Kidney Cancer
Kidney Cancer
Definition
Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma, which occurs in the cells lining the kidneys (epithelial cells), is the most common type of kidney cancer. Eighty-five percent of all kidney tumors are renal cell carcinomas. Wilms' tumor is a rapidly developing cancer of the kidney most often found in children under four years of age.
Description
The kidneys are a pair of organs shaped like kidney beans that lie on either side of the spine just above the waist. Inside each kidney are tiny tubes (tubules) that filter and clean the blood, taking out the waste products and making urine. The urine that is made by the kidney passes through a tube called the ureter into the bladder. Urine is held in the bladder until it is discharged from the body. Renal cell carcinoma generally develops in the lining of the tubules that filter and clean the blood. Cancer that develops in the central portion of the kidney (where the urine is collected and drained into the ureters) is known as transitional cell cancer of the renal pelvis. Transitional cell cancer is similar to bladder cancer.
Kidney cancer accounts for approximately 2-3% of all cancers. In the United States, kidney cancer is the tenth most common cancer and the incidence has increased by 43% since 1973; the death rate has increased by 16%. According to the American Cancer Society, 35,710 Americans were diagnosed with kidney cancer in 2004, and 12,480 died from the disease. RCC accounts for 90-95% of malignant neoplasms that originate from the kidney.
Causes and symptoms
The causes of kidney cancer are unknown, but men seem to have a greater risk than women of contracting the disease; the male:female ratio in the United States and Canada is 3:2 as of the early 2000s. There is a strong association between cigarette smoking and kidney cancer. Cigarette smokers are twice as likely as non-smokers are to develop kidney cancer. Working around coke ovens has been shown to increase people's risk of developing this cancer. Certain types of painkillers that contain the chemical phenacetin are associated with kidney cancer. The United States government discontinued use of analgesics containing phenacetin about 20 years ago. Obesity may be yet another risk factor for kidney cancer. Some studies show a loose association between kidney cancer and occupational exposure to cadmium, petroleum products, lead, dry-cleaning solvents, trichloroethylene (TCE), and asbestos. Other risk factors for the development of kidney cancer include Hispanic heritage and preexisting von Hippel-Lindau disease.
The most common symptom of kidney cancer is blood in the urine (hematuria). Other symptoms include painful urination, pain in the lower back or on the sides, abdominal pain, a lump or hard mass that can be felt in the kidney area, unexplained weight loss, fever, weakness, fatigue, and high blood pressure.
Other symptoms may occur if the cancer has spread beyond its original location. Spread of kidney cancer most commonly occurs to the lung (55%), liver (33%), bone (33%), adrenal (20%), and opposite kidney (10%). Lymph node spread is also common, occurring in about 25% of patients).
Diagnosis
A diagnostic examination for kidney cancer includes taking a thorough medical history and making a complete physical examination in which the doctor will probe (palpate) the abdomen for lumps. Blood tests will be ordered to check for changes in blood chemistry caused by substances released by the tumor. Laboratory tests may show abnormal levels of iron in the blood. Either a low red blood cell count (anemia) or a high red blood cell count (erythrocytosis) may accompany kidney cancer. Occasionally, patients will have high calcium levels.
If the doctor suspects kidney cancer, an intravenous pyelogram (IVP) may be ordered. An IVP is an x-ray test in which a dye in injected into a vein in the arm. The dye travels through the body, and when it is concentrated in the urine to be discharged, it outlines the kidneys, ureters, and the urinary bladder. On an x-ray image, the dye will reveal any abnormalities of the urinary tract. The IVP may miss small kidney cancers.
Renal ultrasound is a diagnostic test in which sound waves are used to form an image of the kidneys. Ultrasound is a painless and non-invasive procedure that can be used to detect even very small kidney tumors. Imaging tests such as computed tomography scans (CT scans) and magnetic resonance imaging (MRI) can be used to evaluate the kidneys and the surrounding organs. These tests are used to check whether the tumor has spread outside the kidney to other organs in the abdomen. If the patient complains of bone pain, a special x ray called a bone scan may be ordered to rule out spread to the bones. A chest x ray may be taken to rule out spread to the lungs.
A kidney biopsy is used to positively confirm the diagnosis of kidney cancer. During this procedure, a small piece of tissue is removed from the tumor and examined under a microscope. The biopsy will give information about the type of tumor, the cells that are involved, and the aggressiveness of the tumor (tumor stage).
Treatment
Each person's treatment is different and depends on several factors. The location, size, and extent of the tumor have to be considered in addition to the patient's age, general health, and medical history. In addition, much has changed in the treatment and management of kidney cancer since the 1980s, including new surgical techniques, new anticancer drugs, and the development of effective treatments for advanced disease.
The primary treatment for kidney cancer that has not spread to other parts of the body, which is a Stage I, II, or III tumor, is surgical removal of the diseased kidney (nephrectomy ). Because most cancers affect only one kidney, the patient can function well with the remaining one. Two types of surgical procedure are used. Radical nephrectomy removes the entire kidney and the surrounding tissue. Sometimes, the lymph nodes surrounding the kidney are also removed. Partial nephrectomy removes only part of the kidney along with the tumor. This procedure is used either when the tumor is very small or when it is not practical to remove the entire kidney. It is not practical to remove a kidney when the patient has only one kidney or when both kidneys have tumors. There is a small (5%) chance of missing some of the cancer. Nephrectomy can also be useful for Stage IV cancers, but alternative surgical procedures such as transarterial angioinfarction may be used.
The rapid development and widespread use of laparoscopic techniques has made it possible for surgeons to remove small tumors while sparing the rest of the kidney. Most tumors removed by laparoscopy are 4 cm (1.6 in) in size or smaller. Laparoscopy also allows the surgeon to remove small tumors with cryoablation (destroying the tumor by freezing it) rather than cutting.
Radiation therapy, which consists of exposing the cancer cells to high-energy gamma rays from an external source, generally destroys cancer cells with minimal damage to the normal tissue. Side effects are nausea, fatigue, and stomach upsets. These symptoms disappear when the treatment is over. In kidney cancer, radiation therapy has been shown to alleviate pain and bleeding, especially when the cancer is inoperable. However, it has not proven to be of much use in destroying the kidney cancer cells. Therefore radiation therapy is not used very often as a treatment for cancer or as a routine adjuvant to nephrectomy. Radiotherapy, however, is used to manage metastatic kidney cancer.
Treatment of kidney cancer with anticancer drugs (chemotherapy ) has not produced good results. However, new drugs and new combinations of drugs continue to be tested in clinical trials. One new drug, semaxanib (SU5416), is reported to have good results in treating patients with kidney cancer. As of 2004, however, semaxanib is still undergoing clinical trials in the United States.
KEY TERMS
Biopsy— The surgical removal and microscopic examination of living tissue for diagnostic purposes.
Bone scan— An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.
Chemotherapy— Treatment with anticancer drugs.
Computed tomography (CT) scan— A medical procedure in which a series of x-ray images are made and put together by a computer to form detailed pictures of areas inside the body.
Cryoablation— A technique for removing tissue by destroying it with extreme cold.
Hematuria— Blood in the urine.
Immunotherapy— Treatment of cancer by stimulating the body's immune defense system.
Intravenous pyelogram (IVP)— A procedure in which a dye is injected into a vein in the arm. The dye travels through the body and concentrates in the urine to be discharged. It outlines the kidneys, ureters, and the urinary bladder. An x-ray image is then made and any abnormalities of the urinary tract are revealed.
Magnetic resonance imaging (MRI)— A medical procedure used for diagnostic purposes in which pictures of areas inside the body can be created using a magnet linked to a computer.
Nephrectomy— A medical procedure in which the kidney is surgically removed.
Radiation therapy— Treatment with high-energy radiation from x-ray machines, cobalt, radium, or other sources.
Renal ultrasound— A painless and non-invasive procedure in which sound waves are bounced off the kidneys. These sound waves produce a pattern of echoes that are then used by the computer to create pictures of areas inside the kidney (sonograms).
Immunologic therapy (or immunotherapy), a form of treatment in which the body's immune system is harnessed to help fight the cancer, is a new mode of therapy that is being tested for kidney cancer. Clinical trials with substances produced by the immune cells (aldesleukin and interferon) have shown some promise in destroying kidney cancer cells. These substances have been approved for use but they can be very toxic and produce severe side effects. The benefits derived from the treatment have to be weighed very carefully against the side effects in each case. Immunotherapy is the most promising systemic therapy for metastatic kidney cancer.
Prognosis
Because kidney cancer is often caught early and sometimes progresses slowly, the chances of a surgical cure are good. Length of survival depends on the size of the original tumor, the aggressiveness of the specific cells making up the tumor, and whether the cancer cells spread from the kidney to surrounding or distant tissues.
Kidney cancer is also one of the few cancers for which there are well-documented cases of spontaneous remission without therapy. Unfortunately, recurrences can occur even as long as ten years after the original diagnosis and treatment, and cancer can also crop up in the other, previously unaffected kidney.
Prevention
The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. However, because a strong association between kidney cancer and tobacco has been shown, avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet may also help prevent kidney cancer.
Resources
BOOKS
Beers, Mark H., MD, and Robert Berkow, MD., editors. "Renal Cell Carcinoma (Hypernephroma; Adenocarcinoma of the Kidney)." Section 17, Chapter 233 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.
Quek, Marcus L., and John P. Stein. "Malignant Tumors of the Urogenital Tract." In Conn's Current Therapy 2001. 53th ed. Philadlphia: W.B. Saunders Company, 2001.
PERIODICALS
Brauch, H., G. Weirich, B. Klein, et al. "VHL Mutations in Renal Cell Cancer: Does Occupational Exposure to Trichloroethylene Make a Difference?" Toxicology Letters 151 (June 15, 2004): 301-310.
Dutcher, J.P. "Immunotherapy: Are We Making a Difference?" Current Opinion in Urology September 2000: 435-9.
Godley, P.A., and K.I. Ataga. "Renal Cell Carcinoma." Current Opinion in Oncology May 2000: 260-4.
Griffiths, T. R., and J. K. Mellon. "Evolving Immunotherapeutic Strategies in Bladder and Renal Cancer." Postgraduate Medical Journal 80 (June 2004): 320-327.
Jennens, R. R., M. A. Rosenthal, G. J. Lindeman, and M. Michael. "Complete Radiological and Metabolic Response of Metastatic Renal Cell Carcinoma to SU5416 (Semaxanib) in a Patient with Probable von Hippel-Lindau Syndrome." Urologic Oncology 22 (May-June 2004): 193-196.
Lam, J. S., O. Svarts, and A. J. Pantuck. "Changing Concepts in the Surgical Management of Renal Cell Carcinoma." European Urology 45 (June 2004): 692-705.
Lotan, Y., D. A. Duchene, J. A. Cadeddu, et al. "Changing Management of Organ-Confined Renal Masses." Journal of Endourology 18 (April 2004): 263-268.
Moon, T. D., F. T. Lee, Jr., S. P. Hedican, et al. "Laparoscopic Cryoablation under Sonographic Guidance for the Treatment of Small Renal Tumors." Journal of Endourology 18 (June 2004): 436-440.
ORGANIZATIONS
American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329. (800) 227-2345. 〈http://www.cancer.org〉.
Cancer Research Institute (National Headquarters). 681 Fifth Avenue, New York, NY 10022. (800) 992-2623. 〈http://www.cancerresearch.org〉.
National Cancer Institute (NCI). 9000 Rockville Pike, Building 31, Room 10A16, Bethesda, MD 20892. (800) 422-6237. 〈http://www.nci.nih.gov〉.
National Kidney Cancer Association. 1234 Sherman Avenue, Suite 203, Evanston, IL 60202-1375. (800) 850-9132.
National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. 〈http://www.kidney.org〉.
Kidney Cancer
Kidney cancer
Definition
Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma occurs in the cells lining the kidneys (epithelial cells) and is the most common type of kidney cancer. About
ninety percent of all kidney tumors are renal cell carcinomas.
Description
The kidneys are a pair of organs about the size of a fist and shaped like kidney beans that lie on either side of the spine just above the waist. Inside each kidney are tiny tubes (tubules) that filter and clean the
blood, taking out the waste products and making urine. The urine made by the kidney passes through a tube called the ureter into the bladder. Urine is held in the bladder until it is discharged from the body. Renal cell carcinoma (RCC) generally develops in the lining of the tubules that filter and clean the blood. Cancer that develops in the central portion of the kidney (where the urine is collected and drained into the ureters) is known as transitional cell carcinoma of the renal pelvis. Transitional cell cancer is similar to bladder cancer .
Demographics
Kidney cancer accounts for approximately 2–3% of all cancers. Newly diagnosed cases of RCC have increased by about two percent per year for the past sixty-five years; the cause of the increase is not known. According to the American Cancer Society, 51,190 Americans were diagnosed with kidney cancer in 2007, and approximately 12,890 died from the disease.
Kidney cancer occurs most often in men over the age of 40 and is uncommon in people under the age of 45. The median age of diagnosis is 65. The male to female ratio is about 3:2. The lifetime risk of developing kidney cancer is 1 in 75.
Causes and symptoms
The causes of kidney cancer are unknown, but there are many risk factors associated with kidney cancer. The risk factors listed from greatest to smallest include:
- von Hippel-Lindau disease (100)
- chronic dialysis (32)
- obesity (3.6)
- tobacco use (2.3)
- first-degree relative with kidney cancer (1.6)
- hypertension (1.4)
- occupational exposure to dry cleaning solvents (1.4)
- diuretics (non-hypertension use) (1.3)
- trichloroethylene exposure (1.0)
- heavy phenacetin use (1.1–6.0)
- polycystic kidney disease (0.8–2.0)
- cadmium exposure (1.0–3.9)
- arsenic exposure (1.6)
- asbestos (1.1–1.8)
The most common symptom of kidney cancer is blood in the urine (hematuria). Other symptoms include painful urination, pain in the lower back or on the sides, abdominal pain, a lump or hard mass that can be felt in the kidney area, unexplained weight loss , fever, weakness, fatigue, and high blood pressure . Some individuals may also experience swelling of the ankles and legs.
Diagnosis
A diagnostic examination for kidney cancer includes taking a thorough medical history and making a complete physical examination in which the doctor probes (palpate) the abdomen for lumps. Urinalysis, a urine test, is usually one of the first tests to be done to look for blood and other substances in the urine. Sometimes a urine cytology test is ordered to look for cancer cells in the urine. Blood tests are ordered to check for changes in blood chemistry caused by substances released by the tumor. Laboratory tests can show abnormal levels of iron in the blood. Either a low red blood cell count (anemia ) or a high red blood cell count (erythrocytosis) may accompany kidney cancer. Occasionally, patients have high calcium levels.
If the doctor suspects kidney cancer, an intravenous pyelogram (also called an IVP or intravenous urography) may be ordered. An IVP is an x-ray test in which a dye is injected into a vein in the arm. The dye travels through the body, and when it is concentrated in the urine to be discharged, it outlines the kidneys, ureters, and the urinary bladder. On an x-ray image, the dye reveals any abnormalities of the urinary tract. The IVP may miss small kidney cancers.
Renal ultrasound is a diagnostic test in which sound waves are used to form an image of the kidneys. Ultrasound is a painless and non-invasive procedure used to detect even very small kidney tumors. Imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) can be used to evaluate the kidneys and the surrounding organs. These tests check whether the tumor has spread outside the kidney to other organs in the abdomen. If the patient complains of bone pain, a special x ray called a bone scan may be ordered to rule out spread to the bones. A chest x ray may be taken to rule out spread to the lungs.
A kidney biopsy is used to positively confirm the diagnosis of kidney cancer. During this procedure, a small piece of tissue is removed from the tumor and examined under a microscope. The biopsy provides information about the type of tumor, the cells involved, and the aggressiveness of the tumor (tumor stage).
Treatment
Each person's treatment is different and depends on several factors. The location, size, and extent of the tumor have to be considered in addition to the patient's age, general health, and medical history.
Staging
The American Joint Committee on Cancer (AJCC) staging system for kidney cancer uses Roman numerals I through IV to describe and define the extent of the cancer. The lower the number, the less the cancer has spread. A higher number usually means a more serious cancer. Stages I through III are usually referred to as localized stages of kidney cancer while Stage IV indicates a kidney cancer that has metastasized or recurred. Staging guidelines for kidney cancer are as follows:
- Stage I: Primary tumor is 7 cm (2.75 in) or less in greatest dimension and is limited to the kidney, with no lymph node involvement.
- Stage II: Primary tumor is larger than 7 cm (2.75 in) in greatest dimension and is limited to the kidney, with no lymph node involvement.
- Stage III: Primary tumor may extend into major veins or invade adrenal glands or perinephric tissues, but not beyond Gerota's fascia. There may be metastasis (spreading of cancer cells) in a single lymph node.
- Stage IV: Primary tumor invades beyond Gerota's fascia. Metastasis may be to more than one lymph node. Possible metastasis to distant structures in the body.
The primary treatment for kidney cancer that has not spread to other parts of the body, a Stage I, II, or III tumor, is surgical removal of the diseased kidney (nephrectomy). Most often, the cancer affects only one kidney, and the patient can function with the remaining kidney. Two types of surgical procedure are used. Radical nephrectomy removes the entire kidney and the surrounding tissue. Sometimes, the lymph nodes surrounding the kidney are also removed. Partial nephrectomy removes only part of the kidney along with the tumor. This procedure is used either when the tumor is very small or when it is not practical to remove the entire kidney. It is not practical to remove a kidney when the patient has only one kidney or when both kidneys have tumors. There is a small (5%) chance of missing some of the cancer.
Nephrectomy can be useful for Stage IV cancers, but alternative surgical procedures such as transarterial angioinfarction may be used.
The rapid development and widespread use of laparoscopic techniques has made it possible for surgeons to remove small tumors while sparing the rest of the kidney. Most tumors removed by laparoscopy are 1.6 in (4 cm) in size or smaller. Laparoscopy allows the surgeon to remove small tumors with cryoablation (destroying the tumor by freezing it) rather than cutting. Some elderly or infirm patients with small tumors may be offered the options of surveillance (watching and waiting to see if the tumor becomes larger or causes more distress prior to treatment) or energy techniques such as cryoablation or radio-frequency ablation (using heat from high-energy radio waves to destroy cancer cells).
Radiation therapy, which consists of exposing the cancer cells to high-energy gamma rays from an external source, generally destroys cancer cells with minimal damage to the normal tissue. Side effects are nausea, fatigue, and stomach upsets. These symptoms disappear when the treatment is over. In kidney cancer, radiation therapy has been shown to alleviate pain and bleeding, especially when the cancer is inoperable. However, because it has not proven useful in destroying the kidney cancer cells, radiation therapy is not used very often as a treatment for cancer or as a routine adjuvant to nephrectomy. Radiotherapy is used to manage metastatic kidney cancer.
Treatment of kidney cancer with anticancer drugs (chemotherapy ) has not produced good results. New drugs and new combinations of drugs continue to be tested in clinical trials. New drugs such as sunitinib malate, sorafenib, and temsirolimus have been recommended for use in some patients with metastatic or relapsed kidney cancer.
Immunologic therapy (or immunotherapy), a form of treatment in which the body's immune system is harnessed to help fight the cancer, is a new mode of therapy being tested for kidney cancer. Clinical trials with substances produced by the immune cells (aldesleukin and interferon) show some promise in destroying kidney cancer cells. A monoclonal antibody, bevacizumab, in combination with interferon has been recommended for use in patients with relapsed or metastatic kidney cancer that cannot be treated surgically. These substances have been approved for use but they can be very toxic and produce severe side effects. The benefits derived from the treatment must be weighed carefully against the side effects in each case. Immunotherapy is a promising systemic therapy for metastatic kidney cancer.
Clinical trials
As of 2008, the National Cancer Institute (NCI) listed over 250 clinical trials in place across the United States studying new types of radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, ways of combining various types of treatment for kidney cancer, side effect reduction, and improving quality of life.
Alternative and complementary therapies
There are several healing philosophies, approaches, and therapies that may be used as supplemental or instead of traditional treatments. Alternative or complementary therapies have varying effectiveness in boosting the immune system and/or treating a tumor. The efficacy of each treatment varies from person to person. None of the treatments have demonstrated safety or effectiveness on a consistent basis. Patients should research such treatments for any potential dangers (laetrile, for example, has caused death due to cyanide poisoning) and notify their physician before taking them.
- 714-X
- antineoplastons
- Cancell
- cartilage (bovine and shark)
- coenzyme Q10
- Gerson therapy
- Gonzalez Protocol
- hydrazine sulfate
- immuno-augmentative therapy
- Laetrile
- mistletoe
Prognosis
Because kidney cancer is often caught early and sometimes progresses slowly, the chances of a surgical cure are good. It is one of the few cancers for which there are well-documented cases of spontaneous remission without therapy. According to the National Comprehensive Cancer Centers Network (NCCN) 2008 Practice Guidelines for Kidney Cancer the estimated five year survival rates for RCC by stage are:
- 96% for patients diagnosed with Stage I renal cell cancer
- 82% for Stage II patients
- 64% for patients presenting in Stage III
- 23% for patients in Stage IV
KEY TERMS
Bone scan —An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.
Chemotherapy —Treatment with anticancer drugs.
Cryoablation —A technique for removing tissue by destroying it with extreme cold.
Hematuria —Blood in the urine.
Immunotherapy —Treatment of cancer by stimulating the body's immune defense system.
Intravenous pyelogram (IVP) —A procedure in which a dye is injected into a vein in the arm. The dye travels through the body and concentrates in the urine to be discharged. It outlines the kidneys, ureters, and the urinary bladder. An x-ray image is then made and any abnormalities of the urinary tract are revealed.
Monoclonal antibody —A type of protein made in the laboratory that can locate and adhere to substances in the body and on the surface of cancer cells.
Nephrectomy —A medical procedure in which the kidney is surgically removed.
Primary tumor —A cancer's origin or initial growth.
Following surgery, about 20–30% of patients with localized tumors experience a relapse of the cancer. The most frequent time of relapse after surgery is within one to two years after surgery with most relapses occurring within three years. The longer the patient goes without relapsing after the initial diagnosis and treatment of kidney cancer, the better the prognosis.
Prevention
The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. A strong association between kidney cancer and tobacco has been shown, so avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet including fruits and vegetables may help prevent kidney cancer.
QUESTIONS TO ASK YOUR DOCTOR
- What type of kidney cancer do I have?
- Has my cancer spread beyond my kidneys?
- What type of treatment(s) will I be receiving for my cancer?
- How long will my treatments last?
- How effective do you think the treatments will be?
- Do you think my cancer will return after treatment?
- What new treatments are being studied in clinical trials?
- What side effects can I expect as a result of my treatment?
- What is my prognosis or how long can I expect to live after treatment?
- What do I need to do to prepare for the treatment?
- What kind of follow-up will I need and for how long?
Caregiver concerns
Side effects of treatment, as well as nutrition , emotional well-being, and other complications, are all parts of coping with cancer. Pain, which may be treated by morphine or similar potent drugs, can be a major concern for people with advanced kidney cancer. There are many possible side effects for cancer treatment including:
- constipation
- delirium
- fatigue
- fever, chills, sweats
- nausea and vomiting
- mouth sores, dry mouth, bleeding gums
- pruritus (itching)
- sexual dysfunction
- sleep disorders
Anxiety, depression , loss, post-traumatic stress disorder, sexual dysfunction , and substance abuse are all possible emotional side-effects. Nutrition and eating before, during, and after a treatment can be of concern. Other complications of coping with cancer include fever and pain.
Resources
BOOKS
Beers, Mark H., MD, and Robert Berkow, MD, editors. “Renal Cell Carcinoma (Hypernephroma; Adenocarcinoma of the Kidney).” Section 17, Chapter 233. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.
PERIODICALS
Brauch, H., G. Weirich, B. Klein, et al. “VHL Mutations in Renal Cell Cancer: Does Occupational Exposure to Trichloroethylene Make a Difference?” Toxicology Letters 151 (June 15, 2004): 301–10.
Dutcher, J. P. “Immunotherapy: Are We Making a Difference?” Current Opinion in Urology September 2000:435–9.
Godley, P. A., and K. I. Ataga. “Renal Cell Carcinoma.” Current Opinion in Oncology May 2000: 260–4.
Griffiths, T. R., and J. K. Mellon. “Evolving Immunotherapeutic Strategies in Bladder and Renal Cancer.” Postgraduate Medical Journal 80 (June 2004): 320–27.
Jennens, R. R., M. A. Rosenthal, G. J. Lindeman, and M. Michael. “Complete Radiological and Metabolic Response of Metastatic Renal Cell Carcinoma to SU5416 (Semaxanib) in a Patient with Probable von Hippel-Lindau Syndrome.” Urologic Oncology 22 (May-June 2004): 193–96.
Lam, J. S., O. Svarts, and A. J. Pantuck. “Changing Concepts in the Surgical Management of Renal Cell Carcinoma.” European Urology 45 (June 2004): 692–705.
Lotan, Y., D. A. Duchene, J. A. Cadeddu, et al. “Changing Management of Organ-Confined Renal Masses.” Journal of Endourology 18 (April 2004): 263–68.
Moon, T. D., F. T. Lee, Jr., S. P. Hedican, et al. “Lapa-roscopicCryoablation under Sonographic Guidance for the Treatment of Small Renal Tumors.” Journal of Endourology 18 (June 2004): 436–40.
ORGANIZATIONS
American Cancer Society (National Headquarters). 1599 Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org.
American Urological Association Foundation. 1000 Corporate Blvd., Linthicum, MD 21090. (866) 746-4282. http://www.auafoundation.org/auafhome.asp.
Cancer Research Institute (National Headquarters). 681 Fifth Ave., New York, NY 10022. (800) 992-2623. http://www.cancerresearch.org.
Kidney Cancer Association. 1234 Sherman Ave., Suite 203, Evanston, IL 60202-1375. (800) 850-9132. http://www.kidneycancerassociation.org.
National Cancer Institute (NCI). 9000 Rockville Pike, Building 31, Room 10A16, Bethesda, MD 20892. (800) 422-6237. http://www.nci.nih.gov.
National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. http://www.kidney.org.
OTHER
Cancer Facts & Figures 2007. American Cancer Society (ACS). http://www.cancer.org/docroot/stt/stt_0.asp.
What is Kidney Cancer? American Cancer Society (ACS). November 6, 2007 [cited March 22, 2008]. http://www.cancer.org/docroot/CRI/content/CRI_2_2_1X_What_is_kidney_cancer_22.asp.
NCCN Practice Guidelines in Oncology-v.1.2008, Kidney Cancer. National Comprehensive Cancer Centers Network (NCCN). September 4, 2007 [cited March 22, 2008]. http://www.nccn.org/professionals/physician_gls/PDF/Kidney.pdf.
Lata Cherath Ph.D.
Kidney Cancer
Kidney cancer
Definition
Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma , sometimes referred to as hypernephroma, occurs in the cells lining the kidneys (epithelial cells). It is the most common type of kidney cancer. Eighty-five percent of all kidney tumors are renal cell carcinomas. Wilms' tumor is a rapidly developing cancer of the kidney most often found in children under four years of age.
Description
The kidneys are a pair of organs shaped like kidney beans that lie on either side of the spine just above the waist. Inside each kidney are tiny tubes (tubules) that filter and clean the blood, taking out the waste products and making urine. The urine that is made by the kidney passes through a tube called the ureter into the bladder. Urine is held in the bladder until it is discharged from the body. Renal cell carcinoma (RCC) generally develops in the lining of the tubules that filter and clean the blood. Cancer that develops in the central portion of the kidney (where the urine is collected and drained into the ureters) is known as transitional cell carcinoma of the renal pelvis. Transitional cell cancer is similar to bladder cancer . Wilms' tumor is the most common type of childhood kidney cancer and is distinct from kidney cancer in adults.
Demographics
Kidney cancer accounts for approximately 3% of all cancers. In the United States, kidney cancer is the tenth most common cancer and the incidence has increased by 43% since 1973; the death rate has increased by 16%. There are approximately 20, 000 new cases of kidney cancer found each year. There are approximately 95, 000 deaths per year worldwide due to kidney cancer. RCC accounts for 90-95% of malignant neoplasms that originate from the kidney.
Kidney cancer occurs most often in men over the age of 40. The median age of diagnosis is 65. Men are twice as likely as women are to have cancer of the kidney.
Causes and symptoms
The causes of kidney cancer are unknown, but there are many risk factors associated with kidney cancer. The risk factors listed from greatest to smallest include:
- von Hippel-Lindau disease (> 100)
- Chronic dialysis (32)
- Obesity (3.6)
- Tobacco use (cigarettes ) (2.3)
- First-degree relative with kidney cancer (1.6)
- Hypertension (1.4)
- Dry-cleaning worker (1.4)
- Diuretics (non-hypertension use) (1.3)
- Trichloroethylene exposure (1.0)
- Heavy phenacetin use (1.1-6.0)
- Polycystic kidney disease (0.8-2.0)
- Cadmium exposure (1.0-3.9)
- Arsenic exposure (1.6)
- Asbestos (1.1-1.8)
The most common symptom of kidney cancer is blood in the urine (hematuria). Other symptoms include painful urination, pain in the lower back or on the sides, abdominal pain, a lump or hard mass that can be felt in the kidney area, unexplained weight loss , fever , weakness, fatigue , and high blood pressure.
Diagnosis
A diagnostic examination for kidney cancer includes taking a thorough medical history and making a complete physical examination in which the doctor will probe (pal-pate) the abdomen for lumps. Blood tests will be ordered to check for changes in blood chemistry caused by substances released by the tumor. Laboratory tests may show abnormal levels of iron in the blood. Either a low red blood cell count (anemia ) or a high red blood cell count (erythrocytosis) may accompany kidney cancer. Occasionally, patients will have high calcium levels.
If the doctor suspects kidney cancer, an intravenous urography (also called pyelogram or IVP) may be ordered. An IVP is an x-ray test in which a dye is injected into a vein in the arm. The dye travels through the body, and when it is concentrated in the urine to be discharged, it outlines the kidneys, ureters, and the urinary bladder. On an x-ray image, the dye will reveal any abnormalities of the urinary tract. The IVP may miss small kidney cancers.
Renal ultrasound is a diagnostic test in which sound waves are used to form an image of the kidneys. Ultrasound is a painless and non-invasive procedure that can be used to detect even very small kidney tumors. Imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) can be used to evaluate the kidneys and the surrounding organs. These tests are used to check whether the tumor has spread outside the kidney to other organs in the abdomen. If the patient complains of bone pain , a special x ray called a bone scan may be ordered to rule out spread to the bones. A chest x ray may be taken to rule out spread to the lungs.
A kidney biopsy is used to positively confirm the diagnosis of kidney cancer. During this procedure, a small piece of tissue is removed from the tumor and examined under a microscope. The biopsy will give information about the type of tumor, the cells that are involved, and the aggressiveness of the tumor (tumor stage).
Staging, treatment, and prognosis
Staging
Staging guidelines for kidney cancer are as follows (2.5 cm equals approximately 1 in):
- Stage I: Primary tumor is 5 cm or less in greatest dimension and is limited to the kidney, with no lymph node involvement.
- Stage II: Primary tumor is larger than 5 cm in greatest dimension and is limited to the kidney, with no lymph node involvement.
- Stage III: Primary tumor may extend into major veins or invade adrenal glands or perinephric tissues, but not beyond Gerota's fascia. There may be metastasis in a single lymph node.
- Stage IV: Primary tumor invades beyond Gerota's fascia. Metastasis in more than one lymph node. Possible metastasis to distant structures in the body.
Treatment
Each person's treatment is different and depends on several factors. The location, size, and extent of the tumor have to be considered in addition to the patient's age, general health, and medical history.
The primary treatment for kidney cancer that has not spread to other parts of the body, which is a Stage I, II, or III tumor, is surgical removal of the diseased kidney (nephrectomy). Because most cancers affect only one kidney, the patient can function well on the one remaining. Two types of surgical procedure are used. Radical nephrectomy removes the entire kidney and the surrounding tissue. Sometimes, the lymph nodes surrounding the kidney are also removed. Partial nephrectomy removes only part of the kidney along with the tumor. This procedure is used either when the tumor is very small or when it is not practical to remove the entire kidney. It is not practical to remove a kidney when the patient has only one kidney or when both kidneys have tumors. There is a small (5%) chance of missing some of the cancer. Nephrectomy can also be useful for Stage IV cancers, but alternative surgical procedures such as transarterial angioinfarction may be used.
Radiation therapy , which consists of exposing the cancer cells to high-energy gamma rays from an external source, generally destroys cancer cells with minimal damage to the normal tissue. Side effects are nausea, fatigue, and stomach upsets. These symptoms disappear when the treatment is over. In kidney cancer, radiation therapy has been shown to alleviate pain and bleeding, especially when the cancer is inoperable. However, it has not proven to be of much use in destroying the kidney cancer cells. Therefore radiation therapy is not used very often as a treatment for cancer or as a routine adjuvant to nephrectomy. Radiotherapy, however, is used to manage metastatic kidney cancer.
Treatment of kidney cancer with anti-cancer drugs (chemotherapy ) has not produced good results. However, new drugs and new combinations of drugs continue to be tested in clinical trials .
Immunotherapy or immunologic therapy , a form of treatment in which the body's immune system is harnessed to help fight the cancer, is a new mode of therapy that is being tested for kidney cancer. Clinical trials with substances produced by the immune cells (aldesleukin and interferon) have shown some promise in destroying kidney cancer cells. These substances have been approved for use but they can be very toxic and produce severe side effects. The benefits derived from the treatment have to be weighed very carefully against the side effects in each case. Immunotherapy is the most promising systemic therapy for metastatic kidney cancer.
Prognosis
Because kidney cancer is often caught early and sometimes progresses slowly, the chances of a surgical cure are good. It is also one of the few cancers for which there are well-documented cases of spontaneous remission without therapy.
Alternative and complementary therapies
There are several healing philosophies, approaches, and therapies that may be used as supplemental or instead of traditional treatments. All of the items listed may have varying effectiveness in boosting the immune system and/or treating a tumor. The efficacy of each treatment also varies from person to person. None of the treatments, however, have demonstrated safety or effectiveness on a consistent basis. Patients should research such treatments for any potential dangers (laetrile, for example, has caused death due to cyanide poisoning) and notify their physician before taking them.
- 714-X
- antineoplastons
- Cancell
- cartilage (bovine and shark)
- Coenzyme Q10
- Gerson Therapy
- Gonzalez Protocol
- Hydrazine sulfate
- immuno-augementative therapy
- Laetrile
- mistletoe
Coping with cancer treatment
Side effects of treatment, as well as nutrition, emotional well-being, and other complications, are all parts of coping with cancer. There are many possible side effects for a cancer treatment that include:
- constipation
- delirium
- fatigue
- fever, chills, sweats
- nausea and vomiting
- mouth sores, dry mouth, bleeding gums
- pruritus (itching )
- sexuality
- sleep disorders
Anxiety, depression , loss, post-traumatic stress disorder, sexuality, and substance abuse are all possible emotional side-effects. Nutrition and eating before, during, and after a treatment can also be of concern. Other complications of coping with cancer include fever and pain.
Clinical trials
There are many clinical trials in place studying new types of radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, ways of combining various types of treatment for kidney cancer, side effect reduction, and improving quality of life. Immunostimulatory agents and gene-therapy techniques that modify tumor cells, antiangiogenesis compounds, cyclin-dependent kinase inhibitors, and differentiating agents are all being investigated as possible therapies. Consult <http://ClinicalTrials.gov> and your doctor for a list of kidney cancer clinical trials.
Prevention
The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. However, because a strong association between kidney cancer and tobacco has been shown, avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet may also help prevent kidney cancer.
See Also Renal pelvis tumors; Von Hippel-Lindau Syndrome
Resources
BOOKS
Berkow, Robert, ed. The Merck Manual of Diagnosis and Therapy, 16th ed. Rahway, NJ: Merck Research Laboratories, 1997.
Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy. How Cancer Is Diagnosed, Treated, and Managed Day to Day. Kansas City: Andrews McMeel, 1998.
Murphy, Gerald P., Lois B. Morris, and Dianne Lange. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery. New York: Viking, 1997.
Scher, H.I., and R.J. Motzer. "Renal Cell Carcinoma." In Harrison's Principles of Internal Medicine. Fauci, Anthony, et al, eds. New York: McGraw-Hill, 1998.
PERIODICALS
Dutcher, J.P. "Immunotherapy: Are We Making a Difference?"Current Opinion in Urology (September 2000): 435-9.
Godley, P.A., and K.I. Ataga. "Renal Cell Carcinoma." Current Opinion in Oncology (May 2000): 260-4.
Halperin, E.C. "Kidney Cancer." Lancet (February 1999): 594.
Vogelzang, N.J., and W.M. Stadler. "Kidney Cancer." Lancet (November 1998): 1691-6.
ORGANIZATIONS
American Cancer Society (National Headquarters). 1599Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. <http://www.cancer.org.>
American Foundation for Urologic Disease. E-mail: [email protected]. Cancer Research Institute (National Headquarters). 681 Fifth Ave., New York, NY 10022. (800) 992-2623. <http://www.cancerresearch.org>.
Kidney Cancer Association. 1234 Sherman Ave., Suite 203, Evanston, IL 60202-1375. (800) 850-9132. <http://www.kidneycancerassociation.org>.
National Cancer Institute. 9000 Rockville Pike, Building 31, Room 10A16, Bethesda, MD 20892. (800) 422-6237. <http://www.nci.nih.gov>.
National Kidney Cancer Association. 1234 Sherman Ave., Suite 203, Evanston, IL 60202-1375. (800) 850-9132.
National Kidney Foundation. 30 East 33rd St., New York, NY10016. (800) 622-9010. <http://www.kidney.org>.
American Urological Association. 1120 N. Charles St., Baltimore, MD 21201. (410) 727-1100. <http://www.auanet.org/patient_info/find_urologist/index.cfm>.
Lata Cherath, Ph.D.
Laura Ruth, Ph.D.
KEY TERMS
Biopsy
—The surgical removal and microscopic examination of living tissue for diagnostic purposes.
Bone scan
—An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.
Chemotherapy
—Treatment with anticancer drugs.
Computed tomography (CT) scan
—A medical procedure in which a series of x-ray images are made and put together by a computer to form detailed pictures of areas inside the body.
Hematuria
—Blood in the urine.
Immunotherapy
—Treatment of cancer by stimulating the body's immune defense system.
Intravenous pyelogram (IVP)
—A procedure in which a dye is injected into a vein in the arm. The dye travels through the body and concentrates in the urine to be discharged. It outlines the kidneys, ureters, and the urinary bladder. An x-ray image is then made and any abnormalities of the urinary tract are revealed.
Magnetic resonance imaging (MRI)
—A medical procedure used for diagnostic purposes in which pictures of areas inside the body can be created using a magnet linked to a computer.
Nephrectomy
—A medical procedure in which the kidney is surgically removed.
Primary tumor
—A cancer's origin or initial growth.
Radiation therapy
—Treatment with high-energy radiation from x-ray machines, cobalt, radium, or other sources.
Renal ultrasound
—A painless and non-invasive procedure in which sound waves are bounced off the kidneys. These sound waves produce a pattern of echoes that are then used by the computer to create pictures of areas inside the kidney (sonograms).
QUESTIONS TO ASK THE DOCTOR
- What should I expect from a biopsy test?
- What type of kidney cancer do I have?
- What is the stage of the disease?
- What are the treatment choices? Which do you recommend? Why?
- What are the risks and possible side effects of each treatment?
- What are the chances that the treatment will be successful?
- What new treatments are being studied in clinical trials?
- How long will treatment last?
- Will I have to stay in the hospital?
- Will treatment affect my normal activities? If so, for how long?
- What is the treatment likely to cost?
Kidney Cancer
Kidney Cancer
How Do Doctors Diagnose and Treat Kidney Cancer?
Kidney cancer occurs when cells in the kidney divide without control or order, forming a growth called a tumor and sometimes spreading to other parts of the body.
KEYWORDS
for searching the internet and other reference sources
Oncology
Nephrology
Renal cell carcinoma
Urology
Wilms’ tumor
The kidneys are two bean-shaped organs located near the spine whose main function is to filter salts, excess water, and impurities from the blood, producing the liquid waste called urine. Urine drains from the kidneys to the bladder through a tube called the ureter. It is stored in the bladder until it leaves the body through another tube called the urethra. The kidneys also help produce red blood cells and help maintain healthy blood pressure.
If cancer develops in the kidneys, it may affect not only the kidneys but nearby organs as well, including the liver, pancreas, and large intestine. Or kidney cancer cells may spread through the bloodstream or lymphatic system to other parts of the body. The most common form of kidney cancer in children is Wilms’ tumor, and the most common form of kidney cancer in adults is renal cell cancer.
Wilms’ Tumor
Wilms’ tumor, the most common cause of kidney cancer in children, begins to develop even before a child is born. As the fetus grows in the womb, the kidney cells develop into the netlike structures of blood vessels and tissues that are needed to filter the blood. When these cells do not mature as they should, the baby is born with some underdeveloped cells. Usually these cells mature by the time a child is three or four. But sometimes they start to grow out of control, forming the jumbled mixture of small cells called a Wilms’ tumor, after the German doctor Max Wilms (1867-1918), who first wrote about it in 1899.
Doctors find the tumor when a mass is felt while examining a baby’s belly. There are usually few, if any, symptoms. If the tumor has not spread out of the kidney, the outlook for the child’s recovery is excellent. Most children with Wilms’ tumor are treated with surgery or chemotherapy* If the cancer has spread beyond the kidney, doctors might also prescribe radiation therapy, which uses focused, high-energy rays to destroy cancer cells.
- * chemotherapy
- (kee-mo-THER-a-pee) is the treatment of cancer with powerful drugs that kill cancer cells.
Adult Kidney Cancer
Kidney cancer in adults is much more common than in children, affecting about 30,000 people each year. In four out of five cases, the tumor forms in the tissue responsible for filtering the blood, but it also can affect the renal pelvis, the structure that collects the urine after filtration. Unlike Wilms’ tumor, kidney cancer in adults often spreads to nearby organs and to other parts of the body.
Kidney cancer is more common in people who smoke cigarettes. Exposure to certain harsh chemicals and to medications containing the pain-reliever phenacetin appears to increase risk for the disease. Heredity can play a role too. However, many cases of kidney cancer develop without apparent cause. The most common early symptoms include:
- Blood in the urine.
- Pain in the lower back.
- Unexplained weight loss.
- Recurring fevers.
- High blood pressure.
How Do Doctors Diagnose and Treat Kidney Cancer?
Diagnosis Doctors start with a medical history, physical examinastion, and laboratory tests of blood and urine samples. Based on their findings, they may order tests that produce pictures of the kidneys and nearby organs. Additional tests may be ordered, including:
- Intravenous pyelogram (IVP) (in-tra-VEN-us PY-e-lo-gram), which is a series of x-rays of the kidneys, ureters, and bladder after dye is injected.
- Arteriogram (ar-TER-ee-o-gram), which is a similar test that creates images of the network of blood vessels in and around the kidney.
- Imaging tests, such as CT scans*, MRIs*, and ultrasound*.
- * CT scans
- or CAT scans are the shortened names for computerized axial tomography (to-MOG-ra-fee), which uses computers to view structures inside the body.
- * MRI,
- which is short for magnetic resonance imaging, produces computerized images of internal body tissues based on the magnetic properties of atoms within the body.
- * ultrasound
- is a painless procedure in which sound waves passing through the body create images on a computer screen.
If kidney cancer is suspected, a surgeon will perform a biopsy by inserting a thin needle into the tumor and removing a sample of tissue to be examined under the microscope. If these cells turn out to be cancerous, doctors need to find out whether or not the cancer has spread beyond the kidney. Kidney cancer cells often spread through the bloodstream or the lymph nodes, which filter the infection-fighting fluid called lymph. Doctors may order more imaging tests to examine nearby organs and to check for swollen lymph nodes in the chest and abdomen. They also may order chest x-rays and bone scans, because the cancer most often spreads to the lungs or the bones. If the cancer is found to have spread to the lungs or other organs, it still will be kidney cancer because those are the cancer cells that have spread.
Treatment
How the disease is treated depends on whether it has spread beyond the kidney. If it has not, the most common treatments are surgery and radiation therapy. Surgery involves removing part or all of the kidney, a procedure called nephrectomy (nef-REK-tom-ee). The remaining kidney generally is able to perform the work of both kidneys.
Kidney cancer that has spread to other parts of the body is very difficult to treat. Doctors can use biological therapy, chemotherapy, and hormone therapy. Biological therapy, also called immunotherapy, attempts to boost the body’s own natural defenses against the cancer. Interleukin-2 and interferon are two examples of substances that are used as “immune boosters.” Chemotherapy delivers anti-cancer drugs into the person’s bloodstream through a needle or in pill form. Hormone therapy involves blocking or increasing the body’s own chemical messengers (hormones) to try to control the growth of cancer cells.
These treatments have helped only a small percentage of people with advanced kidney cancer. That is why researchers are conducting clinical trials, which are research studies with volunteer patients, to test new treatment approaches. People with advanced kidney cancer and their caregivers also find support groups a valuable resource.
See also
Anemia
Bladder Cancer
Cancer
Hypertension
Tumor
Resources
U.S. National Cancer Institute, National Institutes of Health,
Bethesda, MD. NCI posts a fact sheet called What You Need to Know
about Kidney Cancer at its website. Its CancerTrials website
posts information about clinical trials.
Telephone 800-4-CANCER
http://cancernet.nci.nih.gov/wyntk_pubs/kidney.htm
http://cancertrials.nci.nih.gov
U.S. National Kidney and Urologic Diseases Information Clearinghouse,
3 Information Way, Bethesda, MD 20892-3580. This division of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) posts many different fact sheets about the kidney at its website. Telephone 301-654-4415
http://www.niddk.nih.gov/health/kidney
American Cancer Society Cancer Resource Center. The ACS posts information about Wilms’ tumor and adult kidney cancer at its website. Telephone 800-ACS-2345 http://www3.cancer.org/cancerinfo/specific.asp
Kidney Cancer Association, 1234 Sherman Avenue, Suite 203, Evanston, IL 60202-1378. Telephone 800-850-9132 http://www.nkca.org