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The human body is host to two kidneys, which are organs shaped like a bean. The kidneys are located just above your waist and on either side of your spine. The size of each kidney is similar to the size of a fist. The function of a kidney is to filter your blood with tubes contained inside of them, thereby removing any waste and impurities that have made their way into the bloodstream. The waste is then turned into urine and dispelled from the body. When cancer develops in the kidneys, it is most likely to originate in the tiny tubes, or tubules, on the interior of the kidneys that do the filtering although there are a few varieties of kidney cancer that occur on the outside of the organs. Kidney cancer is the result of cells within the kidneys becoming malignant and growing out of control. The overgrowth of cells is a tumor.
Because the most common place to develop kidney cancer is in the tubules of the kidneys, kidney cancer is synonymous with renal cell carcinoma (RCC). While several different kinds of cancers can originate in the kidneys, adults are most likely to develop renal cell carcinoma, and children are most often diagnosed with a variation called a Wilms’ Tumor. Some of the different types of kidney cancer are:
Clear Cell RCC – 80% of kidney cancers are known as a clear cell, which received its name for the very literal reason for the cancer cells are clear when viewed with a microscope.
Papillary RCC – 10-15% of kidney cancer, this type has cells that look like tiny fingers.
Chromophobe RCC – These cancer cells are also clear, but are much bigger than clear cell RCC.
Collecting duct RCC Less than 1% of diagnosed RCC, this type presents as irregular tubes inside of a tumor and is particularly aggressive.
Unclassified RCC – Very rare, an RCC is referred to as unclassified when its type remains unknown even after looking at the cells under a microscope.
Transitional Cell Carcinoma – This RCC develops in the ureters, which connect to the kidneys and transport urine made by the kidneys to the bladder. Also called urothelial cancer or renal pelvis carcinoma.
Renal sarcoma Another form of RCC that is very rare, this type develops in the kidney’s connective tissue.
The occurrence of kidney cancer seems to be on the increase. It may not be that kidney cancer has become more prevalent, however, as we may just be finding it more due to better medical testing. Doctors are leaning on the assistance of CT scans more often, which can lead to the detection of cancerous tumors even when it was not the purpose of the scan. Most of the time cancer in the kidneys is caught before it has the chance to metastasize, or travel and infect other parts of the body. Although they tend to be large at the time of diagnosis, early detection is the key to successful treatment.
It was not until the 1980’s that doctors and researchers began to have any luck with treatments and cures for kidney cancer. Until then, the only treatment available to those whose cancer had not spread was to remove the kidney completely. Complete removal, however, was not always an effective treatment. Others were treated with either chemotherapy or radiation, neither of which was very effective. Thankfully, in recent years there have been some advances that have significantly improved the prognosis of those afflicted.
From better surgical techniques that preserve the kidneys and aid in recovery time, the discovery of immunotherapy and several medications have all contributed to extended lives, shrunken tumors, and a slowing of cancer progression. Although the survival rate for kidney cancer is still not as good as other forms of cancer, the rate is on an upward trend. Researchers are continuing to build upon recent findings as they search for better treatments and a possible cure. Here is a brief look at the timeline of kidney cancer research:
The 40s-60s – Kidney cancer seemed to be curable by removal of the kidneys, although the survival rate of patients after five years was only 65%.
1977 – Partial nephrectomy, or surgery where only the afflicted portion of the kidney is removed, seems to be a viable alternative to complete kidney removal for some patients. This surgery allows patients to retain kidney function and to avoid being dependent on dialysis.
1985 – Patients who have advanced renal cell carcinoma see benefits after undergoing immunotherapy.
1991 – Doctors begin to use laparoscopic surgery, which requires minimal incisions and utilizes telescopic equipment for kidney removal as opposed to a large incision and open surgery. Laparoscopic surgery becomes the standard procedure and allows patients to experience a faster recovery and significantly less pain.
1992 – Interleukin-2 (IL-2) is approved by the FDA as a drug for renal cell carcinoma. This treatment remains the only medication that has provided patients with a cure, however not many patients respond to the drug at all, in fact, that number is less than 20%.
1995–1997 – These years bring new treatments, cryoablation, and radiofrequency ablation. Both are used as alternatives to surgery and involve the insertion of a probe to kill the tumor. Cryoablation freezes the tumor, while radiofrequency ablation utilizes an electric current. Studies on the long-term effects are still underway.
2000 – Survival time increases by 50% after discovering that kidney removal combined with immunotherapy is much more efficient than immunotherapy alone.
2005 – In December, the FDA approved the drug sorafenib, after studies show its ability to slow the growth of tumors in those with advanced cancer or those who are not responsive to immunotherapy. While the history of our understanding of kidney cancer may be short, we have seen significant advancements.
We do not yet know what exactly it is that causes kidney cancer, although we do know several risk factors. Risk factors are anything that increases your likelihood of developing cancer, some of which can be changed with lifestyle and some of which you will have no control over. Having risk factors does not automatically mean you will get cancer, in fact, you can have every risk factor and never develop the disease. Others will get cancer with no risk factors. We simply have very little understanding of what exactly causes this cancer.
Here are some of the factors that seem to make kidney cancer more likely:
The risk appears associated with how much one smokes, and the risk decreases somewhat with the cessation of smoking.
Hormone changes in those who are obese can lead to kidney cancer.
- Workplace Exposure
Some metals such as cadmium, certain herbicides, and organic solvents like trichloroethylene may contribute to kidney cancer. Those who work in environments with these substances should take necessary precautions.
Inherited DNA can cause changes in the body that lead to kidney cancer. If you have a family history of cancer or have siblings who have been diagnosed, it is vital to regularly attend all checkups. Regular screenings can help detect tumors early. Researchers are not sure if it is inherited DNA or a mutual exposure that causes cancer.
- High Blood Pressure
Those who have high blood pressure are at an increased risk of developing kidney cancer. This may be due to the medications that are used for the control of high blood pressure. As of now, we are unsure if it is the raised blood pressure or the medication that leads to the risk increase.
Although due to not being available for the last 20 years, a pain reliever called Phenacetin was at one time linked to kidney cancer. Because it is no longer used, it is not a large risk factor. Water pills, or diuretics, are used for the treatment of high blood pressure and show a link to kidney cancer. The link is not confirmed, so one should not discontinue use to try to avoid cancer.
Men are twice as likely to develop kidney cancer than women. This may be because men are more likely to smoke or to be exposed to certain dangerous chemicals.
- Kidney Disease
Those who are experiencing kidney disease and are reliant on dialysis for the removal of toxins from the body are at a higher risk of developing kidney cancer.
Certain races, such as African Americans, Native Americans, and Alaskan Natives are more likely than those of other races to develop kidney cancer. There is no known reason for this increased incidence.
Screening for kidney cancer is the process of intentionally looking for the presence of the disease before you become aware of cancer’s particular signs and symptoms.
Cancer screenings have been developed by scientists to both lower the number of those who lose their lives due to cancer and to lower the number of people who develop cancer in the first place.
Unfortunately, scientists have yet to develop any form of routine screening that would assist in determining if an individual is in the early stages of kidney cancer. It is imperative if you have any of the risk factors for cancer or if you have a family history, especially siblings diagnosed with kidney cancer, that you are open with your doctor about this information.
Your doctor may suggest that due to your higher risk you allow him to perform routine imaging tests which will enable him to see inside of your body to detect the early formation of tumors. Ultrasounds and CT scans are commonly used for searching for these tumors, although they are not always great at detecting cancer.
Besides being forthcoming with your primary care physician and following any given advice, the next best thing to do is decrease the risk factors over which you have any control.
If you are a smoker, quit. If you have high blood pressure, search for natural ways to lower the condition and reduce your dependence on medications. If you are overweight, reduce your risk of cancer and many other health issues by losing weight.
Those who work in environments that expose them to harmful contaminants should ensure to use proper safety precautions to lower their risk of being harmed by the elements they are exposed to.
As you will see, most of the symptoms that are linked to kidney cancer can be symptoms for many other, far less serious conditions. It is for that reason that the presence of kidney cancer is often discovered during an X-ray or ultrasound for an entirely different reason or procedure. When kidney cancer has just started to develop, there are very few warning signs and no pain.
Unfortunately, this means that it is often only after cancer has had a lot of time to continue to grow and affect other parts of the body that its presence is discovered.
Another issue that causes kidney cancer to go undetected is that many people do not experience any symptoms at any stage. And if they do, there is a good chance that the sign or symptom they are facing is due to another medical condition that brought them to a doctor for treatment. Relying on signs and symptoms to alert one to the presence of kidney cancer may not be enough to catch the disease in time. For that reason, it is important always to try to reduce cancer-causing activities and to be aware of any risk factors one faces. It is also helpful to have an understanding of some of the possible symptoms.
Even if the cause of the symptoms is not cancer-related, it is always a good idea to get a doctor’s input as most are not conditions one should dismiss.
A few commonly referred to symptoms are:
- Blood in the urine, to the point of urine that appears to be dark rust or red color.
- The presence of pain and pressure within either the side or the back.
- Any lumps, mass, or swelling on the side of the back.
- Swollen ankles or legs.
- High Blood Pressure.
- Anemia, or a low red blood cell count.
- Unusual fatigue.
- A lack of interest in food.
- Weight loss, when you are not trying to lose weight.
- A fever that does not go away, without the presence of a cold, the flu, or another infection source.
- In men, the rapid development of varicocele veins (enlarged clusters of veins) around the right testicle. Varicocele veins are a sign of a kidney cancer tumor.
- Coughing that produces blood.
- Pain in your bones.
- Trouble catching your breath.
Just because signs and symptoms alone are not a reliable means of diagnosing kidney cancer, if you have any of these changes and you are concerned, never hesitate to get to your doctor and discuss your concerns with him. During an appointment, your doctor will likely ask about what you have been experiencing and try to determine how long each issue has been bothering you.
A physician will also know what other questions to ask before deciding if your concerns require further testing. Regardless of whether or not you are experiencing the symptoms of cancer, your doctor will work with you to determine a diagnosis.
Should you receive a diagnosis of kidney cancer, your doctor will work with you to give you relief from any symptoms you are experiencing, a process that may be referred to as symptom management, palliative care, or even supportive care. If your symptoms change or you start to experience new symptoms, be sure to alert your doctor as he will be able to adjust your care accordingly.
Diagnosis and Stages
Kidney cancer is one of the few cancer types that may not require a biopsy for a doctor to make a diagnosis. Most of the time, the entire tumor is removed, and then a sample is sent out to be tested. A biopsy will be done to determine how aggressive the cancer is, which will help the doctor know how to proceed with treatment.
There are several different tests a physician may use to assist in a kidney cancer diagnosis:
- Urine Test – Urine will be checked in a lab for symptoms of cancer as well as for the presence of blood
- Blood Test – Blood is tested in a lab for creatinine, as well as other substances that indicate your kidneys are not functioning properly
- Ultrasound – Images produced by ultrasounds sound waves can reveal a tumor in the kidneys
- CT Scan – CT Scans may require the use of contrast material in order to show cancer in produced images of the urinary tract, lymph nodes, and kidneys.
- MRI – Contrast material is also used for an MRI, which uses a strong magnet to reveal images of the kidneys, lymph nodes, and other tissues that may be cancerous.
- IVP – Dye is inserted into the veins and travels through the body, ending up in the kidneys. The dye helps the kidneys to show up on an X-ray and will reveal the presence of a tumor.
- Biopsy – Tissue is removed from the body and examined for cancer cells. A needle is inserted through the skin and into the kidney to remove the sample. Computer imagery from an ultrasound or CT scan guides the needle.
- Surgery – A doctor may remove the entire kidney, or the affected portion via surgery and make a diagnosis after the removal.
After a test confirms the presence of cancer, you may need to undergo follow-up tests to determine if the cancer cells have spread. Additional tests are likely to be in the form of a CT scan, MRI, or chest X-ray. If you have experienced aching bones, they may also perform a bone scan. These tests will also help to determine the stage of cancer.
Kidney cancer is staged in the following way:
- Stage I – cancer is present only in the kidney, and is 7 centimeters or smaller.
- Stage II – Still only present in the kidney but larger than 7 centimeters.
- Stage III -Many situations classify as stage III. There is a tumor in the kidney, but also a nearby lymph node. The cancer is located within the main blood vessel to the kidney and possibly lymph nodes. Fatty tissue surrounding the kidneys is cancerous, and possibly lymph nodes. The kidney tumor has grown into veins or other tissue surrounding the kidney but has not made it as far as the adrenal gland or Gerota’s fascia.
- Stage IV – Another category with multiple situations, this stage includes situations where cancer has moved from even further than the fatty tissue around the kidneys, and possibly into surrounding lymph nodes. Other surrounding organs now have cancer, like the bowel, pancreas, and lungs. Gerota’s fascia has been reached, as well as the adrenal gland.
The prognosis of an individual’s situation relies heavily on their health besides cancer, the grade, and the stage of cancer. A higher stage of cancer indicates cancer that is more advanced than a lower stage.
Treatments and Drugs
Once one has received their diagnosis and stage, it is time to talk with their doctor about the different treatment options available and determine which should be pursued.
- Radial Nephrectomy – Removal of the entire kidney, adrenal gland, and surrounding tissue. Lymph nodes in the immediate area may be removed as well.
- Partial Nephrectomy – Surgery that removes the area of the kidney plagued by kidney cancer and leaves the healthy portion.
Depending on the situation a surgeon may perform open surgery, which requires a large incision, or laparoscopic surgery which is a much smaller incision. With a laparoscopic approach, a lighted probe will be guided to the kidney using a computer monitor. In some instances, this will be done with a robot.
Some individuals are not a good candidate for surgery due to other health problems, or they have very small tumors (less than 4 cm) and do not need surgery for removal. For those who are in this situation, there are many other techniques that a surgeon has at his disposal.
In these cases, he may use:
- Cryosurgery – In this technique, a tool is sent to the kidney via a small incision. This tool will freeze the tumor, effectively killing it.
- Radiofrequency Ablation – Another technique in which a prove is inserted and guided to the kidney either through the skin or directly into the tumor. Electrodes contained in the probe use heat to kill the cancer cells.
Targeted therapy is utilized to either shrink a tumor or to slow its growth. Targeted therapy is generally taken orally and causes fatigue in most who use this approach. There are a number of side effects associated with this treatment, including nausea, diarrhea, sores in the mouth or on the lips, and an increase in blood pressure.
Biological therapy is sometimes used when cancer has spread beyond the kidneys. This treatment hopes to make the body’s ability to fight cancer itself stronger by boosting the immune system. This therapy has been shown to slow down growing tumors and even shrink them. This treatment is given intravenously and can be administered at a hospital or even in your doctor’s office.
Treatment for relief from side effects will be given simultaneously with whatever treatment plan the doctor and patient have chosen. Because individuals will experience side effects differently depending on their body, stage, and treatment, these relief measures will be unique to each person and treatment. Some people find that biological therapy will give them a rash and swelling. Others find themselves tired.
Some will have aches in their head and body, fevers, and general weakness. Sometimes there is not anything a doctor can do for an individual’s kidney cancer. These individuals may opt to take part in clinical trials, which are voluntary studies in which researchers are testing new treatments or therapies to determine both effectiveness and safety.
While using experimental drugs and treatments can never be considered “safe”, clinical trials are held to a very high standard and set of rules that protect volunteers from unnecessary risk.
Those who have agreed to participate in a study may not benefit from the trial themselves, but they can have the satisfaction of knowing that their contribution to kidney cancer studies may help those who find themselves in the same situation in the future by providing researchers more information.
There are many new drugs, therapies, and drug combinations that are currently being studied for their use in the fight against kidney cancer. If this is something you think you would be interested in participating in, your doctor will be able to point you in the right direction.
Coping and Support
Everyone is going to process and cope with a diagnosis of kidney cancer in their own way. For most, they will initially feel shocked and overwhelmed. Once this initial stage is worked through, there are many ways to process this life-changing news and ways that individuals can work through all of the many fears and difficulties that this change brings.
There are many approaches that help, including:
- Gather Information
Many find that gathering as much information on their condition, possible treatments, side effects, and procedures can help to alleviate some of the stress. Much of the fear surrounding a cancer diagnosis stems from not knowing exactly what it means, and what to expect in the future. Your doctor will be able to provide you with all the information you need such as the type and stage of cancer you have been diagnosed with, which can help you pursue information.
If you are going to search online, try to stick with credible sources to avoid fear-inducing misinformation.
- Practice Self-Care
It is ok to focus on you and your individual health during treatment for kidney cancer. Consuming foods that are healthy and immune-boosting such as fruits and vegetables, ensuring adequate exercise, and allowing yourself to sleep when fatigued can help you feel better and your body to fight harder.
- Include Friends and Family
When your friends or family offer to help, accept it. They care about you, and it is ok to admit that you may need some help. Some days you will not feel up to making healthy meals or running errands. Allow your support team to step in. Maybe you will feel more inclined to take a short walk if a friend joins you.
Use the time spent with your friends and family to discuss your fears and feelings, which will help them to better empathize with you and will help you to not feel so alone.
- Set Aside Personal Time
What do you like to do that helps you to feel more relaxed and at peace? If you like to read, do so! The same for listening to music, journaling, or artwork. Find something that you can do every day that benefits your mental health and adds to a sense of peace/
- Find a Support Group
Despite their best intentions, your friends and family may not be able to fully understand what you are going through. Find a local group of people who are going through or who have survived cancer. They may be able to give you a sense of companionship, tips, and hope that others cannot.
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