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Kidney Cancer

Kidney Cancer

Kidney cancer is usually defined as a cancer that originates in the kidney.

 

The two most common types of kidney cancer, reflecting their location within the kidney, are renal cell carcinoma (RCC) and urothelial cell carcinoma(UCC) of the renal pelvis.

 

The distinction between these two types (RCC and UCC) is important because their prognosis, staging, and management, i.e. treatment (e.g. surgery,chemotherapy etc.), are different.

Symptoms

Common symptoms of kidney cancer include:

 

  • Blood in the urine (making the urine slightly rusty to deep red).
  • Pain in the side that does not go away.
  • A lump or mass in the side or the abdomen.
  • Weight loss.
  • Fever.
  • Feeling very tired or having a general feeling of poor health.

 

Most often, these symptoms do not mean cancer. An infection, a cyst, or another problem also can cause the same symptoms. A person with any of these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible.

 

Diagnosis

If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:

 

Physical exam:

The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.

 

Urine tests:

Urine is checked for blood and other signs of disease.

 

Blood tests:

The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.

 

Intravenous pyelogram (IVP):

The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.

 

CT scan (CAT scan):

An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.

 

Ultrasound test:

The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.

 

Biopsy:

In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.

 

Surgery:

In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Causes

Kidney cancer is more common in men than in women. It is most often found in people over 50 years of age.

 

There is no single cause of kidney cancer, but some factors increase the risk of developing it:

  • smoking.
  • being overweight.
  • genetic conditions, such as von Hippel-Lindau (VHL) disease.
  • long-term dialysis.

 

Some studies have suggested that having high blood pressure increases a person's risk of getting kidney cancer but the research isn't clear. Some people develop kidney cancer without any of these risk factors.

Treatment

People with kidney cancer may have surgery, arterial embolization, radiation therapy, biological therapy, or chemotherapy. Some may have a combination of treatments.

 

At any stage of disease, people with kidney cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

 

A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on "The Promise of Cancer Research" has more information about clinical trials.

 

Surgery


Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

 

An operation to remove the kidney is called a nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor.

 

The doctor can explain each operation and discuss which is most suitable for the patient:

 

Radical nephrectomy:

Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.

 

Simple nephrectomy:

The surgeon removes only the kidney. Some people with Stage I kidney cancer may have a simple nephrectomy.

 

Partial nephrectomy:

The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery.

 

Arterial embolization


Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

 

The doctor inserts a narrow tube (catheter) into a blood vessel in the leg. The tube is passed up to the main blood vessel (renal artery) that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.

 

Radiation therapy


Radiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

 

A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

 

Biological therapy


Biological therapy is a type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer.

 

For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 or aldesleukin). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

 

Chemotherapy


Chemotherapy is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer. However, many doctors are studying new drugs and new combinations that may prove more helpful. The section on "The Promise of Cancer Research" has more information about these studies.

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