and higher functioning patients will do best. Further, the amount of tumor able to be removed, also known as resected, impacts prognosis. If all of the tumor is removed, prognosis improves, while if only part of the tumor is removed, prognosis will likely deteriorate. If the tumor recurs, or comes back after removal, the prognosis is worse
Generally, the earlier the cancer is detected, the better the prognosis. Unfortunately, RCC usually has very few symptoms until it has progressed considerably. As a result, 30% of RCC patients have advanced disease at the time of diagnosis. 15-25% of these patients already have metastatic, or disease that has spread from the kidneys to other areas of the body.
Also very important for prognosis is staging and grading of the cancer. Staging of a cancer is the process of classifying how far a cancer has spread, while grading determines the makeup and characteristics of the cancer’s cells. In addition to prognostic value, staging and grading can help predict what therapy is most ideal and the effectiveness of the therapy. The American Joint Committee on
Cancer (AJCC) has standardized staging system that employs the size of the tumor (T), the number of involved lymph nodes (N), and the presence of metastasis (M). Thus, it is referred to as the TNM staging system. The more advanced each of these categories, like tumor size, the higher the number that follows the letter. The size of the tumor ranges from 0-4, while the staging of involved lymph nodes varies from 0-2 and the presence of metastases is determined with 0 or 1. A combination of these three variables and numbers then determines the stage of the cancer.
The grade of a cancer cell describes how similar or dissimilar the cell looks compared to a healthy cell observed under a microscope. Healthy tissue will have many different types of cells grouped together. If the tumor has many different types of cells and appears similar to healthy tissue, it is termed differentiated, or a low-grade tumor. Conversely, if the tumor appears very different from the healthy tissue, it is termed poorly differentiated, or a high-grade tumor. In general, the lower the grade of tumor, the better chance of treatment, survival, and prognosis.
As with most cancers, the prognosis of the disease depends on the type of cancer as well as the individual patients and the response to treatments. According to the University of California – Los Angeles, the 5-year survival rate for localized cancer is 62-97%, while those with metastatic disease have a 5-year survival rate of 8 – 41%.
People with cancer not only face physical challenges, but also mental and emotional challenges. It is important to understand your illness and treatment as it can make you feel more in control. Taking care of your emotional health is also vital. Family and friends can be an important source of support for you during this challenging time.
In addition, it is helpful to consider the following:
There are no official recommendations from the U.S. Preventive Services Task Force to suggest that it is beneficial to perform prophylactic kidney cancer screenings at the current time.
Unfortunately, there is no guaranteed preventative method to stop kidney cancer from developing. However, cases of kidney cancer that are diagnosed early are less likely to progress and to carry worse a worse prognosis than cases that are diagnosed at later stages.
If you experience any of symptoms of kidney cancer, contact your physician immediately.
RCC and Wilms tumor have five general treatment options:
Specific treatments for transitional cell cancer include:
As the definitive treatment for kidney cancer remains chemotherapy, radiation, and surgery, alternative treatments for this condition should only be considered after traditional interventions have been initiated or completed.
Complementary medicine, which refers to interventions performed in addition to traditional or standard treatment, are numerous and may provide additional symptom relief and improved quality of life for many patients. According to the National Center for Complementary and Integrative Health, these include:
Acupuncture – is particularly effective in alleviating treatment-related nausea and vomiting in cancer patients. It may even help control cancer pain. Although complications from acupuncture are rare, it is important to ensure that the needles are properly sterilized. Many cancer patients have weakened immune systems and more prone to infections.
Ginger – may help to control nausea secondary to cancer chemotherapy, especially when used along with standard anti-nausea medications.
Massage therapy – may help to alleviate symptoms experienced by many cancer patients, such as pain, nausea, anxiety, and depression. However, the massage therapist should be careful to avoid deep or too rigorous massage prior to physician approval, especially directly over a tumor or around sensitive skin, which is common following radiation treatments.
Mindfulness-based Stress Reduction – as a type of meditation, mindfulness-based stress reduction can help cancer patients by relieving anxiety, stress, fatigue, and general mood and sleep disturbances. As a result, this can lead to an overall improvement in quality of life.
Yoga – preliminary studies suggest that yoga may improve anxiety, depression, and stress in patients with cancer. It may also alleviate fatigue in breast cancer patients. However, additional studies need to be completed for better evidence and conclusions.
Hypnosis, relaxation therapies, and biofeedback – various studies are currently assessing the benefits of these activities in cancer patients.
Herbal supplements – a 2008 review of research regarding herbal supplements and cancer concluded that the scientific evidence is limited and many clinical trials were not well designed. Furthermore, there are specific concerns regarding some herbal supplements in terms of medication interactions. Thus, any use of herbal medications should be discussed thoroughly with your physician.
If you are experiencing any of the signs or symptoms of kidney cancer (see above), you should seek medical attention as soon as possible. The earlier a diagnosis can be made, the earlier treatment can begin, which generally leads to improved outcomes and better prognosis.
Unless the symptoms are life threatening, you can make an appointment within a reasonable time period and do not need to visit the emergency department.
Your medical team may consist of several healthcare professionals, including your primary care physician, a nephrologist , oncologist, and an oncologic surgeon. The National Cancer Institute can help you find a cancer center near you.
When you go to see your doctor, it’s good to have a list of the questions you’d like to have answered. Take a moment to write down some of the things you want to know. Your questions for your doctor might include some of these:
Other useful resources to help you learn about kidney cancer can be found at:
The National Cancer Institute
Kidney Cancer Association
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