Kidney Cancer

Kidney, or renal, cancer refers to any type of cancer that involves the kidney. Older age, obesity, smoking, and high blood pressure increase the risk of developing kidney cancer.

The kidneys are part of the urinary system, which eliminates waste and excess fluid and electrolytes from the blood. They also control the production of red blood cells and regulate blood pressure.

Kidney cancers mainly originate in two parts of the kidney, the renal tubule and the renal pelvis. A cancer that starts outside the kidney and metastasizes to the kidney is not normally called kidney cancer.

Around 63,990 new cases of kidney cancer are diagnosed in the United States each year, causing over 14,000 deaths annually. In 2017, 40,610 American men and 23,380 women were expected to receive a diagnosis of kidney cancer.

Kidney cancer is one of the 10 most common cancers, affecting about 1 in every 63 people over a lifetime. It occurs more frequently among adults aged between 50 and 80 years.

Worldwide, North America has the highest rate of kidney cancer, but in developing countries, the incidence has been steadily increasing over the last three decades. This increase may be linked to a parallel rise in obesity rates, or it could be due to improved detection and diagnosis.

Symptoms

Kidney cancer rarely causes signs or symptoms in its early stages. And currently there are no routine tests used to screen for kidney cancer in the absence of symptoms. In the later stages, kidney cancer signs and symptoms may include:

Blood in your urine, which may appear pink, red or cola colored

Pain in your back or side that doesn't go away

Loss of appetite

Unexplained weight loss

Tiredness

Fever, which usually comes and goes (intermittent)

Types of kidney cancer

The most common form of kidney cancer is renal cell carcinoma or RCC for short. About 90 per cent of kidney cancers are RCCs. There are several different sub-types of RCC, which are named according to the type of cell that is affected, or the appearance of the cancer cells under the microscope. The most common of these is clear cell, which account for about 75 per cent of RCCs. Other subtypes include papillary, chromophobe, and collecting duct carcinoma.

Subtypes of renal cell carcinoma (RCC):

  • Conventional or clear cell RCC – this can also be called non-papillary RCC and accounts for 75 per cent of RCC cases. The cancer cells appear clear under the microscope and have large nuclei.
  • Papillary or chromophilic RCC accounts for about 10-15 per cent of RCC cases. The tumours have characteristic papillae or nodules on the surface.
  • Chromophobe RCC accounts for about 5 per cent of cases
  • Collecting duct carcinoma
  • Renal medullary carcinoma
  • Mucinous tubular and spindle-cell carcinoma
  • Renal translocation carcinomas
  • Unclassified RCC, the latter five of which together make up the remaining 5-10 per cent of RCC tumours

Tests for kidney cancer

The tests you might need may include:

  • An ultrasound scan – a scan that uses high frequency sound waves to create an image of your kidneys so your doctor can spot any problems
  • a computerised tomography (CT) scan – a detailed scan where several X-rays are taken and then put together by a computer; you may be given an injection of a special dye beforehand so your kidneys show up more clearly
  • a magnetic resonance imaging (MRI) scan – a scan that uses strong magnetic fields and radio waves to produce a detailed image of your kidneys
  • a cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of the body) so your doctor can spot any problems in your bladder
  • a biopsy – where a needle is inserted into your kidney to remove a small tissue sample for analysis in a laboratory; local anaesthetic is used to numb the area so the procedure doesn't hurt
  • These tests can confirm or rule out kidney cancer. If you have cancer, they can help show whether it has spread to other parts of your body.

Stages of kidney cancer

If you're diagnosed with kidney cancer, it will usually be given a "stage". This is a number that describes how far the cancer has spread.

Doctors use the TNM system to stage kidney cancer. This consists of three numbers:

  • T (tumour) – given from 1 to 4, depending on the size of the tumour
  • N (node) – given from 0 to 2, depending on whether the cancer has spread to nearby lymph glands
  • M (metastases) – given as either 0 or 1, depending on whether the cancer has spread to another part of the body

Treatment

The treatment for kidney cancer depends on the size of the cancer and whether it has spread to other parts of the body.

The main treatments are:

  • surgery to remove part or all of the affected kidney – this the main treatment for most people
  • ablation therapies – where the cancerous cells are destroyed by freezing or heating them
  • biological therapies – medications that help stop the cancer growing or spreading
  • embolisation – a procedure to cut off the blood supply to the cancer
  • radiotherapy – where high-energy radiation is used to target cancer cells and relieve symptoms

Cancer that hasn't spread out of the kidney can usually be cured by removing some or all of the kidney, although sometimes cryotherapy or radiofrequency ablation may be used instead.

A complete cure may not be possible if the cancer has spread, but it may be possible to slow its progression and treat any symptoms with surgery, medication and/or radiotherapy.

Surgery

There are two main types of surgery for kidney cancer:

  • an operation to just remove part of the kidney containing the cancer – called a partial nephrectomy
  • an operation to remove the entire affected kidney – called a radical nephrectomy

A partial nephrectomy is usually done if the cancer is small and easy for the surgeon to access. A radical nephrectomy may be necessary for larger cancers or if the cancer has spread beyond the kidney.

It's possible to live a normal life with only one kidney. Your other kidney can usually make up for the kidney that was removed.

Surgery for kidney cancer can be carried out in one of two ways:

  • through a single large incision (cut) in the tummy or back – known as "open" surgery
  • using special surgical tools inserted through smaller incisions – known as laparoscopic or "keyhole" surgery

Keyhole surgery tends to have a faster recovery time, but can only be done by surgeons with special training and it isn't always suitable. Talk to your surgeon about the pros and cons of each method.

Ablation therapies

Ablation therapies are treatments that involve either:

  • destroying cancer cells by freezing them (cryotherapy)
  • destroying cancer cells by heating them (radiofrequency ablation)

Either technique may be recommended in special circumstances (for example, to ensure your kidney keeps working), or if your tumour is small. Both treatments are only available in specialist centres, so you may need to travel to another hospital to have it.

Radiofreqency ablation is carried out by inserting a needle-like probe through your skin, so no large incisions are needed.

Cryotherapy is carried out using needles inserted into the tumour. This can be done through your skin (percutaneous cryotherapy) or through a small incision (laparoscopic cryotherapy).

Side effects of ablation therapies can include bleeding around the kidney and damage to the tube that carries urine from the kidney to the bladder (the ureter).

Biological therapies

If your cancer is advanced, treatment with biological therapies may be offered. These are medications, usually taken once or twice a day, that help stop the cancer growing and spreading.

There are many different biological therapies, including:

  • sunitinib
  • pazopanib
  • axitinib
  • everolimus
  • bevacizumab and interferon
  • nivolumab
  • tivozanib

At present, sunitinib, pazopanib, axitinib, everolimus, nivolumab and tivozanib are recommended for routine use on the NHS.

Some people with advanced kidney cancer may be offered a medication called lenvatinib, to take along with everolimus.

Side effects

Sunitinib, pazopanib, axitinib and tivozanib are all taken as regular tablets. Possible side effects include:

  • feeling and being sick
  • indigestion
  • diarrhoea
  • high blood pressure
  • a sore mouth
  • loss of appetite and weight loss
  • tiredness
  • infertility

Nivolumab is given as a drip directly into a vein every two weeks. It works by helping the body's immune system destroy the cancer cells. Side effects are uncommon, but can include:

  • a rash
  • diarrhoea
  • a cough and shortness of breath
  • tiredness

Embolisation

Embolisation is a procedure to block off the blood supply to the tumour, causing it to shrink.

It's sometimes recommended if you have advanced kidney cancer and you're not in good enough health to have surgery to remove the affected kidney.

During embolisation, the surgeon will insert a small tube called a catheter into a blood vessel in your groin and then guide it to the blood vessel supplying the tumour.

A substance will be injected through the catheter to block the blood vessel.

Radiotherapy

Radiotherapy is a treatment where radiation is used to target or destroy cancerous cells. It can't usually cure kidney cancer, but it can slow down its progress and help control your symptoms.

It may be recommended if you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain.

The treatment involves a large machine directing a carefully aimed beam of radiation at the cancerous cells. It's often carried out for a few minutes every day, over a few weeks.

Side effects of radiotherapy can include:

  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin in the treatment area

Care and support

If you're diagnosed with cancer, your treatment and medical care will be of utmost importance.

But other aspects of your life are also important. You'll need to think about the kind of support you need, and know what assistance is available and where you can get it.

Support is also available for people who care for ill partners, children, relatives or friends.

  • Renal cell carcinoma
  • Types of renal cell carcinoma
  • Renal cell carcinoma risk factors
  • Pathophysiology
  • Treatment and Outcomes
  • Chemotherapy
  • Immunotherapy
  • Targeted Therapy

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4th World Kidney Congress

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14th Annual Conference on Nephrology & Renal Care

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18th International conference on Nephrology and Therapeutics

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15th World Nephrology Conference

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20th Global Nephrologists Annual Meeting

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23rd European Nephrology Conference

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23rd European Nephrology Conference

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