Kidney Cancer

Most people have two functional kidneys, protected by muscles of the back and the ribcage, which produce urine that drains through the ureters and into the bladder.

The kidney performs many other critical bodily functions, such as controlling fluid balance, regulating electrolytes, preventing acid buildup, eliminating waste products and regulating blood pressure. The kidney also manufactures a hormone called erythropoietin that stimulates the production of red blood cells. When the kidneys are damaged or when a significant portion of kidney tissue is removed, many of the processes listed above may suffer or shut down.

The most common type of kidney cancer in adults is renal cell cancer, which occurs slightly more often in males and is usually diagnosed between the ages of 50 and 70. Renal cell cancer is a disease in which malignant cancer cells form in tubules of the kidney and grow into a mass called a tumor. These tiny tubules filter and clean the blood, taking out waste products and making urine. In most cases, a single tumor develops, although more than one tumor can develop within one or both kidneys.

Risk factors for renal cell cancer include:

Smoking
Obesity
Diuretic use or high blood pressure
Chronic kidney failure and/or dialysis
Misusing certain pain medicines, including over-the-counter pain medicines, for a long time
Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma
Family history of kidney cancer
Polycystic kidney disease
Diet with high caloric intake or fried/sautéed meat
Low vitamin E intake
Tuberous sclerosis
Exposure to asbestos, blast furnaces and ovens used in iron/steel manufacturing

Renal cell cancer may cause these symptoms:

Blood in the urine
A lump in the abdomen
A pain in the side that doesn’t go away
Loss of appetite
Fever
Weight loss for no known reason
Anemia

Other conditions may cause the same symptoms or there may be no symptoms in the early stages. Symptoms may appear as the tumor grows. Consult your urologist if any of these symptoms occur.

Your doctor may use the following tests to examine the abdomen and kidneys, and detect and diagnose renal cell cancer:

Physical exam and history
Blood tests and chemistry studies
Urinalysis, or urine test
Liver function test; an abnormal amount of an enzyme released by the liver can be a sign that cancer has spread to the liver
Intravenous pyelogram (IVP), or a series of X-rays of the kidneys, ureters and bladder to find out if cancer is present in these organs
Ultrasound exam
CT scan or CAT scan
MRI, or magnetic resonance imaging
Biopsy

Once the urologist diagnoses the type and stage of cancer you have, an appropriate treatment plan can be outlined. Before starting treatment, you may want to think about taking part in a clinical trial. A treatment clinical trial is a research study to help improve current treatments or explore new treatments for patients with cancer. Choosing the most appropriate cancer treatment is a decision that should involve your family and healthcare team.

For renal cell cancer, five types of standard treatment are used:

Surgery to remove part or all of the kidney, including:

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

A person can live with part of one working kidney, but if both kidneys are removed or not working, the person will need dialysis (a procedure to clean the blood using a machine outside of the body) or a kidney transplant (replacement with a healthy donated kidney).

When surgery to remove the tumor is not possible, a treatment called arterial embolization may be used to shrink the tumor. Many patients also undergo radiation or chemotherapy after surgery to ensure that all cancer cells are destroyed.

Radiation therapy uses high-energy radiology or other types of radiation to kill cancer cells or keep them from growing. There are external and internal radiation therapies.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.
Biologic therapy is a treatment that uses the patient’s immune system to fight cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Targeted therapy uses drugs or other substances that can find and attack specific cancer cells without harming normal cells.

Gerald “Jay” Heulitt, MD

Jeff Marotte, MD