Kidney Cancer - Causes, Symptoms, Stages & Treatment
Renal cell carcinoma is the most common type of cancer in the kidney. In this article, we will talk about renal cell cancer. The kidney also has renal collecting system cancer. However, the incidence of this cancer is 15 times less than renal cell cancer, and the treatment options are entirely different. Therefore, it will not be mentioned in this article. Again, since kidney cancers seen in children have other treatment options than those seen in adults, this subject will not be mentioned.
Learning about the treatment and understanding the treatment process allows patients to be a part of the treatment. The aim of this article is to patients;
- Things to know in the diagnosis and staging of cancer,
- Things to know in the treatment and follow-up of cancer,
- It will tell you what you need to know about research on kidney cancer.
- Thus, when patients see doctors, clearer questions about their diseases will appear in their minds, and they will get more information.
Kidney cancer is a severe disease. What your doctor has to say is essential. Generally, patients are advised to go to the doctor with a family member or trusted friend, record what the doctor says in small notes, and ask their doctor all the questions in their minds.
The kidneys are a pair of organs located in our abdomen. Each kidney is about the size of a fist. The kidney is an organ of the urinary tract. They produce urine by filtering waste materials and excess water from the blood.
Urine collects in a cavity within the kidney called the renal pelvis. This cavity is located in the middle of the kidney. Urine is transferred from the renal pelvis to the bladder through a channel called the ureter. The urine accumulated in the bladder is then transferred out of the body through a channel called the urethra.
The kidneys are also involved in the production of substances that control blood pressure. They also assist in the production of red blood cells. In the upper part of the kidneys is the adrenal gland. The upper part of the kidneys is covered with a thick layer of fat. Outside of this fat layer is the kidney capsule, which consists of fibrous tissue.
Cancer starts in cells. Cells are the building blocks that makeup tissues. Kidney tissues come together to form the kidney organ. Usually, cells are born and grow, multiply by division. Thus, they create new cells and meet the body's needs. As normal cells grow, they age, become damaged, and eventually die. Dead cells are cleared from the body, and new cells take their place.
Sometimes this cycle can be disrupted. New cells may appear even though the body does not need them, or old and damaged cells may not be properly destroyed. The mass growth of unwanted cells creates a mass. These masses are called tumors (cancer).
Tumors in the kidney can be benign (benign = non-cancerous) or malignant (malignant = cancer). Benign tumors are not as harmful as malignant tumors.
Benign (Benign tumors)
- Kidney cysts are examples of benign tumors.
- Usually not life-threatening
- They do not recur when treated or surgically removed.
- They do not spread to surrounding tissues and other organs of the body.
Malignant (Malignant tumors)
- They can be life-threatening.
- They can grow back even if surgically removed
- They can damage the surrounding tissues and show transition to the surrounding tissues.
- They can spread to other parts of the body
Kidney tumor cells can spread by separating from the cancerous tissue formed in the kidney. They can spread to surrounding lymph nodes through lymphatic vessels. Or they can spread through the blood vessels to the lungs, bones, or liver. After spreading, kidney tumor cells can attach to other tissues and grow to form new tumors in these tissues. The growth here becomes harmful by disrupting the regular activity of the tissue in which it is located.
Risk factors for kidney tumor
It is natural for a patient diagnosed with kidney cancer to wonder what causes cancer. However, we, as doctors, are often unable to explain the cause of kidney cancer. One of the two people exposed to the same environmental effects and fed the same way may have a tumor, and the other may not have a tumor.
However, we know that certain risk factors have significant effects on the development of kidney cancer. Kidney cancer is more common in people with the following risk factors.
Smoking: It is one of the most critical risk factors for the development of kidney cancer. Smokers are diagnosed with kidney cancer at a higher rate than non-smokers. The longer the smoking time, the higher the risk of developing kidney cancer.
Obesity: It increases the risk of kidney cancer.
High blood pressure: Long-term high blood pressure increases the risk of kidney cancer.
Family history: People with a family history of kidney cancer have a slightly increased risk than the average population. However, in some special genetic conditions, kidney cancer can be found in many individuals in the family.
Von Hippel Lindau (VHL syndrome): VHL is an inherited disease seen in a small number of families. It occurs due to changes in the VHL gene. Those who have this gene are at risk of developing kidney cancer. Cysts and tumors can also develop in the eyes, brain, and elsewhere in the body. Those with a family history of this syndrome should be tested for the VHL gene.
Most patients with kidney cancer do not have any of the above risk factors. In addition, most people with the above risk factors do not develop kidney cancer.
Quitting smoking is essential for treatment. Quitting smoking provides significant benefits. In addition, it reduces the risk of developing heart disease and lung diseases. Thus, the response to treatment is more successful, and the probability of surviving kidney cancer increases.
Symptoms of Kidney Cancer
- Blood in the urine (urine may be tea-colored, rust-colored, or dark red)
- Pain that does not go away on the right or left side of the back
- The prominence of a mass on either the patient's side or abdomen
- Losing more than the average weight for no reason
- High fever
- The feeling of extreme tiredness
The symptoms listed above may be due to kidney cancer or may be due to other health problems. For instance, infection or kidney cyst can cause the same symptoms if patients with these symptoms apply to a doctor, kidney cancer and other diseases that cause the same symptoms if there is no cancer and to be treated.
Diagnosis of kidney cancer
If you have symptoms suggestive of kidney cancer, your doctor will take you for a detailed examination. A physical examination can be done. One or more of the following tests may be requested.
Urine analysis: It is evaluated in the laboratory for blood or other signs of disease in the urine.
Blood tests: In the laboratory, blood is tested for many substances. Creatine is an essential indicator of kidney cancer. It is necessary to decide whether or not taking a kidney will harm the patient rather than the diagnosis of cancer. In cases of kidney failure, removal of the tumor, not the kidney, takes priority.
Ultrasonography: It is a unique device that works with sound waves that humans cannot hear. The computer detects the sound waves that go to the organs and reflect, and the shape of the organs is determined. Ultrasonography is successful in the diagnosis of kidney cancer and has an important place.
Computed tomography (CT): It works by taking X-ray films of the patient many times from various aspects and editing these films by computer to reveal complex images. A contrast agent (a substance that allows radiological imaging of the urine) may be given to the patient. Computed tomography is the most important diagnostic tool in the diagnosis of kidney cancer. The size of cancer, whether there is tumoral spread in the surrounding lymph nodes and kidney vessels, and whether there is a tumor elsewhere in the abdomen are determined.
Magnetic resonance (MRI): MRI, which consists of a giant magnet connected to a computer, can make essential contributions to imaging the urinary tract and surrounding lymph nodes. Administration of contrast material may also be required in MRI. However, the possibility of side effects is less than the contrast agent given in tomography.
IVP: With recent developments in computed tomography technology, IVP has been removed from being used as a diagnostic tool in kidney cancer.
Biopsy: Taking tissue samples from organs to be sure that there is cancer is called a biopsy. In some cases, a biopsy is recommended when the diagnosis of kidney cancer is uncertain. In such cases, a biopsy is taken from the kidney tissue by advancing a thin needle from the skin to the kidney under the guidance of ultrasonography or tomography. The pathologist examines whether there are cancer cells in this biopsy. Kidney biopsy is not generally accepted because it is difficult to perform, and tissue sampling is low. Complete removal of radiologically suspicious masses in the kidney gives more positive results in terms of treatment success.
Surgery: When there is cancer in the kidney, part or all of the kidney is removed, and the pathologist understands the type of kidney cancer.
When kidney cancer is diagnosed in a patient, it is necessary to understand how far cancer has spread before deciding on treatment. This study is called tumor staging. In tumor staging, the size of the tumor in cm and whether it has spread to the surrounding tissues are evaluated. Some tests are used to obtain these data.
Blood tests: Some substances in the blood of patients may need to be checked. Patients with kidney cancer may have elevated levels of calcium or LDH in the blood. Liver tests may be ordered to look for spread to the liver.
Lung X-ray: It is tried to determine whether kidney cancer has spread to the lung using lung X-ray.
Tomography: With tomography, the size of the tumor, whether it has spread to the lymph nodes, whether it has spread to the lungs and other parts of the body is evaluated.
When cancer spreads from its origin to another part of the body, the spread tumors have the same characteristics as the original tumors. For instance; If kidney cancer spreads to the lung, the tumor cells in the lung are kidney cancer cells. In this case, the disease is called metastatic kidney cancer, not lung cancer. It is treated like kidney cancer, not lung cancer.
Below are the types of the staging of kidney tumors:
Stage 1: At this stage, the tumor is smaller than 7 cm. The tumor is located only in the kidney and has not spread to other organs.
Stage 2: The tumor is more significant than 7 cm but has not spread to organs other than the kidney.
Stage 3: The tumor can be any size. It has migrated to the lymph nodes or has spread to the surrounding blood vessels.
Stage 4: The tumor has spread to the fatty tissue around the kidney or the fibrous capsule tissue. At the same time, cancer may have spread to the surrounding lymphatic tissues or other organs such as the lungs, liver, and bones.
The most crucial treatment option in a patient with kidney cancer is surgical treatment. The effectiveness of non-surgical treatments, especially chemotherapy and radiotherapy, in treating kidney cancer is unfortunately very low. Apart from surgical treatment, there are treatment options called targeted and biological therapy. It is decided to apply one of these treatment options to the patient.
The treatment method is decided according to:
- Tumor size
- Whether the tumor has spread to tissues other than the kidney
- Whether the tumor has spread to other parts of the body
- It is decided by looking at the age and general health of the patient.
The success rate increases when a urology team carries out kidney cancer treatment specialized in neurooncology in hospitals with all facilities such as radiotherapy and chemotherapy for cancer.
Doctors involved in the treatment:
Urologists: They are people who specialize in surgery that treats diseases related to the urinary tract.
Urooncologist: A urologist who deals specifically with urological cancers. It is essential to program the treatment by the urooncologist in the treatment of kidney cancer. Apart from this, a medical oncologist and a radiation oncologist should be included in the team that decides on the treatment.
The treatment options for kidney cancer are explained to the patient in detail. The expected success rate of the treatment and possible side effects should be presented to the patients without hiding. Cancer treatment is a necessary treatment that can cause serious side effects on the patient’s general condition. The patient must be informed about the side effects of treatment. The patient should fully understand the time to return to everyday life and the changes in usual activities.
Questions you may need to ask your doctor before starting treatment:
- What are the size of the tumor and the stage of the disease?
- Has the tumor spread to other organs other than the kidney?
- What are the treatment options? What treatment do you recommend to me and why?
- What are the expected positive effects according to treatment alternatives?
- What should I do to prepare for treatment?
- Will I have to stay in the hospital? If needed, how much?
- What are the side effects and risks of the recommended treatments? How to deal with possible side effects?
- What is the cost of the treatment? Can my social security cover the treatment?
- Will the treatment change activities in everyday life?
- Do I need to get a second opinion on this disease and the proposed treatment? Do you recommend it?
- How often do I need to be checked after treatment?
The most successful treatment for kidney cancer is surgical treatment. There are various forms of surgery. The type of treatment varies according to the size and stage of the tumor, whether the patient's other kidney is intact and whether there is a tumor in the other kidney.
Removal of the entire kidney (Radical Nephrectomy)
In this surgery, all the kidney tissue and the fatty tissue around the kidney and the adrenal gland are surgically removed. If the enlargement is detected in the surrounding lymph nodes, the lymph nodes can also be removed.
Removal of part of the kidney (Partial Nephrectomy)
Only the part of the kidney containing the tumor is removed. In cases where the size of the tumor and the location on the kidney are appropriate, the method of removing a part of the kidney, not the whole, can be selected.
Open surgery method or laparoscopic surgery method can be preferred in kidney surgery. In open surgery, the operation is performed by making an incision of 15-25 cm in the abdominal skin of the affected kidney. In laparoscopic surgery, 4-5 incisions varying between 5-10 millimeters are made, and cameras and working tools for performing the surgery are advanced into the abdomen (abdomen). To remove the kidney, an incision of 5-6 cm must be made during the operation.
The use of robots in laparoscopic surgery can also be selected. In robotic nephrectomy operation, robot arms are used by the surgeon with the help of a computer. When the tumor size is very small, and conditions that prevent the patient from undergoing surgical treatment are detected, methods of non-surgical destruction of the tumor tissue may be preferred.
Cryo Surgery: The surgeon inserts a device through a small incision into the tumor in the patient's kidney. The device freezes the tumor, and the tumor cells die.
Radiofrequency Ablation: In this method, the tumor tissue is destroyed by heat by transmitting heat with radiofrequency energy from a particular probe advanced into the tumor tissue in the kidney.
Although the recovery period after surgery varies from patient to patient, it may be slightly longer after open surgery and shorter after laparoscopic surgery. The patient usually feels some pain and discomfort for the first few days. Medication is recommended for patients to minimize these complaints.
If the entire kidney needs to be removed, the remaining kidney is often sufficient to meet the body's needs. However, if the patient's remaining kidney does not function adequately, dialysis may be required for the patient temporarily or permanently.
Questions to ask your doctor:
- Which surgical method do you recommend to me? (Open surgery, laparoscopic surgery, or robotic surgery?
- Will lymph nodes be removed during the operation?
- What will I feel after the surgery? Will I have pain? How will it be controlled in case of pain?
- How long will I stay in the hospital?
- When will I be able to return to my normal activities?
- What are the long-term effects of surgical treatment? Will I need to go on dialysis?
Nutrition Diet After Treatment
After kidney cancer treatment, the patient's diet is essential. Good nutrition includes the right amount of calories and protein intake. In this way, the patient will be comfortable in healing his wounds and regaining his former strength. Generally, patients may tend to gain weight rapidly after the removal of cancer tissue from the body. A healthy and balanced diet is essential during this period. Loss of appetite, indigestion, nausea, and vomiting may occur in the first days of the surgery, but these may be temporary. In the following process, the patient's appetite returns to normal. A diet recommended by the dietitian will shorten the patient's return to everyday life.
Kidney tumor follow-up
6-month follow-ups are recommended after kidney cancer operations. Thanks to check-ups, it will be determined whether cancer has recurred, and if there is any change in the general health status, it will be detected early. Kidney cancer is one of the cancers that can recur. During the controls, blood tests, chest X-rays, kidney tomography, and ultrasonography are used.
After five years of follow-up, the follow-up intervals of the patient are extended and continued with follow-ups once a year. It is extra essential to preserve the functions of the remaining kidney in patients who have one kidney removed for cancer, and only one kidney remains. Generally, the remaining kidney in the long term shows some growth and changes that allow it to increase its functions and fulfill its duties in the other kidney.
The damage of diabetes and hypertension, which are harmful to the kidneys, maybe more important in people with only one kidney left. Therefore, the patient should be followed closely not only in terms of recurrence of cancer but also in terms of general health status.
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