Kidney cancer

What is Kidney Cancer

Your kidneys are a pair of organs in your abdomen. Each kidney is about the size of a fist.

Your kidneys are part of the urinary tract. They make urine by removing wastes and extra water from your blood. Urine collects in a hollow space (renal pelvis) in the middle of each kidney. Urine passes from your renal pelvis into your bladder through a long tube called a ureter. Urine leaves your bladder through a shorter tube.

Your kidneys also make substances to help control blood pressure and to make red blood cells. Attached to the top of each kidney is an adrenal gland. A layer of fatty tissue and an outer layer of fibrous tissue surround the kidney and adrenal gland.

Types of Kidney Cancer

Tumors in the kidney can be benign (not cancer) or malignant (cancer):

Benign tumors

• item Are rarely a threat to life
• item Don’t invade the tissues around them
• item Don’t spread to other parts of the body
• item Usually don’t need to be removed

Malignant tumors

• item May be a threat to life
• item Can invade nearby organs and tissues
• item Can spread to other parts of the body
• item Often can be removed but may grow back

Kidney cancer cells can spread by breaking away from the kidney tumor. They can travel through lymph vessels to nearby lymph nodes. They can also spread through blood vessels to the lungs, bones, or liver. After spreading, kidney cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.

Molecular classification

Risk factor of Kidney Cancer

When you get a diagnosis of kidney cancer, it’s natural to wonder what may have caused the disease. Doctors usually can’t explain why one person gets kidney cancer and another doesn’t.

However, we do know that people with certain risk factors may be more likely than others to develop kidney cancer. A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for kidney cancer:

• item__Smoking: Smoking tobacco is an important risk factor for kidney cancer. People who smoke have a higher risk than nonsmokers. The risk is higher for those who smoke more cigarettes or for a long time.
• Item__Obesity: Being obese increases the risk of kidney cancer.
• Item__High blood pressure: Having high blood pressure may increase the risk of kidney cancer.
• Item__Family history of kidney cancer: People with a family member who had kidney cancer have a slightly increased risk of the disease. Also, certain conditions that run in families can increase the risk of kidney cancer.
• Item__Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It’s caused by changes in the VHL gene. People with a changed VHL gene have an increased risk of kidney cancer. They may also have cysts or tumors in the eyes, brain, or other parts of the body. Family members of those with VHL can have a test to check for a changed VHL gene. Many people who get kidney cancer have none of these risk factors, and many people who have known risk factors don’t develop the disease.

Symptoms of Kidney Cancer

Common symptoms of kidney cancer include:

• item Blood in your urine (which may make urine look rusty or darker red)
• item Pain in your side that doesn’t go away
• item A lump or mass in your side or abdomen
• item Weight loss for no known reason
• item Fever
• item Feeling very tired

These symptoms may be caused by kidney cancer or by other health problems, such as an infection or a kidney cyst. People with these symptoms should tell their doctor so that any problem can be diagnosed an treated as early as possible.

Diagnosis & Tests

If you have symptoms that suggest kidney cancer, your doctor will try to find out what’s causing the problems.

You may have a physical exam. Also, you may have one or more of the following tests:

• item Urine tests: The lab checks your urine for blood and other signs of disease.
• item Blood tests: The lab checks your blood for several substances, such as creatinine. A high level of creatinine may mean the kidneys aren’t doing their job.
• item Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside your abdomen. The echoes create a picture of your kidney and nearby tissues. The picture can show a kidney tumor.
• item CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your abdomen. You may receive an injection of contrast material so your urinary tract and lymph nodes show up clearly in the pictures. The CT scan can show cancer in the kidneys, lymph nodes, or elsewhere in the abdomen.
• item MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your urinary tract and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in your kidneys, lymph nodes, or other tissues in the abdomen.
• item IVP: You’ll receive an injection of dye into a vein in your arm. The dye travels through the body and collects in your kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through your kidneys to your ureters and bladder. The x-rays can show a kidney tumor or other problems. (IVP is not used as commonly as CT or MRI for the detection of kidney cancer.)
• item Biopsy: The removal of tissue to look for cancer cells is a biopsy. In some cases, your doctor will do a biopsy to diagnose kidney cancer. Your doctor inserts a thin needle through your skin into the kidney to remove a small sample of tissue. Your doctor may use ultrasound or a CT scan to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue.
• item Surgery: After surgery to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer cells.

Stage of Kidney Cancer

If kidney cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on the size of the kidney tumor and whether the cancer has invaded nearby tissues or spread to other parts of the body.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It’s treated as kidney

cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.

These are the stages of kidney cancer:

• item__Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters). Cancer cells are found only in the kidney.
• item__Stage II: The tumor is bigger than a tennis ball. But cancer cells are found only in the kidney.
• item__Stage III: The tumor can be any size. It has spread to at least one nearby lymph node. Or it has grow through the kidney to reach nearby blood vessels.
• item__Stage IV: The tumor has grown through the layer of fatty tissue and the outer layer of fibrous tissue that surrounds the kidney. Or cancer cells have spread to nearby lymph nodes or to the lungs, liver, bones, or other tissues.

Treatment

Common treatment options for people with kidney cancer are surgery, targeted therapy, and biological therapy. You may receive more than one type of treatment. The treatment that’s right for you depends mainly on the following:

• item The size of the tumor
• item Whether the tumor has invaded tissues outside the kidney
• item Whether the tumor has spread to other parts of the body
• item Your age and general health You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral.

Surgery

Surgery is the most common treatment for people with kidney cancer. The type of surgery depends on the size and stage of the cancer, whether you have two kidneys, and whether cancer was found in both kidneys.

You and your surgeon can talk about the types of surgery and which may be right for you:

Removing all of the kidney (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 may also be removed.

Removing part of the kidney (partial nephrectomy):

The surgeon removes only the part of

the kidney that contains the tumor. People with a kidney tumor that is smaller than a tennis ball may choose this type of surgery.

There are two approaches for removing the kidney. The surgeon may remove the tumor by making a large incision into your body (open surgery). Or the surgeon may remove the tumor by making small incisions (laparoscopic surgery). The surgeon sees inside your abdomen with a thin, lighted tube (a laparoscope) placed inside a small incision. Sometimes a robot is

used. The surgeon uses handles below a computer display to control the robot’s arms.

The surgeon may use other methods of destroying the cancer in the kidney. For people who have a tumor smaller than 4 centimeters and who can’t have surgery to remove part of the kidney because of other health problems, the surgeon may suggest:

Cryosurgery:

The surgeon inserts a tool through a small incision or directly through the skin into the tumor. The tool freezes and kills the kidney tumor.

Radiofrequency ablation:

The surgeon inserts a special probe directly through the skin or through a small incision into the tumor. The probe contains tiny electrodes that kill the kidney cancer cells with heat.

If one kidney is removed, the remaining kidney is usually able to do the work of both kidneys. However, if your remaining kidney isn’t doing a good job cleaning your blood, you may need dialysis. Some people may need a transplant with a healthy kidney from a donor.

Targeted Therapy

People with kidney cancer that has spread may receive a type of drug called targeted therapy. Many kinds of targeted therapy are used for kidney cancer. This treatment may shrink a kidney tumor or slow its growth. Usually, the targeted therapy is taken by mouth. You may feel very tired while taking targeted therapy for kidney cancer. Other side effects may include diarrhea, nausea, vomiting, sores on the lips or in the mouth, and high blood pressure.

Biological Therapy

People with kidney cancer that has spread may receive biological therapy. Biological therapy for kidney cancer is a treatment that may improve the body’s natural defense (the immune system response) against cancer. The treatments used for kidney cancer can slow the growth of tumors or shrink them. The biological therapy is injected intravenously or under the skin. The treatment may be given at the hospital or a doctor’s office. Other drugs may be given at the same time to prevent side effects. The side effects differ with the biological therapy used, and from person to person. Biological therapy commonly causes a rash or swelling. You may feel very tired during treatment. The treatment may also cause a headache, muscle aches, a fever, or weakness.

Kidney Cancer related genes

Kidney Cancer Drugs

Kidney Cancer Clinical Trials

You can ask your doctor to help you find a clinical trial, what’s involved, and what to consider -- for instance, if you’d need to travel to take part. You can also check these websites for information.

Eviti Clinical Trials

This website, developed by the nonprofit Coalition of Cancer Cooperative Groups, is the leading cancer clinical trial search engine. You can search for cancer trials based on disease and location.

National Cancer InstituteThis website lists more than 6,000 cancer clinical trials and explains what to do when you find one that you think is right for you.

ClinicalTrials.gov

This website, a service of the National Institutes of Health, is a database of clinical studies worldwide.

CenterWatch

This web site lists industry-sponsored clinical trials that are recruiting patients.

Side Effects

Surgery

Pain and weakness. Your doctor will prescribe medication to relieve your pain, but you’ll need to allow time to rest and heal. It’s a good idea to keep a journal so you can track and describe your symptoms. If it gets worse, work with your doctor to adjust medications and fine-tune the dosage.

Nutrition of the patients

It’s important for you to take very good care of yourself before, during, and after cancer treatment. Taking care of yourself includes eating well so that you get the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.

Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don’t taste as good as they used to. In addition, the side effects of some treatments (such as poor appetite, nausea, or vomiting) can make it hard to eat well. Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs. Also, the NCI booklet Eating Hints has many useful ideas and recipes.

Follow-up Care

You’ll need regular checkups (such as every months) after treatment for kidney cancer. Checkups help ensure that any changes in your health are noted and treated if needed.

Kidney cancer may come back after treatment. Your doctor will check for return of cancer. Checkups may include blood tests, a chest x-ray, CT scans, or an ultrasound.