Kidney Cancer, Symptoms and Causes
Kidney cancer, also called renal carcinoma, is a cancer that starts in the kidneys. Kidneys are 4- to 5-inch organs located on either side of the back at the level of the lowest ribs. The kidneys' main job is to filter blood and help the body get rid of excess water, salt and waste products. The waste is made into urine. Risk factors for kidney cancer include smoking, obesity, job-related chemical hazards and some inherited conditions.
The Urologic Oncology Program at North Shore-LIJ Health System's Arthur Smith Institute for Urology brings together experts from collaborative departments including Urology, Radiation Medicine and Medical Oncology to provide the most advanced and comprehensive multidisciplinary treatments of urological malignancies including kidney cancer, bladder cancer, prostate cancer and testicular cancer.
Treatment options include:
- Minimally invasive surgeries
- Novel chemotherapeutic protocols
- Immunotherapy — a type of treatment that uses the body's immune system to halt the growth of cancer cells and usually produces fewer side effects
- Cryoablation — a minimally-invasive treatment using extreme cold to freeze and kill cancer cells
- Robotic Surgery
- Radiation Therapy
Kidney Tumors Overview
Under normal conditions, cells that make up the kidneys grow in a controlled and organized fashion to replace cells that naturally wear out and die. Occasionally, cells can mutate into cells that grow independently and do not carry out their usual normal functions. The collection of these cells is called a tumor. Not all tumors are cancerous. Benign tumors only grow locally in the kidney and do not move to other parts of the body.
Cancer cells are mutated cells that grow out of control at a faster rate than normal tissue. They can also spread into normal tissue, invade the blood stream and travel to other parts of the body where they continue to multiply. If left untreated, these cells begin competing with normal cells for space and nutrients. These new deposits of cancer cells are called metastases. This can lead to destruction of normal tissues and their functions.
With the advent of improved radiographic imaging such as ultrasound and computed tomography (CT), it is becoming more common to detect renal tumors. These tumors are being found when they are relatively small. The majority of these tumors are benign lesions, however, potentially life-threatening cancers can be found.
Kidney Tumor Types
- Renal Cysts — Approximately 70% of renal lesions are simple cysts. These are fluid filled sacs on or in the kidney. Simple cysts affect approximately half the population in the world over the age of 50 and are benign. These are often picked up incidentally on ultrasound or CT examinations ordered by the doctor for unrelated reasons. They do not require treatment unless they cause persistent symptoms.
- Benign Tumors — Approximately 25% of incidentally found renal tumors are benign. These lesions include oncocytomas, angiomyolipomas, hemorrhagic cysts, leiomyomas and fibromas. With the exception of angiomyolipomas, it can be difficult to diagnose these lesions without removal. Surgically removing the lesion may require a partial or radical nephrectomy.
- Renal Cancer — Renal cancers can be divided into two broad categories based on where they first develop in the kidney: Renal parenchyma tumors develop in the solid part of the kidney while transitional cell carcinomas develop from the lining of the inner hollow part of the kidney, ureter or bladder.
- Renal Cell Carcinoma — Renal cell cancer is the most common type of renal parenchymal tumor. It affects approximately 32,000 individuals in the US each year, accounts for 12,000 deaths and represents 3% of adult malignancies.
Kidney Cancer Symptoms
Most kidney tumors today are detected incidentally when patients are undergoing X-ray studies for unrelated reasons. This is very fortunate, as the cure rate for most of these small lesions is over 90%. Due to the location of the kidney deep in the back, symptoms usually do not develop until the tumor gets quite large. Moreover, these symptoms are often due to other benign causes and none are specific for a renal tumor. These symptoms include:
- Blood in the urine (visual to the patient or only with the microscope)
- Abdominal or back pain
- A mass that can be felt in the abdomen
- Some renal carcinomas can produce hormones that can cause symptoms such as high blood pressure, nausea, decreased appetite, fever and fatigue. These tumors can also cause abnormalities in liver tests, calcium level and blood count. It is important to realize that there currently is no specific blood test that can detect renal carcinoma.
Diagnosis and Staging
Routine screening for renal cancer is not recommended other than yearly urinalysis and blood work as well as a physical examination. Patients with a family history (multiple relatives) should consider screening X-ray studies.
When a renal tumor is detected, several tests are performed to help in the diagnosis and staging of the tumor to help formulate the best treatment plan. Staging helps determine how extensive the tumor has grown locally and if it has spread to other parts of the body.
- Complete history and physical exam — helps assess extent of tumor, how long it may have been present, possible causes and other known medical conditions that may impact upon treatment
- Blood work and urinalysis — tests that help assess the overall kidney function and gives clues to any evidence of spread of tumor or other unrecognized medical problems.
- Imaging studies that assess the size and location of the tumor include:
- Renal ultrasound
- Computerized axial tomography (CAT) scan
- Imaging studies that assess if the cancer has spread beyond the kidney include:
- Magnetic resonance imaging (MRI)
- Chest x-ray
- CT scan of the brain, if neurological symptoms exist
- Bone scan, if there is new bone pain or elevation in a blood test
- Unfortunately, biopsy is not helpful, as studies have shown that an error in diagnosis may occur in up to 28% of patients.
Kidney Cancer Treatment
Several options exist for patients with renal carcinoma:
- Observation — Small renal tumors in older patients or individuals with multiple medical problems can be followed with x-ray studies every 6-12 months.
- Surgery — Localized renal tumors are best managed by surgical removal. For tumors less than 5cm in size on X-ray, it may be possible to remove the tumor without the need to remove the entire kidney. For larger tumors, the entire kidney may need to be removed with possibly the adrenal gland and lymph nodes. Most kidney surgery can be performed laparoscopically.
- Percutaneous ablation — A needle placed through the skin into the tumor can freeze or heat the tumor, causing it to die over time. Close follow-up with X-rays is necessary to be certain that the tumor is completely gone and does not recur over time.
- Chemotherapy/immunotherapy — Several protocols are available to treat patients with metastatic renal carcinoma. Interleukin and interferon have both shown some activity in treating metastatic renal carcinoma. Sometimes the kidney containing the tumor is removed prior to beginning therapy.
- Follow-up — The schedule for follow-up depends upon the stage of the tumor. All patients should have a yearly exam with blood tests to assess kidney and liver function. A yearly chest X-ray may also be recommended. Higher risk patients may require CT scans at scheduled intervals.
For more information about kidney cancer treatment, visit Arthur Smith Institute for Urology.
Kidney Cancer Clinical Trials
The North Shore-LIJ Cancer Institute offers a full array of clinical trials. The result of this research not only impacts survival, but also enhances the quality of life. For more information about clinical trials for Kidney Cancer, visit Cancer Clinical Trials.
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