Kidney Cancer
Overview
Kidney cancer is a tumor which arises from the kidneys. Some of the kidney masses are benign and majority are cancerous. This can occur at any age of life but most of them occur in older age.
Risk factors
There are no known causes for developing kidney cancer. Some of the factors can increase risk of developing tumors like
Smoking
Obesity and poor diet
High blood pressure
Being on kidney dialysis
Long term use of pain killers like Phenacetin.
Exposure to industrial chemicals like asbestos and cadmium
Certain rare genetic disease like von hippel-lindau syndrome etc.
Symptoms
Main symptoms are:
- Hematauria – blood in urine
- Flank pain between ribs and hips
- Low back ache
- Loss of appetite
- Unusual weight loss
- Fever not due to any infection
- Anemia (low red blood cell count)
Diagnosis
- As was already told, most of them are detected due to investigation like (USG/CT) done for other reasons.
- USG of abdomen will pick up majority of kidney masses.
- CT/MRI will be useful to characterize kidney masses and to stage.
- Bone scan/PET CT scan, will also help to assess the extent of spread and to monitor treatment.
- Urine cytology is usually done if the patient has hematuria, to rule out Urothelial Cancer.
Usually biopsy is not required for renal masses as USG/CT/MRI will be able to characterise them better. Any large solid mass in kidney is considered to be cancer unless proved otherwise.
Treatment
Kidney tumor confined to kidneys are treated with
Active Surveillance
This is done in patients with less than 3 cm tumors, which are confined to kidneys and if patient is not suitable or willing for surgery. These patients needs frequent evaluation to assess the tumor and investigation is done when there is increase in size or progression
Partial Nephrectomy
Usually done for tumor, which are smaller and to one part of kidney (upper or lower ends). In this surgery the tumor is reseated with a rim of normal tissue persevering the remaining kidneys.
Radical Nephrectomy
This is done usually for layer tumors or tumors, which are not suitable for partial Nephrectomy. In this surgery the kidney with tumor is removed along with the surrounding covering tissues (Gerota’s fascia) along with lymph nodes.
Systemic Therapy
Patients who have high risk features following surgery and patients who have tumors which has spread outside kidney to other organs are treated with systemic therapy.
Targeted therapy – various drugs like Kinase inhibitors like sunitinib, pazopanib etc. can be used.
Immunotherapy – various drugs like nivolumab, pembrolizumab, ipilimumab are used to improve patient’s immune system to fight against cancer.