We all have a general idea about the kidney. It is a part of the urinary system. It is a paired organ in the right and left side of the abdomen, its job being to make urine and excrete it out of the body. Urine is first made by the bean-shaped kidneys and is then carried to the urinary bladder through thin tubes called the ureters. As you urinate, the bladder contracts and the urine thus is forced to flow out of the bladder through another connecting tube called the urethra, and then to the outside of the body.The kidneys have some additional work as well, such as regulating & controlling blood pressure by producing the hormone ‘renin’. What’s more, they synthesize erythropoietin. It is erythropoietin that makes the bone marrow produce additional red blood cells.
What are kidney cancer ?
Kidney cancers are basically tumours of the KIDNEY.
How is a kidney cancer caused ?
Cigarette smoking is an important known risk factor for kidney cancer. Obesity & high blood pressure may also predispose to kidney cancer. Certain occupations or workplace exposures such as that to cadmium, herbicides & organic solvents predispose their workers to a greater risk for cancer. Family history of renal cancers and certain conditions like von Hippel-Lindau disease may predispose to renal cancer.
What are the types of kidney cancers ?
There are several types of cancer that can initiate in the kidney.There are mainly three categories of kidney cancer: renal cell carcinoma, arising in the portion of the kidney that filters out the blood and makes urine (the renal parenchyma); transitional cell carcinoma, which arises in the portion of the kidney where urine collects and drains (the renal pelvis); and Wilms’ Tumor (nephroblastoma), which may arise in embryonic cells in the kidney.
- Renal cell carcinoma: Renal cell carcinoma (RCC), also known as renal cell cancer or renal cell adenocarcinoma, is the commonest type of kidney cancer. Approximately 70% of kidney cancers are renal cell carcinomas. There are many variants, like the clear cell renal cell cancer, the papillary renal cell cancer or the chromophobe renal cell cancer.
- Urothelial carcinoma or transitional cell carcinoma (TCC): Urothelial carcinoma, otherwise known as the transitional cell carcinoma (TCC), generally starts in the innermost lining, ie. in the transitional cells or the urothelial cells.These urothelial cells are seen in most parts of the urinary tract, like the bladder, ureters or the urethra as well.
- Wilms tumour (nephroblastoma): Wilms tumours, also known as nephroblastoma, occur mostly in young children with a strong genetic influence.
- Renal sarcomas: The fourth type, the renal sarcomas include sarcomas of the kidney, but they are rare.
What are the clinical features of kidney cancers ?
The first and most common clinical sign of kidney cancer is painless hematuria, that is blood in the urine that can be seen by the patient. The bleeding is often occasional and short-lived rather than consistently present. It can even change the colour of the urine. Sometimes, the bleeding may be minimal or microscopic, (known as microscopic hematuria) and can only be checked by special tests. However, blood in the urine does not necessitate a definitive diagnosis of kidney cancer.Other conditions like kidney stones, urinary tract infections and even blood-thinning medications may cause urinary bleeding. To differentiate between urinary tract infections and kidney cancers, bacterial urine culture is a must. It is best to go to a urologist for detailed investigations.Kidney Cancers can also lead to complete difficulty in passing urine, lower back or abdominal pain, loss of appetite and weight loss and feeling of tiredness or weakness.
How are kidney cancers diagnosed ?
- A complete physical examination of the body is mandatory.
- Urinalysis: One way to test for renal cancer is to check and examine for blood in the urine (called hematuria). This can be tested by a urinalysis, which is an uncomplicated test to check for blood in a urine sample.
- Urine Cytology: In this test, the doctor looks for cancer cells under a microscope in urine.
- Urine tests for Tumour Markers: Tumour markers in the urine like carcinoembryonic antigen (CEA) can point towards kidney cancer.
- Cytoscopy: The urinary tract can be viewed with a flexible scope.
- Imaging Tests: To determine the exact extent of disease, additional tests may need to be performed so doctors can view, assess and judge the cancer and determine how far it has progressed or spread. These important diagnostic tests include the following such as X- rays, CT Scan, MRI Scan or PET Scans.A urologist can recommend specific radiographic imaging techniques like an intravenous pylegram (IVP) or a CT urogram. In the IVP, dye or contrast media is combined with conventional x-ray technology to assess the urinary tract system for any abnormalities. In the CT urogram, a CT scan with contrast is used to examine the kidneys, ureters, and bladder. This is the recommended procedure nowadays.
- Biopsy: Surgically removed tissue examined in a microscope by a pathologist gives a definitive cancer diagnosis.
How are kidney cancers staged ?
Grade and Stage describe the kidney tumour, helping to provide guidance for the urologist in determining the ideal treatment option(s). Staging is a careful attempt to find out the exact extent and spread of the cancer. The higher the stage the further the cancer has grown away from its original site in kidney. Grade refers to how the cancer cells look in the microscope, and how much they resemble their cell of origin or differentiation. The higher the grade is, the more destructive the tumour is.
How are kidney cancers treated ?
There are several treatment options for kidney cancer, which can be used singly or in combination. Treatment options depend on the cancer type, staging of the cancer, and its location.The treatments are:
- Surgery: Ranges from resection of only the tumour of the kidney and some surrounding normal tissue or to complete removal of the kidney and adjacent organs or areas where the tumour may have spread.
- Radiation therapy: A cancer treatment that utilizes high-energy x-rays or basically radiation to eradicate cancer cells. Radiation therapy can be used post surgery to kill any remaining cancer cells.
- Chemotherapy: Another kind of cancer treatment that uses either drugs or chemical substances (hence the name chemotherapy) to kill cancer cells and prevent them from dividing.
- Immunotherapy or Biological Therapy: Immunotherapy works by utilizing your own body’s immune system to fight cancer cells. This treatment is given through your urethra and straight into the bladder by a small catheter.
What is the care to be taken after the removal of a kidney cancer ?
Metastatic diagnostic workup and monitoring post-treatment has to include imaging and scanning of the limbs, thorax, chest, retroperitoneum, and abdomen with radiography, MRI or CT scans because of the risk of recurrence of cancer.
Adjuvant chemotherapy or radiotherapy may be required in cases wherein excision cannot be done completely.
How to find and reach cancer specialists for kidney cancer treatment ?
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Disclaimer: The content provided here is meant for general informational purposes only and hence SHOULD NOT be relied upon as a substitute for sound professional medical advice, care or evaluation by a qualified doctor/physician or other relevantly qualified healthcare provider.
