Generality
Kidney cancer is the result of a malignant neoplastic process that begins in a cell of renal tissue.
At the beginning, kidney cancer tends to be asymptomatic; in fact, the most characteristic symptoms (hematuria, flank pain, etc.) appear only at a later stage.
Renal biopsy is essential for a precise diagnosis of the severity of a kidney tumor.
There are several treatments for kidney cancer. Generally, the first line therapy is surgical and consists in removing the tumor mass.
Brief anatomical reference of the kidneys
The kidneys are two and represent the main organs of the excretory apparatus; together with the urinary tract, they constitute the urinary system .
The kidneys reside in the abdominal cavity, on the sides of the last thoracic vertebrae and the first lumbar vertebrae, they are symmetrical and have a shape that is very reminiscent of a bean.
The main renal functions are:
- Filter the harmful and foreign waste materials present in the blood and convert them into urine;
- Adjust the hydro-saline balance of blood;
- Adjust the acid-base balance of the blood;
The blood on which the kidneys act comes from the renal artery and returns to the venous system entering the renal vein, which then joins the vena cava.
The kidney is composed of different structures, which the reader can view in the figure below:
What is kidney cancer?
Kidney cancer is the result of a malignant neoplastic process that begins in a renal cell.
WHAT IS A TUMOR?
In medicine, the term tumor and its synonym neoplasia identify an abnormal mass of very active cells, able to divide and grow uncontrollably.
- Doctors talk about a malignant tumor when the abnormal cell mass has the ability to grow very quickly and to spread to the surrounding tissues and the rest of the body.
The terms "malignant tumor", "cancer" and "malignant neoplasia" all have the same meaning.
KIDNEY TYPES OF CANCER
According to the most recent medical studies, there are more than 200 different types of kidney cancer.
The absolute most common type - representing more than 80% of clinical cases - is the so-called renal carcinoma .
Renal carcinoma is a kidney tumor that originates in the proximal or distal tubule of the nephron.
The second most common type of kidney cancer is transitional cell carcinoma (kidney).
Transitional cell carcinoma of the kidney originates from the cells constituting the particular transition epithelia.
Epidemiology
Kidney cancer mainly affects people over 40-50 years old, belonging to the male sex.
According to statistical research on the United Kingdom, it would represent the eighth most common form of malignancy in the adult population, with more than 10, 000 diagnoses each year.
Causes
Any malignant tumor is the consequence of a series of genetic mutations, which affect cellular DNA and are the cause of that uncontrolled process of division and growth, typical of neoplastic processes.
Kidney cancer is no exception.
WHAT CAUSES THE GENETIC MUTATIONS AT THE BASE OF THE KIDNEY CANCER?
Doctors and pathology experts ignore the precise causes of the mutations underlying kidney cancer, while they are quite sure what the risk factors are.
According to several clinical investigations, the most important factors favoring kidney cancer would be:
- Obesity and overweight. Obesity and overweight are two conditions that raise the level of estrogen in the blood (NB: estrogens are hormones). On the basis of various scientific studies, an increase in the estrogen level beyond the normal level would represent a stimulus to the development and growth of neoplastic cells;
- Cigarette smoke. According to the most recent studies, smokers are twice more at risk of kidney cancer than non-smokers;
- The presence of severe kidney disease. Generally, such a condition requires dialysis; dialysis would appear to be a treatment that predisposes to the development of malignant neoplasms of the kidneys;
- The presence of some inherited genetic diseases, including tuberous sclerosis, Von Hippel-Lindau syndrome etc;
- Prolonged exposure to certain chemical pollutants, such as asbestos, cadmium, benzene, organic solvents and certain herbicides.
Other likely risk factors for kidney cancer:
- Hypertension;
- Prolonged use over time of some anti-inflammatory and pain-relieving drugs, such as ibuprofen (NSAIDs);
- Membership in the male sex;
- The presence of a lymphoma;
- Belonging to the black race.
Symptoms and Complications
To learn more: Kidney Tumor Symptoms
At the beginning, kidney cancer is an asymptomatic condition, that is, devoid of obvious clinical manifestations.
The first symptoms and signs of kidney cancer begin to appear at a medium / advanced stage of the condition, when the tumor mass has assumed certain dimensions.
In these situations, the most common symptomatic picture includes:
- Hematuria, or blood in the urine. The patient immediately realizes it, because his urine takes on a red or dark brown color;
- The sensation of a bulge or bulge on the side where the diseased kidney resides;
- Strong pain in the side where the diseased kidney resides;
- An unexplained loss of appetite associated with a reduction in body weight;
- Prolonged fever ;
- Sense of recurrent fatigue ;
- Anemia ;
- Sense of general malaise ;
- Night sweats ;
- Hypertension ;
- Presence of edema at the level of the hips and / or legs.
COMPLICATIONS
At an advanced stage, kidney cancer can infiltrate neighboring tissues and spread metastasis to various organs of the body, some of which are also fairly distant from the original site.
The most common site for metastasis of a kidney tumor is the lungs and bones.
WHEN TO REFER TO THE DOCTOR?
Symptoms and signs to be immediately exposed to your doctor, or for which you should go to the nearest hospital, are: the presence of pain or swelling in the areas where the kidneys reside and the presence of blood in the urine.
Diagnosis
In general, the diagnostic procedure for detecting a kidney tumor begins with an accurate physical examination and a careful medical history. Then, it continues with a urine test, blood tests and a series of diagnostic imaging tests (abdominal ultrasound, intravenous pyelography, abdominal CT, abdominal nuclear magnetic resonance and renal arteriography). Finally, a kidney biopsy ends.
The search for any metastases in the bones requires the realization of a bone scan; the search for possible metastases in the lungs, instead, requires the realization of a CT scan or a nuclear magnetic resonance of the thorax.
Based on an interesting Anglo-Saxon statistic, about half of kidney cancer diagnoses occur quite randomly, during an abdominal ultrasound performed for other reasons.
RENAL BIOPSY
Renal biopsy is the most reliable test and confirms any suspicion of kidney cancer.
Furthermore, it allows to establish two important characteristics of the current neoplastic condition: staging and grade .
- Staging of a malignant tumor → includes all the information regarding the size of the tumor mass, its infiltrating power and its metastasizing capacities.
- Degree of a malignant tumor → includes all the data concerning the extent of tumor cell transformation, compared to healthy counterparts.
Treatment
To learn more: Kidney Cancer Treatment Drugs
The choice of which therapy to adopt in case of kidney cancer depends on several factors, first of all the staging of the neoplasm.
Currently, the list of possible treatments available to a subject with a renal neoplasm includes:
- The surgery of total or partial removal of the diseased kidney. This surgery is called nephrectomy ;
- The alternatives to surgery, namely: cryotherapy, radiofrequency ablation, arterial embolization, radiotherapy and chemotherapy;
- Biological drugs for so-called "targeted therapy" (in English is targeted therapy ).
SURGERY
Nephrectomy is the first-line treatment for most cases of kidney cancer.
There are three types of nephrectomy: radical nephrectomy, simple nephrectomy and partial nephrectomy.
Readers are reminded that the human being can lead a normal and healthy life even with a single kidney.
ALTERNATIVES TO SURGERY
Doctors consider the use of cryotherapy, radiofrequency ablation, arterial embolization, radiotherapy and / or chemotherapy, when nephrectomy surgery is not possible.
TARGETED THERAPY
The drugs for targeted kidney cancer therapy include:
- Sunitinib
- Pazopanib
- axitinib
- Sorafenib
- Temsirolimus
- Everolimus
- bevacizumab
Prognosis
The prognosis of kidney cancer depends on how timely the diagnosis is: in fact, first the identification of the condition takes place and the greater the chance that the therapies are successful.
According to the most recent statistical studies:
- For people with kidney cancer identified at an early stage, the 5-year survival rate from diagnosis is between 65 and 90%.
- For people with kidney cancer detected at a medium-advanced stage, but not yet metastatic, the 5-year survival rate from the diagnosis is between 40 and 70%.
- For people with kidney cancer identified at an advanced and metastatic stage, the 5-year survival rate from diagnosis is 10-12%.
Prevention
As long as the triggering causes are not clear, preventing kidney cancer with absolute certainty is impossible.
WHAT CAN YOU DO?
To protect themselves from kidney cancer, doctors advise paying attention to risk factors: not smoking (or quitting smoking if you are a smoker), controlling body weight, monitoring blood pressure and avoiding exposure to certain chemical pollutants are the main behaviors to reduce the possibility of developing kidney cancer.
