Kidney Cancer - What you need to know?

The Kidneys

WJMC Urology Specialists - Kidney CancerThe kidneys are a pair of organs on either side of the spine in the lower abdomen. Each kidney is about the size of a fist. Attached to the top of each kidney is an adrenal gland. A mass of fatty tissue and an outer layer of fibrous tissue (Gerota's fascia) enclose the kidneys and adrenal glands.

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

The kidneys also make substances that help control blood pressure and the production of red blood cells.

Understanding Cancer

WJMC Urology Specialists - Kidney CancerCancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

  • Benign tumors are rarely life threatening.
  • Usually, benign tumors can be removed, and they seldom grow back.
  • Cells from benign tumors do not invade tissues around them or spread to other parts of the body.

Malignant tumors are cancer:

  • Malignant tumors are generally more serious than benign tumors. They may be life threatening.
  • Malignant tumors often can be removed, but they can grow back.
  • Cells from malignant tumors can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream or lymphatic system. That is how cancer cells spread from the original cancer (primary tumor) to form new tumors in other organs. The spread of cancer is called metastasis.

WJMC Urology Specialists - Kidney CancerSeveral types of cancer can start in the kidney. Renal cell cancer is the most common type of kidney cancer in adults. This type is sometimes called renal adenocarcinoma or hypernephroma. Another type of cancer, transitional cell carcinoma, affects the renal pelvis. It is similar to bladder cancer and is often treated like bladder cancer. Wilms' tumor is the most common type of childhood kidney cancer. It is different from adult kidney cancer and requires different treatment.

When kidney cancer spreads outside the kidney, cancer cells are often found in nearby lymph nodes. Kidney cancer also may spread to the lungs, bones, or liver. And it may spread from one kidney to the other.

When cancer spreads (metastasizes) 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 tumor. For example, if kidney cancer spreads to the lungs, the cancer cells in the lungs are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It is treated as kidney cancer, not lung cancer. Doctors sometimes call the new tumor metastatic or "distant" disease.

Kidney Cancer: Who's at Risk?

Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Doctors can seldom explain why one person develops kidney cancer and another does not. However, it is clear that kidney cancer is not contagious. No one can "catch" the disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop kidney cancer. A risk factor is anything that increases a person's chance of developing a disease.

Studies have found the following risk factors for kidney cancer:

WJMC Urology Specialists - Kidney Cancer
  • Smoking: Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as nonsmokers to develop kidney cancer. Cigar smoking also may increase the risk of this disease.
  • Obesity: People who are obese have an increased risk of kidney cancer.
  • High blood pressure: High blood pressure increases the risk of kidney cancer.
  • Long-term dialysis: Dialysis is a treatment for people whose kidneys do not work well. It removes wastes from the blood. Being on dialysis for many years is a risk factor for kidney cancer.
  • Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It is caused by changes in the VHL gene. An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body. Family members of those with this syndrome can have a test to check for the abnormal VHL gene. For people with the abnormal VHL gene, doctors may suggest ways to improve the detection of kidney cancer and other diseases before symptoms develop.
  • Occupation: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk.
  • Gender: Males are more likely than females to be diagnosed with kidney cancer. Each year in the United States, about 20,000 men and 12,000 women learn they have kidney cancer.

Most people who have these risk factors do not get kidney cancer. On the other hand, most people who do get the disease have no known risk factors. People who think they may be at risk should discuss this concern with their doctor. The doctor may be able to suggest ways to reduce the risk and can plan an appropriate schedule for checkups.

Symptoms

Common symptoms of kidney cancer include:

  • Blood in the urine (making the urine slightly rusty to deep red)
  • Pain in the side that does not go away
  • A lump or mass in the side or the abdomen
  • Weight loss
  • Fever
  • Feeling very tired or having a general feeling of poor health

Most often, these symptoms do not mean cancer. An infection, a cyst, or another problem also can cause the same symptoms. A person with any of these symptoms should see a doctor so that any problem can be diagnosed and treated as early as possible.

Diagnosis

If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:

  • Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.
  • Urine tests: Urine is checked for blood and other signs of disease.
  • Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.
  • Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.
  • WJMC Urology Specialists - Kidney CancerCT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.
  • Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram
  • Biopsy : In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
  • Surgery : In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Staging

To plan the best treatment, the doctor needs to know the stage (extent) of the disease. The stage is based on the size of the tumor, whether the cancer has spread and, if so, to what parts of the body.

Staging may involve imaging tests such as an ultrasound or a CT scan. The doctor also may use an MRI. For this test, a powerful magnet linked to a computer makes detailed pictures of organs and blood vessels.

Doctors describe kidney cancer by the following stages:

  • Stage I: is an early stage of kidney cancer. The tumor measures up to 2 3/4 inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.
  • Stage II: is also an early stage of kidney cancer, but the tumor measures more than 2 3/4 inches. The cancer cells are found only in the kidney.
  • Stage III: is one of the following:
    • The tumor does not extend beyond the kidney, but cancer cells have spread through the lymphatic system to one nearby lymph node; or
    • The tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue. Cancer cells may be found in one nearby lymph node; or
    • The cancer cells have spread from the kidney to a nearby large blood vessel. Cancer cells may be found in one nearby lymph node.
  • Stage IV: is one of the following:
    • The tumor extends beyond the fibrous tissue that surrounds the kidney; or
    • Cancer cells are found in more than one nearby lymph node; or
    • The cancer has spread to other places in the body such as the lungs.
  • Recurrent cancer: is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.

Treatment

Many people with kidney cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctor—to take part in the discussion, to take notes, or just to listen.

The doctor may refer the patient to a specialist, or the patient may ask for a referral. Specialists who treat kidney cancer include doctors who specialize in diseases of the urinary system (urologists) and doctors who specialize in cancer (medical oncologists and radiation oncologists).

Getting a Second Opinion

WJMC Urology Specialists - Kidney CancerBefore starting treatment, a person with kidney cancer might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.

There are a number of ways to find a doctor for a second opinion:

  • The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.
  • The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.
  • A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
  • The American Board of Medical Specialties (ABMS) offers a list of doctors who have met specific education and training requirements and have passed a specialty examination. Their directory—the Official ABMS Directory of Board Certified Medical Specialists—lists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information by telephone and on the Internet. The toll-free telephone number is 1-866-ASK-ABMS (1-866-275-2267). The Internet address is http://www.abms.org.
  • The NCI provides a helpful fact sheet on how to find a doctor called "How To Find a Doctor or Treatment Facility If You Have Cancer." It is available on the Internet at http://www.cancer.gov/publications.

Preparing for Treatment

Treatment depends mainly on the stage of disease and the patient's general health and age. The doctor can describe treatment choices and discuss the expected results. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.

People may want to ask the doctor these questions before treatment begins:

  • What is the stage of the disease? Has the cancer spread? If so, where?
  • What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
  • What are the expected benefits of each kind of treatment? Will it cure or control the disease?
  • What are the risks and possible side effects of each treatment? Will I be given anything to control side effects?
  • How long will treatment last?
  • Will I have to stay in the hospital?
  • What is the treatment likely to cost? Is this treatment covered by my insurance plan?
  • How will treatment affect my normal activities?
  • How often should I have checkups?
  • Would a clinical trial (research study) be appropriate for me?

Methods of Treatment - Three forms of Surgical Treatments:

Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

An operation to remove the kidney is called a nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:

  • Partial nephrectomy: A surgical procedure to remove the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed.
  • Simple nephrectomy: A surgical procedure to remove the kidney only.
  • Radical nephrectomy: A surgical procedure to remove the kidney, the adrenal gland, surrounding tissue and, usually, nearby lymph nodes.

Kidney surgery is traditionally performed using an open approach, which requires a large abdominal incision. Another approach, conventional laparoscopy, is less invasive, but limits the doctor’s dexterity, visualization and control, compared to open surgery.

da Vinci® Laparoscopic Robotic Surgery for Kidney Cancer

WJMC Urology Specialists - Kidney CancerIf your doctor recommends surgery for kidney cancer, you may be a candidate for a new, minimally invasive approach - da Vinci Partial Nephrectomy or Nephrectomy.

da Vinci Surgery uses state-of-the-art technology to help your doctor perform a more precise operation than conventional instrumentation allows. It offers numerous potential benefits over a conventional open surgery, including:

  • Significantly less pain
  • Less blood loss
  • Fewer transfusions
  • Less risk of infection
  • Less scarring
  • Shorter hospital stay
  • Shorter recovery time
  • Increased potential for kidney preservation in certain prescribed cancer operations
  • Better clinical outcomes, in many cases

da Vinci Surgery for kidney cancer incorporates the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach.

The precision and dexterity afforded by the da Vinci Surgical System’s advanced instrumentation facilitates a minimally invasive approach for treating kidney cancer.

People may want to ask the doctor these questions before having surgery:

  • What is the stage of the disease? Has the cancer spread? If so, where?
  • What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
  • What are the expected benefits of each kind of treatment? Will it cure or control the disease?
  • What are the risks and possible side effects of each treatment? Will I be given anything to control side effects?
  • How long will treatment last?
  • Will I have to stay in the hospital?
  • What is the treatment likely to cost? Is this treatment covered by my insurance plan?
  • How will treatment affect my normal activities?
  • How often should I have checkups?
  • Would a clinical trial (research study) be appropriate for me?

Arterial Embolization

Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

The doctor inserts a narrow tube (catheter) into a blood vessel in the leg. The tube is passed up to the main blood vessel (renal artery) that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.

People may want to ask the doctor these questions before having arterial embolization:

  • Why do I need this procedure?
  • Will I have to stay in the hospital? How long?
  • What are the risks and side effects?
  • Would a clinical trial be appropriate for me?

Radiation Therapy

WJMC Urology Specialists - Kidney CancerRadiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

People may want to ask the doctor these questions before having radiation therapy:

  • Why do I need this treatment?
  • What are the risks and side effects of this treatment?
  • Are there any long-term effects?
  • When will the treatments begin? When will they end?
  • How will I feel during therapy?
  • What can I do to take care of myself during therapy?
  • Can I continue my normal activities?
  • How often will I need checkups?
  • Would a clinical trial be appropriate for me?

Biological Therapy

Biological therapy is a type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer.

For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 or aldesleukin). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

Chemotherapy

Chemotherapy is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer. However, many doctors are studying new drugs and new combinations that may prove more helpful. The section on "The Promise of Cancer Research" has more information about these studies.

People may want to ask the doctor these questions before having biological therapy or chemotherapy:

  • Why do I need this treatment?
  • What are the risks and side effects of this treatment? What can I do about them?
  • How does it work?
  • When will the treatment begin? When will it end?
  • What are the expected benefits of the treatment?
  • Will I need to stay in the hospital? How long?
  • Can I continue my normal activities?
  • Would a clinical trial be appropriate for me?

Follow-up Care

WJMC Urology Specialists - Kidney CancerFollow-up care after treatment for kidney cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because cancer cells can remain in the body after treatment. The doctor monitors the recovery of the person treated for kidney cancer and checks for recurrence of cancer. Checkups help ensure that any changes in health are noted. The patient may have lab tests, chest x-rays, CT scans, or other tests.

Information provided by National Cancer Institute, visit www.cancer.gov