about Kidney cancer
Cancer begins when cell in the body start to divide and grow out of control. This can occur at any site of the body with living cells. When this out of control grow of cells occur in the kidney it is called kidney cancer.
Kidney is a bean shaped organ located at the upper back wall of the abdomen. Normally a person has two kidneys one on the right and the other on left hand side of the body. Each kidney is about the size of the fist. Kidneys are reddish brown in colour. Although most people have two kidneys, each kidney functions independently making it possible for a person to live with one kidney. Also due to the presence of dialysis machines it is possible for a person to live without functioning kidneys.
Kidneys are responsible for filtering waste products, excess mineral, water and excess salt from blood to form urine which will be removed from the body through urination process. This process of urine production occurs in tubes (tubules) inside kidney. Urine is carried out of kidney to the urinary bladder where it is stored temporary before being removed from the body by the tube called ureter.
Statistically kidney cancer affects more men than women with the majority being those above 45 years of age. Although there is some type of kidney cancer that affects more children than adults. For example Wilms tumor.
Types of kidney cancer
• Renal cell carcinoma. This is the type of kidney cancer more common in adults than other age group. This type of cancer starts in renal proximal tubules that make up renal filtration system. There are thousands of these tubules in each kidney. Renal cell carcinoma is also divided into further subtypes including the following,
• Clear renal cell carcinoma
• Papillary renal cell carcinoma
• Chromophobe renal cell carcinoma
• Transitional cell carcinoma. This is also called urothelial carcinoma. Urothelial carcinoma starts in renal pelvis. Renal pelvis is where urine collects before entering ureter.
• Sarcoma.This is the rare type of kidney cancer that starts in the connective tissues surrounding the kidney, soft tissues or surrounding fats. This type can spread to other near organs. It is commonly treated by using surgery.
• Wilms tumors. This is the most common type of kidney cancer in children.
• Lymphoma.Lymphoma of kidney involves enlarging of kidneys that may be associated with enlarged lymph nodes in other sites of the body such as neck, chest and abdomen.
Risk factors of kidney cancers
When it comes to cancer, anything that increases your probability of developing cancer is called a risk factor. Risk factors only influence development of cancer but it does not directly cause cancer. Sometimes people with risk factors do not develop the disease while those with no risk factors do develop the disease. Knowing risk factors will help you live your life making some better healthy choices to reduce the risk. Risk factors for kidney cancer include the following;
• Smoking. According to various researches, cigarette smoking doubles the risk of developing kidney cancers.
• Age. People with the age of above 45 years are more at risk of developing the disease than the young ones. And the risk increases as age increases.
• Gender. Statistically men are at more risk of this disease compared to women.
• Chronic kidney diseases. Having untreated kidney diseases for long time may increase your risk of developing kidney cancers.
• Overuse of some medication drugs. These include the use of over the counter drugs in addition to prescribed drugs. Painkillers containing phenacetin are highly linked with this type of cancer.
• Exposure to cadmium organic solvents. Frequent exposure to this metallic element is said to increase the risk of developing kidney cancer. This include those dealing with welding, painting and those working with batteries.
• Having certain genetic conditions. Some genetic conditions like Von hippel-lindau disease increases the risk of developing this type of cancer.
• Family history of the disease. To the family with the history of kidney cancer, the risk for the sibling to develop the disease is slightly high
• Obesity. Obese people have slightly increased chance of developing the disease due to the hormonal changes that may be influenced by excess fat it the body. These hormonal changes may increase the chance of developing kidney cancer.
• High blood pressure. People with high blood pressure are said to be at slightly higher risk of developing kidney cancer than those who are not having this problem.
Prevention of kidney cancer
The specific cause of kidney cancer is not known so preventing this cancer is still not possible but there are some other ways that may help you reduce the risk of developing the disease. These include making some better life style choices. These include the following;
• Avoid or quitting smoking
• Doing physical exercises and avoiding too much fat in your food to avoid obesity
• Using protective gear for those working in dangerous environment. For example welders and painters
Early detection and screening
When it comes to cancer, early detection normally provide better treatment outcome. When kidney cancer is found early, chances for better treatment outcome are very high. For most cancers, early detection has been greatly contributed by the presence of screening process.
Screening is the process of running some tests to someone who has no signs or symptoms of a certain disease with the intention of verifying presence or absence of such disease. For kidney cancers there are no screening tests recommended for those at an average risk but there are tests recommended to those with high risk of developing the disease like those with family history of the disease. These tests include CT scan, MRI scan and ultrasound test.
Although there are no recommended screening tests for those at average risk, most of kidney cancers are detected while they are still confined in the kidney (early stage). This is commonly through accidental detection during routine checkup that normally involves urine test (urinalysis).
This test may detect some blood in the urine which is a sign of kidney cancer too. From there further tests will be required to confirm if it is kidney cancer or not because blood in the urine can be due to other health reasons like bladder cancer, urinary tract infection, gall stones and other health complications.
Signs and symptoms of kidney cancer
Normally people with kidney cancers do not experience any signs or symptoms while the disease is at an early stage.But sometimes those signs and symptoms are caused by medical condition that is not cancer, hence seeing the doctor upon experiencing any of those symptoms is strongly advised.Signs and symptoms of kidney cancer include the following;
• Hematuria. Hematuria simply means presence of blood in the urine. Although not all people with the disease can show such symptom.
• Flank mass. These people may have an explained mass between their ribs and hip.
• Feeling pain in the side or back of the body. These people may experience pain in their side or back of their body.
• Malaise. Feeling uneasy, uncomfortable or illness.
• Night sweats
• Loss of body weight
• Loss of appetite
• Hypertension. Increased blood pressure
• Hypercalcemia. These people may have excess amount of calcium in their blood.
Medical diagnosis simply means identification of nature of an illness by elimination of the symptoms. Normally people don`t go to hospital knowing they have cancer but during diagnostic procedures is when doctors detect the disease.
Following suspicion of the disease, doctors normally run combination of tests to determine whether there are cancerous cells in the body or not and if there are cancer cells, how far have they spread. Along with thorough medical history and physical examination, doctors normally use combination of the following tests to diagnose cancer.
Laboratory tests are important in ruling out other conditions and confirming diagnosis. For cancer diagnosis laboratory tests normally include blood tests, urine tests, tumor markers and other body fluids tests.
• Blood tests. Blood tests help to reveal level of different substances in the blood which will help doctors to know if there is anything wrong in the body. From blood tests doctors can see complete blood count which indicates number, size and maturity of blood cells. Also from the blood tests doctors can analyze if kidney and liver are working properly.
• Urine tests. Urine tests (urinalysis) involve laboratory examination of urine to check presence of blood, proteins, and other substances such as drugs. For instance blood in the urine may be an indication of benign condition, infection or other health problem.
• Tumor markers. These are biomarkers (proteins) that can be produced by both cancer cells and normal body cells in response to cancer. Tumor markers are released into the blood or urine. Although studies are still conducted to determine role of these markers in diagnosing cancer because sometimes people with benign condition will have elevated level of these proteins. Also not all tumors have their markers and some markers are not specific to one type of tumor.
• Other body fluids. Despite being rarely used, sometimes body fluids can be tested in the lab during diagnosis of cancer. For instance the use of cerebral spinal fluid (CSF) and pleural fluid. CSF is used in diagnosis of brain tumors while pleural fluid for lung cancer.
Diagnostic imagings involve tests that create pictures of inside the body that help the doctor to see if there is tumor or not. There are several imaging tests used in cancer diagnosis depending on the type and location of cancer suspected. These imaging tests include;
• Computed tomography (CT) scan. CT scan machine is a donut-shaped scanner that uses x-rays to create series of pictures of body organs from different angles. This machine is linked to a computer where those series of pictures taken will be combined to create a 3D- image of inside the body. During the scanning process patient will lie still on the table which will slide into the scanner. In order to get a clear image, sometimes the doctor will inject the patient with a contrast material before scanning. From the images the doctor will be able to differentiate between healthy and unhealthy tissues.
• Magnetic resonance imaging (MRI). MRI is an imaging technique that uses powerful magnet and radio waves to take series of pictures of body organs and create a 3D image in a computer linked to a machine. Just like in CT, during MRI procedure the patient will lie on a table that will slide into a long round chamber. Also during this procedure the doctor may inject the patient with a contrast material for clear image view.
• X-ray. This is an imaging technique that is uses low dose of radiation to create pictures of inside your body. Technician will position the patient and direct the x-ray beam to the intended part of the body.
• Ultrasound. Ultrasound is a diagnostic imaging procedure that uses high energy sound waves to produce images of organs inside the body. During the examination, a patient will lie on the table while the technician will slowly move a device called transducer on the skin over the part of the body that is being examined.
• PET scan. Positron emission tomography (PET) scan is an imaging test that uses radioactive glucose to create 3-D images of areas inside the body. Radioactive glucose is used for this test because cancer cells tend to absorb more glucose than normal body cells, so the scan will show which areas of the body has more glucose than others. Before the scan, doctor will inject the patient with tracer called radioactive glucose then during imaging the patient will be asked to lie on the table that will be moving back and forth through the scanner.
• Bone scan. Bone scan is used to examine bones. When it comes to cancer, bone scan is used for diagnosis of bone cancer or cancer that has metastasized into the bones. Before the test, patient will be injected with small amount of radioactive material that tends to collect more on abnormal parts of the bones. Then pictures that will be taken by a scan will indicate the distribution of those radioactive materials in the bones throughout the body.
Biopsy is a diagnostic procedure that involves removing a tissue sample from the body and examines it under microscope in the laboratory. Examination in the laboratory is normally done by a pathologist who will check if the cells in the tissue are cancerous or not. In most cancer cases, biopsy is considered to be the confirmatory test. Depending on the location and type of cancer, biopsy can be obtained in different ways. Some of them include;
• Using needle. By using a thin needle, doctors can draw same tissue or fluid for examination under microscope. This method can be used to draw some fluid (spinal tap), bone marrow (bone marrow aspiration), blood or small amount of tumor from the suspected organ such as liver and breast (fine needle aspiration).
• Surgery. Abnormal tissue samples are obtained while the doctor is performing the surgery. Tissues are then sent to the lab for examination during the surgery. If the surgeon removes just a portion of abnormal area it is called incisional biopsy while when the entire tumor (abnormal site) is removed it is called excisional biopsy.
• Using endoscope. Endoscope is a thin, lighted tube with a camera (focusing telescope) at the end. It is used for viewing inside the body through natural openings like mouth and anus. During an examination if the doctor sees any abnormal tissue, then endoscope can also be used to take sample for that tissue. There are different kinds of endoscopy exams depending on the site of the body being examined. Some of the exams include colonoscopy (for rectum and colon), bronchoscopy (for trachea, bronchi and lungs) and esophagogastroduodenoscopy EGD (for esophagus, stomach and duodenum)
In addition to medical history and physical examination, common diagnosis tests for kidney cancer include, urinalysis, blood tests, ultrasound, CT scan, MRI scan, biopsy, chest X-ray, bone scan and intravenous pyelogram which involve x-raying kidneys after dye is injected. Dye will travels through the urinary tract indicating any tumor available.
Kidney cancer staging
Your general prognosis of kidney cancer treatment depends on various factors including your general health and stage of the disease. Staging kidney cancer TNM system is normally used. TNM is the combination of T (tumor), N (node) and M (metastasis).
• Tumor. Tumor explains size (how large is the tumor?) and its location.
• Node. This explain lymph nodes involved
• Metastasis. Metastasis explains how far has disease spread?
TNM system is the method most often used for staging kidney cancer.The results is combined to determine the stage of cancer for the particular case. There are four stages (stage I to IV) of kidney cancer as described below.
Stage I: The tumor is less than 7cm and it is confined in the kidney.
Stage II: Tumor is larger than 7 cm with the possibility of invading renal vein or the outer
tissues of the kidney. There are no lymph nodes involved or distant metastasis.
Stage III: Tumoris of any size with regional (nearby) lymph nodes involvement.Tumor may have
Spread to the adrenal gland
Stage IV: Tumor is of any size. There is distant lymph node involvement and distant metastasis
such as to the abdomen,liver, lungs, bone or brain.
Following cancer diagnosis, the doctor will break the news and it is normally not very easy to accept that it is cancer. The doctor will be there to help the patient process the news and to help the patient in taking the next steps.
After the patient receives and processes the news that he/she has cancer, one of the most important steps that will follow is decision making. The doctor will present to the patient (relatives/parents/guardians) with all the possible treatment options and explain what they mean. Then with the help of the doctor, the patient (relatives/parents/guardian) will have to choose which treatment option is good depending on benefits of such option.
Despite all the information given by the doctor, sometimes the patient may still be unsatisfied with what he/she has been told. In such situation, the patient is free and advised to seek a second opinion. Second opinion is the opinion that the patient may seek from another specialist (doctor) regarding his/her health problem and in this case it is cancer. Second opinion may include confirmation of the diagnosis, more clarification on your primary doctor recommendations or even reassurances that all the options have been explored.
In addition to standard care treatment options, sometimes there are those new treatments or drugs or combination of treatments that have not been approved yet to be used as standard care treatments for a particular cancer (disease) but have shown some promising results that they may help. These type of treatments are called clinical trials.
If there are some clinical trials for your case, the doctor may present to the patient or the patient may ask if there are any clinical trials for the particular cancer case. Over the years, have improved treatments and led to better outcomes to people diagnosed with various diseases including cancer. If you have decided to take part in clinical trial, you can also withdraw at any time
Treatment of kidney cancer requires a team of doctors and other health care professionals. This team work together and it is called multidisciplinary team. Team may vary depending on the treatment option for a particular case. But generally multidisciplinary team for treatment of kidney includes surgical oncologist, medical oncologist, radiation oncologist and other health care professionals like oncology nurses and palliative care team. Treatment options of kidney include the following;
Surgery is the treatment option that involves removing the tumor and some surrounding healthy tissues through operation. If cancer has not spread beyond kidney, then surgery may be the possible treatment option. Surgery also involves the removal of nearby involved lymph nodes. Below are some of the forms of the surgery depending on the extent of the disease.
• Radical nephrectomy. Radical nephrectomy is the most common operation for large tumors. It involves removing the whole kidney, small part of the ureter and the surrounding fatty tissue.Depending on extent of spread, the adrenal gland and nearby lymph nodes might also be removed.
• Partial nephrectomy. Partial nephrectomy is an option for tumors that are confined to the kidney,and is particularly useful for people with pre-existing kidney disease, cancer in both kidneys or only one working kidney. Only cancer and a small part of the kidney are removed, which means more of the kidney’s function is preserved. A partial nephrectomy isa more difficult operation than a radical nephrectomy, and whetherit is possible depends on the position of the tumor.
Sometimes surgery may not be recommended due to state of the disease or patient`s overall health. In this case below are some of the options that are recommended.
• Radiofrequency ablation. This procedure involves inserting needle into the tumor and destroys the tumor by using electric current. This procedure is like cooking the tumor.
• Cryoablation. This procedure involves freezing the tumor by using metal probe through small incision. Metal probe is placed in cancerous tissues. During the procedure ultrasound and CT scan are used to guide the probe.
Side effects of surgery
Side effects after kidney cancer surgery depend on various factors like type of surgery and general health before surgery. Some of the possible side effects of surgery of kidney cancer involve the following;
• Reaction to anesthesia
• Excess bleeding
• Blood clots
These side effects can be relieved by using medications for pain and infections, blood transfusion for excess bleeding and medications for reaction to anesthesia.
Targeted therapy is an option that involves targeting specific molecules in the cancer cells using drugs. The drug will stop the growth and spread of cancer cells and at the same time limit harm to normal cells. Drugs for this kind of treatment work differently to that of normal chemotherapy drugs. Drugs for this treatment option can sometimes help even when chemo isn’t, but they can also be used along with normal chemotherapy to help it work better. One type of targeted therapy is anti-angiogenic agents. These help to keep blood vessels from feeding a tumor, causing it to shrink and stop growing.
Side effects of targeted therapy Targeted therapy drugs minimizeharm to healthy cells, but they can still have side effects. These vary depending on the drug used, but may include the following;
• Changes in blood pressure
• Blood clotting reactions
• Allergic reactions
Immunotherapy is the treatment option that involves the use of drugs to boost natural immune system of the body to fight of the disease. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.Some older immune therapies like interferon alpha and interleukin-2 were successful in some kidney cancer patients, but were very toxic and so are now rarely used.A new family of immunotherapy drugs works by permitting the immune system to bypass ‘checkpoints’ set up by the cancer that block the immune system.
Side effects of immunotherapy
Although side effects of immunotherapy drugs vary depending on the type of drug that has been used, below are some of the common side effects.
• Flue like symptoms (chills, fever and muscle aches)
• Kidney damage
• Heart attacks
• Low blood pressure
• Fluid buildup in the lungs
• Loss of appetite.
Some of these symptoms may become very severe but are rarely fatal and can be relieved by medications.
Radiation therapy is the use of high energy X-rays and other particles to kill cancer cells. For kidney cancer, radiation therapy is not normally the primary treatment choice due to the harm it brings to the healthy kidney. It is used only if a patient cannot have surgery and even then, the irradiated sites are normally areas where the disease has spread. Most often, radiation therapy is used to ease symptoms, such as bone pain or swelling in the brain.
Side effects of radiation therapy
Normally side effects of radiation therapy go away soon after completion of radiation therapy but some of them can be relieved by medication. Some of the possible side effects include the following;
• Mild skin reactions
• Upset stomach
• Loose bowel movement.