Cancer starts when cells in the body begin to grow out of control. Kidney cancer also called renal cancer is a cancer that starts in the kidneys. Almost all kidney cancers first appear in the lining of tiny tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma.
What causes kidney cancer?
Cancers can be caused by DNA mutations (changes) that turn on oncogenes or turn off tumor suppressor genes, resulting in cells growing out of control. Changes in many different genes are usually needed to cause kidney cancer.
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Here, you will find information about signs and symptoms, causes and risk factors, types, diagnosis, staging and prevention about kidney cancer.
Early kidney cancers do not usually cause any signs or symptoms, but larger ones might. Some possible signs and symptoms of kidney cancer include:
Blood in the urine (hematuria)
Low back pain on one side (not caused by injury)
A mass (lump) on the side or lower back
Fatigue (tiredness), Loss of appetite
Unexplained weight loss not caused by dieting
Fever that is not caused by an infection and that doesn't go away
Anemia (low red blood cell counts)
Swelling of the ankles and legs
High blood pressure
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A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. These are some risk factors for kidney cancer:
Smoking: If you smoke cigarettes, your risk for kidney cancer is more.
Older age: Your risk of kidney cancer increases as you age.
Being obese: Extra weight may cause changes to hormones that increase your risk of kidney cancer than people who are considered average weight.
Using certain pain medications for a long time: This includes over-the-counter drugs in addition to prescription drugs.
Having lymphoma: For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.
Having certain genetic conditions: People who are born with certain inherited syndromes such as von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma.
High blood pressure (hypertension): High blood pressure increases your risk of kidney cancer.
Being exposed to certain chemicals: such as asbestos, cadmium, benzene, organic solvents, or certain herbicides.
Treatment for kidney failure: People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.
There are several types of kidney cancer:
Renal cell carcinoma: Renal cell carcinoma is the most common type of adult kidney cancer. This type of cancer develops in the proximal renal tubules that make up the kidney's filtration system.
There are several subtypes of RCC, based mainly on how the cancer cells look under a microscope.
1. Clear cell renal cell carcinoma
2. Papillary renal cell carcinoma
3. Chromophobe renal cell carcinoma
4. Rare types of renal cell carcinoma
5. Unclassified renal cell carcinoma
Urothelial carcinoma: This is also called transitional cell carcinoma. It accounts for 10% to 15% of the kidney cancers diagnosed in adults. Urothelial carcinoma begins in the area of the kidney where urine collects before moving to the bladder, called the renal pelvis.
Sarcoma: Sarcoma of the kidney is rare. This type of cancer develops in the soft tissue of the kidney; the thin layer of connective tissue surrounding the kidney, called the capsule; or surrounding fat. Sarcoma of the kidney is usually treated with surgery.
Wilms tumor: Wilms tumor is most common in children and is treated differently from kidney cancer in adults. This type of tumor is more likely to be successfully treated with radiation therapy and chemotherapy than the other types of kidney cancer when combined with surgery.
Lymphoma: Lymphoma can enlarge both kidneys and is associated with enlarged lymph nodes, called lymphadenopathy, in other parts of the body, including the neck, chest, and abdominal cavity. In rare cases, kidney lymphoma can appear as a lone tumor mass in the kidney and may include enlarged regional lymph nodes.
Tests and procedures used to diagnose kidney cancer include:
Urinalysis (urine testing): Tests of your blood and your urine may give your doctor clues about what's causing your signs and symptoms.
Imaging tests: Imaging tests help to visualize a kidney tumor or abnormality. Imaging tests might include an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI).
Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder are taken to see if cancer is found there. A contrast dye is injected through a vein. It moves through these organs, and x-rays are taken to look for blockages.
Removing a sample of kidney tissue (biopsy): In rare cases, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer.
After someone is diagnosed with kidney cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.
The TNM system is based on 3 key pieces of information:
The size of the main (primary) tumor (T) and whether it has grown into nearby areas.
If the cancer has spread to nearby (regional) lymph nodes (N). Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first.
If the cancer has spread (metastasized) to other organs (M). Kidney cancer can spread almost anywhere in the body, but common sites of spread are the bones, brain, and lungs.
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Taking steps to improve your health may help reduce your risk of kidney cancer. To reduce your risk, try to:
Quit smoking: If you smoke, quit. Smokers develop kidney cancer twice the rate of nonsmokers.
Maintain a healthy weight: Work to maintain a healthy weight. If you're overweight or obese, reduce the number of calories you consume each day and try to be physically active most days of the week.
Control high blood pressure: If your blood pressure is high, you need to lower your numbers. Lifestyle measures such as exercise, weight loss and diet changes can help.
Find out if you're exposed to certain toxins at work or at home: Some toxins that may increase the risk for kidney cancer include cadmium, asbestos, and trichloroethylene.
Genetic testing: You need to go for genetic testing to determine if you have a higher risk of developing kidney cancer.
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The best treatment approach for kidney cancer may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment. Kidney cancer is most often treated with surgery, targeted therapy, immunotherapy, or a combination of these treatments. Some forms of treatment include:
Surgery is the main treatment for most kidney cancers. Depending on the stage and location of the cancer and other factors, surgery might be done to remove either the cancer along with some of the surrounding kidney tissue (known as a partial nephrectomy), or the entire kidney (known as a radical nephrectomy). The adrenal gland (the small gland that sits on top of each kidney) and fatty tissue around the kidney is sometimes removed as well.
1. Radical nephrectomy: In this operation, the surgeon removes your whole kidney, the attached adrenal gland, nearby lymph nodes, and the fatty tissue around the kidney.
2. Partial nephrectomy (nephron-sparing surgery): In this procedure, the surgeon removes only the part of the kidney that contains cancer, leaving the rest of the kidney behind.
3. Regional lymphadenectomy (lymph node dissection): This procedure removes nearby lymph nodes to see if they contain cancer.
4. Removal of an adrenal gland (adrenalectomy): Although this is a standard part of a radical nephrectomy, if the cancer is in the lower part of the kidney (away from the adrenal gland) and imaging tests show the adrenal gland is not affected, it may not have to be removed.
Radiation therapy uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. It is also known as radiotherapy. Radiation therapy might be used in advanced kidney cancer to shrink a tumour and relieve symptoms. For people with kidney cancer, radiation therapy is more often used to palliate, or ease, cancer symptoms such as pain, bleeding, or problems caused by cancer spread (especially to the bones or brain).
When radiation therapy is used to treat kidney cancer, it is usually external beam therapy, which focuses radiation from a source outside the body on the cancer.
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Chemotherapy (chemo) uses anti-cancer drugs that are given into a vein (IV) or taken by mouth (as pills). These drugs enter your blood and reach nearly all areas of the body, which makes this treatment potentially useful for cancer that has spread (metastasized) to organs beyond the kidney.
Some chemo drugs, such as vinblastine, floxuridine, 5-fluorouracil (5-FU), capecitabine, and gemcitabine have been shown to help a small number of patients. Still, chemo is often only used for kidney cancer after targeted drugs and/or immunotherapy have already been tried.
The targeted drugs are different from standard chemotherapy drugs. Targeted drugs are proving to be especially important in kidney cancer, where chemotherapy has not been shown to be very effective.
When might targeted drugs be used?
Treating advanced kidney cancer: All of the targeted drugs below can be used to treat advanced kidney cancers. They can often shrink or slow the growth of the cancer for a time, but it doesn't seem that any of these drugs can actually cure kidney cancer.
Adjuvant therapy after surgery: Sunitinib (Sutent) can also be used after surgery is done to remove the cancer, to help lower the risk that the cancer will come back. This is known as adjuvant therapy.
Which targeted drugs are used to treat kidney cancer?
The targeted drugs used to treat advanced kidney cancer work by blocking angiogenesis (growth of the new blood vessels that nourish cancers) or important proteins in cancer cells (called tyrosine kinases) that help them grow and survive. Some targeted drugs affect both.
Sorafenib (Nexavar), Sunitinib (Sutent), Temsirolimus (Torisel), Everolimus (Afinitor), Bevacizumab (Avastin), Pazopanib (Votrient), Axitinib (Inlyta), Cabozantinib (Cabometyx), Lenvatinib (Lenvima)
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Immunotherapy is the use of medicines to boost a person's own immune system to recognize and destroy cancer cells more effectively. Several types of immunotherapy can be used to treat kidney cancer.
Immune checkpoint inhibitors
An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses "checkpoints," which are proteins on immune cells that need to be turned on (or off) to start an immune response. Kidney cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But these drugs target the checkpoint proteins, helping to restore the immune response against the cancer cells.
Pembrolizumab (Keytruda) and Nivolumab (Opdivo) are drugs that target PD-1, a protein on immune system cells (called T cells) that normally help keep these cells from attacking other cells in the body. By blocking PD-1, these drugs boost the immune response against kidney cancer cells. This can often shrink some tumors or slow their growth.
Avelumab (Bavencio) targets PD-L1, a protein related to PD-1 that is found on some tumor cells and immune cells. Blocking the PD-L1 protein can help boost the immune response against cancer cells. This can often shrink some tumors or slow their growth.
Ipilimumab (Yervoy) is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check.
Cytokines are small proteins that boost the immune system in a general way. Man-made versions of cytokines, such as interleukin-2 (IL-2) and interferon-alpha, are sometimes used to treat kidney cancer. Both cytokines can cause kidney cancers to shrink in a small percentage of patients.
In the past, IL-2 was commonly used as first-line therapy for advanced kidney cancer, and it may still be helpful for some people.
Interferon has less serious side effects than IL-2, but it does not seem to be as effective when used by itself. It is more often used in combination with the targeted drug bevacizumab (Avastin).
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