Kidney Cancer

It is important to realize that with timely diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent.

Overview

Most people have two functional kidneys. The kidneys produce urine that drains through narrow tubes (called ureters ) into the bladder. The kidneys are usually located in each flank protected by muscles of the back and ribcage. The kidneys are contained within a fibrous sheath called the Gerota's fascia and surrounded by a layer of fat. The kidney capsule is a thin layer that covers the outer surface of the kidney (similar to the red peel of an apple). The primary vein that drains the kidney (renal vein) merges with the vein that takes blood to the heart (vena cava). An adrenal gland is located above each kidney within Gerota's fascia.

The adrenal glands, which are not part of the kidney, are located near the top of each kidney. The adrenal glands regulate blood sugar, potassium, body fluids and sex hormones. They also control the body's response to stress by producing a hormone called adrenaline.

The kidney performs many bodily functions, such as controlling fluid balance, regulating electrolytes (e.g., sodium, potassium, calcium, magnesium), preventing acid buildup, eliminating waste products, producing urine, 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 a significant portion of kidney tissue is removed, the normal processes listed above may be impaired. In most cases, mild to moderate impairment causes very minor problems. In cases when kidney function is severely impaired, dialysis may be required.

Risk Factors

The following associations may increase the risk of developing kidney cancer.

• Smoking
• Family history of kidney cancer
• Polycystic kidney disease
• Chronic kidney failure and/or dialysis
• Diet with high caloric intake or fried meat
• Low vitamin E intake
• Diuretic use
• Tuberous sclerosis
• Exposure to asbestos, blast furnaces and ovens used in iron/steel manufacturing

Signs and Symptoms

Many kidney tumors do not produce symptoms, but may be detected incidentally during the evaluation of an unrelated problem. Compression, stretching and invasion of structures near the kidney may cause pain (in the flank , abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung, bone pain or fracture may occur when cancer is in the bone and neurologic symptoms may occur when cancer is in the brain.

In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 30 percent of patients with kidney cancer and can occur in any stage (including cancers confined to the kidney). Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated red blood cell sedimentation rate, low blood count ( anemia ), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high blood count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.

Investigation

To diagnose kidney cancer, the patient's personal and family medical history is taken and a thorough physical examination is conducted. In addition to checking temperature, pulse, blood pressure, and other general signs of health, the doctor usually orders blood and urine tests and one or more of the below mentioned exams :

Ultrasound Intravenous                  Urogram(IVU) CT or CAT scan

Magnetic       Resonance       Imaging         (MRI) Arteriogram Nephrotomogram

Treatment

If these tests suggest that a tumor is present, it is important to know the extent, or stage, of the disease. Because kidney cancer can spread to the bones, lungs, liver, or brain, staging procedures may include special x-rays and tests to check these organs.

Treatment for kidney cancer depends on the location and size of the tumor and whether the cancer has spread to other organs. Kidney cancer is treated with surgery, embolization, or hormone therapy, biological therapy, or chemotherapy, which are forms of systemic therapy and rarely Radiation therapy.

Surgery

Most kidney cancer patients have surgery, an operation called Radical Nephrectomy. In some cases, the surgeon removes the whole kidney(palliative Nephrectomy) or just the part of the kidney that contains the tumor(partial nephrectomy). More often, the surgeon removes the whole kidney along with the adrenal gland and the fat around the kidney. Also, nearby lymph nodes may be removed because they are one of the first places where kidney cancer spreads. Finding cancer cells in the lymph nodes means there may be cancer elsewhere in the body.

Radical Nephrectomy is major surgery. For a few days after the operation, most patients need medicine to relieve pain. However nowadays LAPARASCOPIC Radical or Partial Nephrectomy is done which allows fast recovery and early discharge with minimal pain.

ADJUVANT Therapy

Immunotherapy is a new way of treating kidney cancer. This treatment attempts to improve the way the body's immune system fights disease. Interleukin-2 and interferon are two forms of biological therapy being studied to treat advanced kidney cancer. Doctors are also exploring the benefits of using biological therapy after surgery for early stage kidney cancer. This additional treatment is called adjuvant therapy. Doctors are trying to find out whether adjuvant biological therapy can prevent the cancer from recurring by killing undetected cancer cells that may remain in the body.

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