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The 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.
Cancer 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 tumour.
Tumours can be benign or malignant:
Benign tumours are not cancer:
Benign tumours are rarely life threatening.
Usually, benign tumours can be removed, and they seldom grow back.
Cells from benign tumours do not invade tissues around them or spread to other parts of the body.
Malignant tumours are cancer:
Malignant tumours are generally more serious than benign tumours. They may be life threatening.
Malignant tumours often can be removed, but they can grow back.
Cells from malignant tumours can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumour and enter the bloodstream or lymphatic system. That is how cancer cells spread from the original cancer (primary tumour) to form new tumours in other organs. The spread of cancer is called metastasis.
Several types of cancer can start in the kidney. The most common type of kidney cancer in adults is 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' tumour 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 from its original place to another part of the body, the new tumour has the same kind of abnormal cells and the same name as the primary tumour. 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 tumour metastatic 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.
Von Hippel-Lindau (VHL) syndrome
Studies have found the following risk factors for kidney cancer:
Smoking: Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as non-smokers 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.
: 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 tumours 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.
: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk.
: Males are more likely than females to be diagnosed with kidney cancer. Each year in the United Kingdom, about 4,879 men and 2,961 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.
Common symptoms of kidney cancer include:
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.
If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:
: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumours.
: Urine is checked for blood and other signs of disease.
: 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.
CT 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 tumour or cyst shows up on a sonogram.
: 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.
: 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 the entire kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.
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 tumour, whether the cancer has spread and, if so, to what parts of the body.
Staging may involve imaging tests such as Bone scan or a CT scan. The doctor also may use an MRI.
is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.
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 specialise in diseases of the urinary system (urologists) and doctors who specialize in cancer (medical oncologists and radiation oncologists).
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.
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 tumour.
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 tumour. The doctor can explain each operation and discuss which is most suitable for the patient:
: 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.
: A surgical procedure to remove the kidney only.
: A surgical procedure to remove the kidney, the adrenal gland, surrounding tissue and, usually, nearby lymph nodes.
In the past Kidney surgery was traditionally performed using an open approach, which requires a large abdominal incision. In recent times, technological advances permit a less invasive approach to the removal of the kidney. This is called a laparoscopic partial nephrectomy or radical nephrectomy. It offers numerous potential benefits over a conventional open surgery, including:
Arterial embolisation is a type of local therapy that shrinks the tumour. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolisation 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.
Radiation 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 tumour. 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.
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. 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 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.
Follow-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.
For more information on kidney cancer visit kidney cancer UK at http://www.kcuk.org