Kidney Cancer: Symptoms and Treatment

Kidney cancer is one of the 10 most common forms of cancer. According to the American Cancer Society’s 2017 estimated statistics, almost 64,000 people were diagnosed with kidney cancer, and about 14,400 deaths resulted from it. The average age of diagnosis is 64, and men are nearly twice as likely to be diagnosed.

Causes of Kidney Cancer

Although it is unclear what causes kidney cancer, several risk factors increase your chances of developing it:

• Gender (higher in men)
• Race (higher in African Americans, American Indians, and Alaskan natives)
• Genetic and hereditary factors. Kidney cancers that occur in younger patients (in their 20s or 30s), occur in multiple locations simultaneously or associated with other tumors are more likely to have a hereditary component.
• Smoking
• Obesity
• Family history
• High blood pressure
• Advanced kidney disease

Symptoms of Kidney Cancer

There are no specific symptoms of kidney cancer in early stages. However, if you have any of the following, you should see a doctor for diagnosis and treatment. These are some of the signs of kidney cancer, but they are also seen in less serious conditions like kidney stone and urine infection.

• Blood in urine. If you can see blood in the urine- either with or without pain- it should never be ignored. You should consult a healthcare provider immediately
• Unexplained lower back pain on one side
• Fatigue
• Loss of appetite
• Unexplained weight loss
• Persistent fever not caused by an infection

Diagnosis of Kidney Cancer

Kidney cancer is often suspected on tests like X-ray or CT scan done for other conditions. Some people go to the doctor because of symptoms mentioned above.

• Blood tests like CBC( Complete Blood Count) and Renal labs to look for anemia as well as kidney function.
• Imaging tests:This is best way to diagnose kidney cancer. A computed tomography scan (CT Scan) with a special dye can not only find out whether there is a kidney mass or tumor, but also whether there are associated abnormalities including enlarged lymph nodes, growth of the tumor into veins etc. In certain cases, and MRI may be done, but it is generally not needed
• Kidney biopsy: Kidney biopsy is not routinely recommended for the diagnosis of kidney cancer. In some instances, a biopsy may help if there is doubt about the diagnosis and the nature of the tumor. Furthermore, a biopsy might be necessary to enroll in certain kinds of clinical trials.

Staging of Kidney Cancer

The diagnostic tests not only help in making the diagnosis but also in determining the stage of cancer (how far the cancer has spread). The staging is usually based on size of the cancer and it spread to other organs.

Stage I: Cancer is 7cm or smaller and has not spread beyond the kidney.

Stage II: Cancer is larger than 7cm but has not spread beyond the kidney OR it is growing into a major vein or tissue around the kidney BUT not into the adrenal gland or Gerota’s fascia. It has not spread to lymph nodes or distant organs.

Stage III: Cancer is any size and may be outside the kidney, but it is has spread beyond Gerota’s fascia. It has spread to nearby lymph nodes but not distant lymph nodes or other organs.

Stage IV: Cancer has spread beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney. OR It may be any size and may have grown outside the kidney. It has spread to distant lymph nodes or other organs.

Treatment of Kidney Cancer

Treatments options will depend on the type and stage of the cancer and include the following:

Local treatments (do not affect the rest of the body):

• Surgery to remove partial or whole kidney: In cases where the tumor is limited to the kidney, surgery offers the best chance of cure; and survival rates are greater than 90% in many cases. Over the last 10 years, minimally invasive kidney surgery using laparoscopic or robotic surgery have become commonplace and are widely offered throughout the world.
• Ablation and other local therapies: CryoAblation (freezing the tumor), and radiofrequency ablation (RFA – using radio waves to cause tumor death) are novel methods for killing the cancerous tissue without having to do surgery. These are however only appropriate for small tumors (<3 cm); in patients who cannot undergo surgical therapy due to overall poor health. Their rate of cure is also very high, but slightly less than that of surgery.
• Active surveillance:Small tumors can be safely observed with serial CT scans or MRIs. The only caveat is that patients stay compliant with intensive monitoring regimens.
• Radiation therapy: generally not offered for kidney cancer.

Systemic treatments (medication that can reach anywhere in the body):

Systemic treatments are offered when the tumor has spread beyond the kidney, or when it has come back after initial treatment. Newer medications are a lot safer and better tolerated than older therapies.

• Targeted therapy
• Immunotherapy
• Chemotherapy

Prevention of Kidney Cancer

In most cases, the cause of kidney cancer is unknown, and when it is known, it still may not be preventable. However, smoking cessation, blood pressure control, weight control etc are simple interventions that will have a beneficial effect not only on kidney cancer risk, but also overall health.

References: 

• www.cancer.org
• American Cancer Society. Cancer Facts & Figures 2017. Atlanta, Ga: American Cancer Society; 2017