Kidney Cancer
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Renal cell
cancer is a disease in which malignant (cancer) cells form in
tubules of the kidney.
Renal
cell cancer (also called kidney
cancer or renal adenocarcinoma)
is a disease in which malignant
(cancer) cells
are found in the lining of tubules (very small tubes) in the kidney.
There are 2 kidneys, one on each side of the backbone, above the
waist. The tiny tubules in the kidneys filter and clean the blood,
taking out waste products and making urine.
The urine passes from each kidney into the bladder
through a long tube called a ureter.
The bladder stores the urine until it is passed from the body.
Cancer that starts in the
ureters or the renal pelvis (the part of the kidney that collects urine and drains it
to the ureters) is different from renal cell cancer.
Smoking and
misuse of certain pain medicines can affect the risk of developing
renal cell cancer.
Risk
factors include the following:
- Being a smoker.
- Misusing certain pain medicines, including
over-the-counter pain medicines, for a long time.
- Having certain genetic
conditions, such as von
Hippel-Lindau disease or hereditary papillary renal cell
carcinoma.
Possible signs
of renal cell cancer include blood in the urine and a lump in the
abdomen.
These and other symptoms
may be caused by renal cell cancer or by other conditions. There
may be no symptoms in the early stages.
Symptoms may appear as the tumor
grows. A doctor should be consulted if any of the following problems
occur:
- Blood in the urine.
- A lump in the abdomen.
- A pain in the side that doesn't go away.
- Loss of appetite.
- Weight loss for no known reason.
- Anemia.
Tests that
examine the abdomen and kidneys are used to detect (find) and
diagnose renal cell cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs
of health, including checking for signs of disease, such as lumps or anything
else that seems unusual. A history of the patient’s health habits and past
illnesses and treatments will also be taken.
- Blood chemistry studies: A procedure in which a blood sample is checked
to measure the amounts of certain substances released into the blood by
organs and tissues in the body. An unusual (higher or lower than normal)
amount of a substance can be a sign of disease in the organ or tissue that
produces it.
- Urinalysis: A test to check the color of urine and its contents, such
as sugar, protein, blood, and bacteria.
- Liver function test: A procedure in which a sample of blood is checked
to measure the amounts of enzymes released into it by the liver. An abnormal
amount of an enzyme can be a sign that cancer has spread to the liver. Certain
conditions that are not cancer may also increase liver enzyme levels.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters,
and bladder to find out if cancer is present in these organs. A contrast
dye is injected into a vein. As the contrast dye moves through the kidneys,
ureters, and bladder, x-rays are taken to see if there are any blockages.
- Ultrasound: A procedure in which high-energy sound waves (ultrasound)
are bounced off internal tissues or organs and make echoes. The echoes form
a picture of body tissues called a sonogram.
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Biopsy: The removal of cells or tissues so they can be viewed under a
microscope to check for signs of cancer. A thin needle is inserted into
the tumor and a sample of tissue is withdrawn. A pathologist then views
the tissue under a microscope to check for cancer cells.
Certain
factors affect prognosis (chance of recovery) and treatment
options.
The prognosis
(chance of recovery) and treatment options depend on the
following:
- The stage of the disease.
- The patient's age and general
health.
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After renal
cell cancer has been diagnosed, tests are done to find out if cancer
cells have spread within the kidney or to other parts of the body.
The process used to find out if cancer
has spread within the kidney
or to other parts of the body is called staging.
The information gathered from the staging process determines the stage
of the disease. It is important to know the stage in order to plan
treatment. The following tests and procedures may be used in the
staging process:
- CT scan (CAT scan): A procedure that makes a series of detailed pictures
of areas inside the body, taken from different angles. The pictures are
made by a computer linked to an x-ray machine. A dye may be injected into
a vein or swallowed to help the organs or tissues show up more clearly.
This procedure is also called computed tomography, computerized tomography,
or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio
waves, and a computer to make a series of detailed pictures of areas inside
the body. This procedure is also called nuclear magnetic resonance imaging
(NMRI).
- Chest x-ray: An x-ray of the organs and bones inside the chest. An x-ray
is a type of energy beam that can go through the body and onto film, making
a picture of areas inside the body.
- Bone scan: A procedure to check if there are rapidly dividing cells, such
as cancer cells, in the bone. A very small amount of radioactive material
is injected into a vein and travels through the bloodstream. The radioactive
material collects in the bones and is detected by a scanner.
The following
stages are used for renal cell cancer:
In stage
I, the tumor
is no larger than 7 centimeters
and is found in the kidney only.
In stage
II, the tumor is larger than 7 centimeters
and is found in the kidney only.
In stage
III, cancer is found:
- in the kidney and in 1 nearby lymph
node; or
- in an adrenal
gland or in the layer of fatty tissue around the kidney, and
may be found in 1 nearby lymph node; or
- in the main blood
vessels of the kidney and may be found in 1 nearby lymph node.
In stage
IV, cancer has spread:
- beyond the layer of fatty tissue around the
kidney and may be found in 1 nearby lymph node; or
- to 2 or more nearby lymph nodes; or
- to other organs, such as the bowel,
pancreas,
or lungs,
and may be found in nearby lymph nodes.
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Recurrent
renal
cell cancer is cancer that has recurred (come back) after it has
been treated. The cancer may come back many years after initial
treatment, in the kidney
or in other parts of the body.
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There are
different types of treatment for patients with renal cell
cancer.
Different types of treatments are available for
patients with renal
cell cancer. Some treatments are standard
(the currently used treatment), and some are being tested in clinical
trials. Before starting treatment, patients may want to think
about taking part in a clinical trial. A treatment clinical trial is
a research study meant to help improve current treatments or obtain
information on new treatments for patients with cancer. When
clinical trials show that a new treatment is better than the
standard treatment, the new treatment may become the standard
treatment.
Clinical trials are taking place in many parts of the
country. Information about ongoing clinical trials is available from
the NCI Cancer.gov Web site.
Choosing the most appropriate cancer treatment is a decision that
ideally involves the patient, family, and health care team.
Four types of
standard treatment are used:
Surgery
to remove part or all of the kidney
is often used to treat renal cell cancer. The following types of
surgery may be used:
- Partial nephrectomy: A surgical procedure to remove the cancer within
the kidney and some of the tissue around it. A partial nephrectomy may be
done to prevent loss of kidney function when the other kidney is damaged
or has already been removed.
- Simple nephrectomy: A surgical procedure to remove the kidney only.
- Radical nephrectomy: A surgical procedure to remove the kidney, the adrenal
gland, surrounding tissue, and, usually, nearby lymph nodes.
A person can live with part of 1 working kidney, but
if both kidneys are removed or not working, the person will need dialysis
(a procedure to clean the blood
using a machine outside of the body) or a kidney transplant
(replacement with a healthy donated kidney). A kidney transplant may
be done when the disease is in the kidney only and a donated kidney
can be found. If the patient has to wait for a donated kidney, other
treatment is given as needed.
When surgery to remove the cancer is not possible, a
treatment called arterial
embolization may be used to shrink the tumor.
A small incision
is made and a catheter
(thin tube) is inserted into the main blood
vessel that flows to the kidney. Small pieces of a special
gelatin sponge are injected
through the catheter into the blood vessel. The sponges block the
blood flow to the kidney and prevent the cancer cells
from getting oxygen and other substances they need to grow.
Even if the doctor removes all the cancer that can be
seen at the time of the surgery, some patients may be given chemotherapy
or radiation
therapy after surgery to kill any cancer cells that are left.
Treatment given after the surgery, to increase the chances of a
cure, is called adjuvant
therapy.
Radiation therapy is a cancer treatment that uses
high-energy x-rays
or other types of radiation
to kill cancer cells. There are 2 types of radiation therapy. External
radiation therapy uses a machine outside the body to send
radiation toward the cancer. Internal
radiation therapy uses a radioactive
substance sealed in needles, seeds,
wires, or catheters that are placed directly into or near the
cancer. The way the radiation therapy is given depends on the type
and stage
of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to
stop the growth of cancer cells, either by killing the cells or by
stopping the cells from dividing. When chemotherapy is taken by
mouth or injected into a vein or muscle, the drugs enter the
bloodstream and can reach cancer cells throughout the body (systemic
chemotherapy). When chemotherapy is placed directly into the
spinal column, an organ,
or a body cavity such as the abdomen,
the drugs mainly affect cancer cells in those areas (regional
chemotherapy). The way the chemotherapy is given depends on the
type and stage of the cancer being treated.
Biologic
therapy is a treatment that uses the patient's immune
system to fight cancer. Substances made by the body or made in a
laboratory are used to boost, direct, or restore the body's natural
defenses against cancer. This type of cancer treatment is also
called biotherapy or immunotherapy.
Other types
of treatment are being tested in clinical trials. These include the
following:
Stem
cells (immature blood cells) are removed from the blood
or bone
marrow of a donor and given to the patient through an infusion.
These reinfused stem cells grow into (and restore) the body's blood
cells.
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Standard
treatment of stage
I renal cell cancer may include the following:
- Surgery
(radical
nephrectomy, simple
nephrectomy, or partial
nephrectomy).
- Radiation
therapy as palliative
therapy to relieve symptoms
in patients who cannot have surgery.
- Arterial
embolization as palliative therapy.
New treatments for stage I renal cell cancer are
being studied in clinical
trials. Information about these and other ongoing clinical
trials is available from the NCI Cancer.gov Web
site.
Standard treatment of stage
II renal cell cancer may include the following:
- Surgery (radical nephrectomy or partial
nephrectomy).
- Surgery (nephrectomy), before or after
radiation therapy.
- Radiation therapy as palliative therapy to
relieve symptoms in patients who cannot have surgery.
- Arterial embolization as palliative therapy.
New treatments for stage II renal cell cancer are
being studied in clinical trials. Information about these and other
ongoing clinical trials is available from the NCI Cancer.gov Web
site.
Standard treatment of stage
III renal cell cancer may include the following:
- Surgery (radical nephrectomy). Blood
vessels of the kidney
and some lymph
nodes may also be removed.
- Arterial embolization followed by surgery
(radical nephrectomy).
- Radiation therapy as palliative therapy to
relieve symptoms and improve the quality
of life.
- Arterial embolization as palliative therapy.
- Surgery (nephrectomy) as palliative therapy.
- Radiation therapy before or after surgery
(radical nephrectomy).
One of the treatments being studied in clinical
trials for stage III renal cell cancer is biologic
therapy following surgery. Information about this and other
ongoing clinical trials is available from the NCI Cancer.gov Web
site.
Standard treatment of stage
IV renal cell cancer may include the following:
- Biologic therapy.
- Radiation therapy as palliative therapy to
relieve symptoms and improve the quality of life.
- Surgery (nephrectomy) as palliative therapy.
- Surgery (radical nephrectomy, with or
without removal of cancer from other areas where it has spread).
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Standard
treatment of recurrent
renal
cell cancer may include the following:
- Biologic
therapy.
- Radiation
therapy as palliative
therapy to relieve symptoms
and improve the quality
of life.
- Chemotherapy.
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