Renal Cancer Kidney Cancer Kidney Cancer Kidney Cancer

Kidney Cancer

Overview

The kidneys are paired organs which filter the blood, control blood pressure, and secrete certain hormones responsible for red blood cell formation. A malignant tumor of the kidney is called "renal cell carcinoma" or "hypernephroma". These types of tumors account for 85% of kidney tumors. If detected early, kidney tumors can be curable by surgical removal of either the tumor or the entire kidney. In 1998, there were 29,900 new cases of kidney cancer and 11,600 people died of the disease. Kidney cancer is the 8th most common cancer in men and the 10th most common cancer in women.

Diagnosis

Most renal cancers have no symptoms early in their course. The most common presenting sign of a renal tumor is blood in the urine (hematuria). Microscopic blood in the urine may be detected by a simple office test which is usually performed at the time of a yearly physical examination. Blood that is detectable by the naked eye should always be evaluated promptly since it may be a sign of significant disease. When a renal tumor is more advanced, there may be other signs such as weight loss, back or flank pain, fever, or loss or energy. A mass or lump in the abdomen may also be noted by a physician when the tumor is large.

Once a kidney tumor is suspected by any of the above signs, diagnostic studies need to be performed to confirm that a tumor exists. The initial study ordered by a physician will depend upon the individual patient's signs/symptoms. These tests may include:

IVP (Intravenous pyelogram)
Ultrasound
CT scan of the abdomen and pelvis
MRI

In most cases, a CT scan will eventually be performed since this test will confirm that a renal tumor exists and to ensure that it has not spread to other organs. The CT scan will determine the extent (size and location) of the tumor and whether or not other studies are needed. If there is a suspicion that the tumor involves adjacent blood vessels or the lungs, additional testing may include a MRI, CT scan of the chest, or arteriogram. Other routine studies include a chest x-ray, bone scan, and blood tests.

Biopsies of kidney tumors are not routinely performed. Since a biopsy of the kidney mass may "miss" the tumor, a negative biopsy does not exclude the presence of a malignancy. Therefore, if a tumor has the characteristics of a malignancy on appropriate x-ray studies, then treatment is warranted.

Treatment

Most patients have 2 equally functioning kidneys. Removal of 1 kidney does not affect a person's overall kidney function and most patients can live with only 1 kidney for the remainder of their life. In general, surgical removal of a renal malignancy is considered the most curable treatment. Standard surgical treatment is called a "radical nephrectomy" and includes removal of the kidney, adrenal gland, and surrounding tissues. For small tumors, a "partial nephrectomy" may be able to remove the tumor but leave the remaining healthy kidney in place. The size and location of the tumor determines which procedure will be the best choice. Although advanced kidney tumors may not be curable with removal of the kidney, at times surgery is still a viable option if a patient has ongoing symptoms of bleeding, pain, or other systemic symptoms.

Kidney tumors which are advanced at the time of diagnosis may still be treated surgically although other options do exist. These options include:

Radiation therapy
Embolization - to remove blood supply to the tumor
Immunotherapy - medications to make the body fight the tumor
Chemotherapy - not effective for this type of tumor

Patients who present with advanced disease may be candidates for clinical trials of new therapies which have not yet been proven to be effective. These clinical trials may allow some patients to try medications and treatments which are currently experimental but which may become standard treatments in the future.

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