What is the kidney cancer?
The abnormal proliferation of cells in kidney tissue is known as kidney cancer. These cells eventually join together to create a tumor. Cancer develops when something causes a change in the cells, causing them to divide uncontrollably. A cancerous or malignant tumor may spread to other tissues and important organs (metastasize).
What forms of kidney cancer are there?
This text is about renal cell carcinoma, which is the most prevalent kind of kidney cancer. There are, however, other forms of kidney cancer, including:
Renal cell carcinoma (RCC) is the most prevalent kind of kidney cancer in adults, accounting for around 85% of all cases. Renal cell carcinoma normally starts off as a solitary tumor in one kidney, but it may spread to both. Renal cell carcinoma starts in the cells that lining the tiny tubes that make up the kidney's nephrons. (The term "carcinoma" refers to cancer that originates in the cells that line or cover an organ, and "renal" is the Latin word for kidney.)
Transitional cell carcinoma is a kind of kidney cancer that accounts for 6% to 7% of all kidney malignancies. The ureter links to the major section of the kidney, and thus cancer generally starts there. The renal pelvis is the name for this region. The ureters and bladder may also be affected by transitional cell cancer.
Renal sarcoma: Renal sarcoma is the least frequent kind of kidney cancer, accounting for about 1% of all cases. It starts in the connective tissues of the kidneys and may spread to neighboring organs and bones if not addressed.
Wilms' tumor is the most frequent kind of pediatric kidney cancer. It is responsible for around 5% of all kidney malignancies.
What is the prevalence of kidney cancer?
In the United States, kidney cancer accounts for roughly 3.7 percent of all malignancies. More than 62,000 Americans are diagnosed with kidney cancer every year. Kidney cancer is more common as people become older. Men are more likely than women to have it.
What are the stages of kidney cancer?
Stage I: The tumor is 7 cm in diameter or less and exclusively affects the kidney. It hasn't spread to lymph nodes or other areas of the body. (Infection-fighting cells are stored in lymph nodes, which are little "filters" that catch germs and cancer cells.)
Stage II: The tumor has grown to a diameter of more than 7 cm but is still solely in the kidney. It hasn't spread to lymph nodes or other areas of the body.
Stage III: The tumor has progressed to important blood arteries such as the renal vein and inferior vena cava, as well as surrounding tissue and lymph nodes.
Stage IV: The tumor has progressed to the adrenal gland (a tiny gland that lies on top of the kidney), distant lymph nodes, or other organs outside of the kidney.
Tumors are also graded, which is a method of assigning a numerical value to a tumor depending on how aberrant its cells seem. Grading a tumor may also inform a doctor how quickly the tumor will develop. High-grade tumors are those that include cells that don't appear like normal cells and proliferate quickly. Cancers with a higher grade likely to develop and spread faster than tumors with a lower grade.
What causes kidney cancer in the first place?
Although the specific etiology of kidney cancer is unknown, there are a number of risk factors that have been found. A risk factor is a quality or action that raises your chances of becoming sick. Kidney cancer is linked to a number of variables, including:
- Smoking: Smokers are more likely to get kidney cancer. Furthermore, the longer someone smokes, the greater the danger.
- Obesity is linked to a higher risk of kidney cancer. Furthermore, the bigger the danger, the more overweight a person is.
- High blood pressure, sometimes referred to as hypertension, has been related to a higher risk of kidney cancer.
- People having a family history of kidney cancer may be at a higher risk of acquiring the disease themselves.
- Radiation: Women who have had radiation treatment for cancer of the reproductive organs may have a slightly higher risk of kidney cancer.
- Gene alterations (mutations): Genes are the instructions that tell a cell how to operate. Changes in some genes have been linked to an increased risk of kidney cancer.
- Dialysis for a long time: Dialysis is a procedure that cleans the blood by running it through a machine. When a person's kidneys aren't working correctly, dialysis is utilized.
- Tuberous sclerosis is a condition that causes convulsions, intellectual impairments, and tumors in a variety of organs.
- Von Hippel-Lindau disease (VHL): People who have this genetic illness are more likely to develop kidney cancer. Noncancerous tumors in the blood arteries, usually in the eyes and brain, are caused by this condition.
What symptoms do you have if you have kidney cancer?
In the early stages of kidney cancer, there may be no apparent symptoms. Symptoms, on the other hand, may arise as the tumor grows. As a result, kidney cancer is often not detected until it has spread.
The following are some of the signs and symptoms of kidney cancer:
- Urine with blood (a condition called hematuria).
- A lump or mass in the region of the kidneys.
- A nagging pain in the side.
- A overall sensation of being unwell.
- Appetite and/or weight loss
- Fever of a low intensity.
- Bone ache.
- Blood pressure that is too high.
- Anemia is a disorder in which a person (a condition that results from not having enough red blood cells).
How can you know if you have kidney cancer?
If you are experiencing symptoms, your doctor will conduct a thorough medical history and physical examination. The doctor may also request tests to aid in the diagnosis and assessment of cancer. These tests may involve the following:
- Urine tests are used to determine whether or not a sample of urine contains blood. Urine tests may identify even the tiniest quantities of blood, which are undetectable to the human eye.
- Blood testing: These tests are used to determine the amount of various types of blood cells as well as the electrolytes in your body. A blood test may reveal whether you have anemia (insufficient red blood cells) or if your kidney function is affected (by looking at the creatinine).
- CT or CAT scan: This is a kind of X-ray that utilizes a computer to generate a sequence of pictures, or slices, of the interior of the body. Intravenous contrast is often used in this examination (dye). The dye may not be able to be given to patients with compromised renal function.
- Magnetic resonance imaging (MRI) is a test that uses a huge magnet, radio waves, and a computer to create pictures of the interior of the body.
- Ultrasound: This test creates pictures on a monitor by using high-frequency sound waves that are transferred via bodily tissues. This test aids in the detection of malignancies, which vary in density from healthy tissues.
- A tiny needle is introduced into the tumor and a small sample of tissue is extracted during a renal mass biopsy (biopsy). The doctor will examine the tissue under a microscope to check whether any cancer cells are present. Your doctor may or may not prescribe this test since biopsies for kidney cancer are not usually totally trustworthy.
What factors are used to determine the stage of kidney cancer ?
- The tumor's location and size.
- The number of lymph nodes that have been impacted.
- The extent to which the cancer spread to other tissues and organs, if at all.
- To assess the stage of cancer, the doctor examines data from a variety of procedures, including CT, MRI, and biopsy.
What is the treatment for kidney cancer?
Treatment is determined by the kind of cancer, the tumor's stage and grade, as well as the patient's age and general condition.
The main treatments are:
- surgery to remove part or all of the affected kidney – this is the main treatment for most people
- ablation therapies – where the cancer cells are destroyed by freezing or heating them
- targeted therapies (also called biological therapies) – medicines that help stop the cancer growing or spreading
- embolisation – a procedure to cut off the blood supply to the cancer
- radiotherapy – where high-energy radiation is used to target cancer cells and relieve symptoms
Surgery in treatment of kidney cancer
There are 2 main types of surgery for kidney cancer:
- an operation to remove the part of the kidney containing the cancer – called a partial nephrectomy
- an operation to remove the entire kidney – called a radical nephrectomy
A partial nephrectomy is usually done if the cancer is small and easy for the surgeon to get to. A radical nephrectomy may be necessary for larger cancers or if the cancer has spread beyond the kidney.
It's possible to live a normal life with only 1 kidney. Your other kidney can usually make up for the kidney that was removed.
Surgery for kidney cancer can be done in 2 ways:
- through a single large cut in the tummy or back – known as "open" surgery
- using surgical tools inserted through smaller cuts – known as laparoscopic or "keyhole" surgery
Keyhole surgery tends to have a faster recovery time, but it can only be done by trained surgeons and it is not always suitable. Talk to the surgeon about the pros and cons of each method.
Ablation therapies in treatment of kidney cancer
Ablation therapies are treatments that destroy cancer cells by either:
- freezing them (cryotherapy)
- heating them (radiofrequency ablation)
Either technique may be recommended in certain circumstances (for example, to ensure your kidney keeps working), or if the tumour is small. Both treatments are only available in specialist centres, so you may need to travel to another hospital to have it done.
Radiofrequency ablation is done by inserting a needle-like probe through your skin, so no large cuts are needed.
Cryotherapy is done using needles inserted into the tumour. This can be done through your skin (percutaneous cryotherapy) or through a small cut (laparoscopic cryotherapy).
Side effects of ablation therapies can include bleeding around the kidney and damage to the tube that carries pee from the kidney to the bladder (the ureter).
Targeted therapies in treatment of kidney cancer
If your cancer is advanced, you may be offered targeted therapies (also called biological therapies). These are medicines, usually taken once or twice a day, that help stop the cancer growing and spreading.
There are many different biological therapies, including:
- sunitinib
- pazopanib
- cabozantinib
- axitinib
- everolimus
- bevacizumab and interferon
- nivolumab
- Tivozanib
At present, sunitinib, pazopanib, cabozantinib, axitinib, everolimus, nivolumab and tivozanib are recommended for routine use on the NHS.
Some people with advanced kidney cancer may be offered a medicine called lenvatinib, to take along with everolimus.
Other medicines are not currently recommended, but some may be available through the Cancer Drugs Fund.
Side effects
Sunitinib, pazopanib, cabozantinib, axitinib and tivozanib are all taken as tablets. Possible side effects include:
- feeling and being sick
- indigestion
- diarrhoea
- high blood pressure (hypertension)
- a sore mouth
- loss of appetite and weight loss
- tiredness
- infertility
Nivolumab is given by a drip directly into a vein every 2 weeks. It works by helping your body's immune system destroy the cancer cells. Side effects are uncommon, but can include:
- a rash
- diarrhoea
- a cough and shortness of breath
- Tiredness
Embolisation in treatment of kidney cancer
Embolisation is a procedure to block the blood supply to the tumour, causing it to shrink.
It's sometimes recommended if you have advanced kidney cancer and you're not in good enough health to have surgery to remove the affected kidney.
During embolisation, the surgeon will insert a small tube called a catheter into a blood vessel in your groin and then guide it to the blood vessel supplying the tumour.
A substance will be injected through the catheter to block the blood vessel.
Radiotherapy in treatment of kidney cancer
Radiotherapy is a treatment where radiation is used to target or destroy cancerous cells. It cannot usually cure kidney cancer, but it can slow down its spread and help control your symptoms.
It may be recommended if you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain.
Radiotherapy uses a large machine to carefully direct beams of radiation at the cancerous cells. It's often done for a few minutes every day, over a few weeks.
Side effects of radiotherapy can include:
- tiredness
- feeling and being sick
- diarrhoea
- reddening of the skin in the treatment area
Robotic Kidney Cancer surgery
The type of kidney cancer surgery that is right for you will depend on your diagnosis and unique needs.
- Robotic partial (kidney-sparing) nephrectomyremoves the tumor while preserving the normal and unaffected portion of the kidney. By saving the kidney, this procedure reduces the chance for long-term kidney failure and provides better overall kidney function. Our surgeons have experience performing this procedure for even the most complex cases, including large, deep or multiple tumors; obese patients; vascular invasion; proximity to critical structures; prior abdominal surgeries; and hereditary kidney cancer.
- Robotic nephrectomycompletely removes the entire affected kidney. This procedure is often used for certain large, advanced tumors, or for kidneys that no longer function. In some cases, the adrenal gland and fatty tissue surrounding the kidney may need to be removed. The remaining kidney usually provides adequate function without the risk of failure or dialysis in the future, if it is healthy.
- Robotic-assisted nephroureterectomyremoves the kidney and its ureter (the duct through which urine passes from the kidney to the bladder) for patients diagnosed with urothelial cancer.
Some patient with large kidney tumors may also undergo renal embolization prior to surgery. Performed by our interventional radiologists, this minimally invasive procedure blocks an artery or vein by injecting small particles through a catheter into the tumor. It is done to decrease blood loss during surgery.
How long does robotic kidney surgery take?
Laparoscopic and robotic partial nephrectomy requires that patients undergo a general anesthesia. While operative time varies from one individual to another, the average operating time is approximately 3-4 hours.
How long does it take to recover from kidney cancer surgery?
With traditional surgery, four or five days of hospitalization are usually needed after kidney removal, plus six to eight weeks for recovery. Patients of open surgery typically require heavy pain medication over extended time, too.
What are the advantages of Robotic Surgery for Kidney Cancer ?
As with most robotic-assisted procedures, there is typically much less pain than with the open procedure, less blood loss (and therefore less need for a blood transfusion), less scarring (both internally and externally), a shorter hospital stay (usually one to two days versus up to a week), and shorter overall recovery time before a return to normal activities.
Using the robot, we can complete lymph node dissections that may match or surpass what most experienced open surgeons are able to offer. If your urologist tells you that you are not a candidate for a minimally invasive approach or a kidney-sparing approach, a consultation with a Temple robotic surgeon is highly recommended.
