The kidney is made up of two parts: the parenchyma (the meat) which is responsible for filtering one’s blood and removing waste products, and the collecting system (the plumbing system) which is responsible for collecting and transporting urine from the kidney down to the bladder.
Kidney cancer can be a cancerous (malignant) growth in either of these parts of the kidney. In 2016, there is estimated to be approximately 63,000 new cases of kidney cancer - the vast majority of which will arise from the parenchyma of the kidney and is referred to as renal cell carcinoma. The information provided here is entirely devoted to renal cell carcinoma.
What are the causes?
Fortunately, most forms of renal cell carcinoma are detected incidentally and early when they are small in size. These tumors are usually very slow-growing and do not spread quickly. In fact, for some people, depending on their age and other health issues, we do not elect to pursue active treatment at initial diagnosis and instead survey their kidney mass.
However, there are some tumors which are already advanced at the time of their diagnosis. For these tumors, though, there have been a number of important pharmaceutical advances over the last 10 years that have resulted in markedly improved survival.
What are the risks linked to this condition?
Renal cell carcinoma is strongly associated with:
- Smoking
- Obesity
- End-stage renal disease (dialysis)
- Family history, especially some familial kidney cancer syndromes
It is weakly associated with:
- Hypertension
- Diabetes
What are the symptoms?
Symptoms may include:
- Blood in the urine
- Flank pain
- Weight loss/loss of appetite
- Fatigue
Many renal masses nowadays are found incidentally when patients are undergoing an ultrasound, CT scan or MRI for other unrelated reasons.
Exams and tests:
Your urologist will perform a physical exam and check a urinalysis and blood tests to evaluate your kidney function. If not already done, imaging with an ultrasound, CT scan or MRI is routinely used. A biopsy of the mass is sometimes done.
Treatment:
As with any cancer, the goal of treatment is to totally remove the tumor without it coming back. Many cancers require two forms of treatment, such as chemotherapy and/or radiation therapy and surgery or some combination of the three.
Fortunately, for most kidney cancers, surgical removal of only the tumor and a small part of the surrounding kidney (partial nephrectomy) is necessary and possible. This approach allows for preserving as much of the patient’s kidneys as possible to prevent future dialysis. This type of surgery is especially important in patients with only one kidney or in whom their kidney function is already compromised and can be done for even large tumors.
Outlook:
Surgery for most kidney tumors will usually result in a complete cure with a less than 2% chance of the cancer returning within 5 years.
For advanced tumors, total removal of the kidney (radical nephrectomy) followed by newer non-chemotherapeutic agents is recommended and can result in significant prolongation, if not cure, of a given patient.
Possible complications of kidney surgery:
- Infection
- Bleeding
- Prolonged healing time of “plumbing system” of the kidney (urinary fistula)
New techniques/advances in renal cell carcinoma:
Although surgery is the mainstay of treatment for most kidney cancers, many of these surgeries can be performed using minimally-invasive techniques (laparoscopic or robotic surgery). Minimally-invasive surgery requires much smaller incisions with less pain, shorter hospital stays, improved cosmesis and faster recovery. This type is routinely performed by the urology department at the Ochsner.
When to Contact a Medical Professional:
Call your health care provider if you notice blood in your urine or if a kidney tumor or mass is found during an ultrasound, CT scan or MRI done for other reasons. Also, if you have a family history of kidney cancer, you should consult a urologist to see if you require further screening.
