HEALTH - KIDNEY CANCER (RENAL CELL CARCINOMA) SYMPTOMS
What is Kidney Cancer?
Kidney cancer is a disease in which normal cells in the kidneys begin to change, grow without control, and no longer die, forming a mass of cells called a tumor.
The kidneys are reddish-brown organs about the size of a small fist located above the waist on either side of the spine. They are closer to the back of the body than to the front. Kidneys filter blood and remove impurities, excess minerals and salts, and surplus water. Every day, the kidneys filter about 200 quarts of blood to generate two quarts of wastewater (urine).
The kidneys also produce hormones to help control blood pressure,
red blood cell production, and other functions. Although people have
two kidneys, each works independently, which means that the body can
function with less than one complete kidney. With dialysis, a
mechanized filtering process, it is possible to live without kidneys health wise.
In adults, the most common type of kidney cancer is renal cell carcinoma, which begins in the cells that line the small tubes within your kidneys. It occurs most often in men ages 50-70. Children are more likely to develop a kind of kidney cancer called Wilms' tumor. It is different from adult kidney cancer and requires different treatment. Information about transitional cell carcinoma and Wilms tumor is available from the Cancer Information Service at 1-800-4-CANCER and at http://cancer.gov.
The most common types of kidney cancer include:
- Renal cell carcinoma. This type of kidney cancer usually begins in the cells that line the small tubes of each nephron. In most cases, renal cell tumors grow as a single mass, but you may have more than one tumor in a kidney or develop tumors in both kidneys.
- Transitional cell carcinoma. This type of kidney cancer develops in the tissue that forms the tubes that connect the kidneys to the bladder. Transitional cell carcinomas can also begin in the ureters themselves or in the bladder.
- Wilms' tumor. Wilms' tumor is a type of kidney cancer that occurs in young children.
When kidney cancer spreads outside the kidney, cancer cells are often found in nearby lymph nodes. Kidney cancer also may spread to the lungs, bones, or liver. And it may spread from one kidney to the other.
When cancer spreads (metastasizes) from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if kidney cancer spreads to the lungs, the cancer cells in the lungs are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It is treated as kidney cancer, not lung cancer. Doctors sometimes call the new tumor metastatic or "distant" disease.
The American Cancer Society estimates that almost 51,000 people in the United States are diagnosed with kidney cancer each year. The incidence of kidney cancer seems to be increasing, though it isn't clear why. Many kidney cancers are detected during procedures for other diseases or conditions. Imaging techniques, such as computerized tomography (CT), are being used more often, which may help find more kidney cancers.
Health: Risk Factors of Kidney Cancer (Carcinoma)
Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Doctors can seldom explain why one person develops kidney cancer and another does not. However, it is clear that kidney cancer is not contagious. No one can "catch" the disease from another person.
Research has shown that people with certain risk factors are more likely than others to develop kidney cancer. A risk factor is anything that increases a person's chance of developing a disease.
Studies have found the following risk factors for kidney cancer:
- Age. Your risk of renal cell carcinoma increases as you age. Renal cell carcinoma occurs most commonly in people 60 and older.
- Gender. Men are more likely to develop renal cell carcinoma than women are.
- Race. African Americans have higher rates of kidney cancer.
- Smoking. Smokers have a greater risk of renal cell carcinoma than nonsmokers do. The risk increases the longer you smoke and decreases after you quit.
- Obesity. People who are obese have a higher risk of renal cell carcinoma than do people who are considered average weight.
- High blood pressure (hypertension). High blood pressure increases your risk of renal cell carcinoma, but it isn't clear why. Some research in animals has linked high blood pressure medications to an increased risk of kidney cancer, but studies in people have had conflicting results.
- Chemicals in your workplace. Workers who are exposed to certain chemicals on the job may have a higher risk of renal cell carcinoma. People who work with chemicals such as asbestos, cadmium and trichloroethylene may have an increased health risk of kidney cancer.
- Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater health risk of developing kidney cancer. People who have a kidney transplant and receive immunosuppressant drugs also are more likely to develop kidney cancer.
- Von Hippel-Lindau disease. People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, renal cell carcinoma.
- Hereditary papillary renal cell carcinoma. Having this inherited condition makes it more likely you'll develop one or more renal cell carcinomas.
Transitional cell carcinoma risk factors
Risk factors for transitional cell carcinoma include:
- Smoking. Smoking increases your risk of transitional cell carcinomas.
- Chemicals in your workplace. Working with certain chemicals may increase your risk of transitional cell carcinoma.
- A withdrawn medication. Phenacetin, which was removed from the market in the United States in the early 1980s, has been linked to kidney cancer. Phenacetin was used in prescription and over-the-counter pain relievers.
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Health: Symptoms of Kidney Cancer (Carcinoma)
Often, kidney cancer is found when a person has an x-ray or ultrasound. In its earliest stages, kidney cancer causes no pain. Therefore, symptoms of the disease usually appear when the tumor is large and begins to affect nearby organs.
People with kidney cancer may experience the following symptoms. Sometimes, people with kidney cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical health condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor or health care provider.
- Hematuria (blood in the urine)
- Pain or pressure in the side or back
- A mass or lump in the side or back
- Swelling of the ankles and legs
- High blood pressure, or anemia (low red blood cell count)
- Fatigue
- Loss of appetite
- Unexplained weight loss
- Recurrent fever (not from cold, flu, or other infection)
- For men, a rapid development of a varicocele (a cluster of enlarged veins) around the testicle
Routine screening tests to detect kidney cancer early are not available. Doctors may recommend that people with a high health risk of the disease have imaging tests to look inside the body. For people with a family history of kidney cancer, CT scans are sometimes used to search for early-stage kidney cancer. However, CT scans have not been proven to be a useful screening tool for kidney cancer for most people.
Health: Diagnosis of Kidney Cancer (Carcinoma)
The following tests may be used to diagnose kidney cancer:
Blood and urine tests. A blood test to check the number of red blood cells, and a urine test to detect blood, bacteria, or cancer cells, may be performed. These tests may suggest that kidney cancer is present, but cannot make a definite diagnosis.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. Then the pathologist issues a pathology report (laboratory test results) that becomes a permanent part of the person’s medical record. Doctors must have a pathology report before they use radiation therapy or chemotherapy to treat the cancer. The pathology report identifies the type of cell involved in the kidney cancer, which is important in planning treatment. For instance, people with clear cell tumors have mutations of the Von Hippel-Lindau (VHL) gene (a tumor suppressor gene [a type of gene that prevents a tumor from growing]), making the cancer more likely to be treated with drugs that target the vascular endothelial growth factor.
The type of biopsy performed depends on the location of the cancer. A separate biopsy may not be needed if the cancer is found on the CT scan and removal of the kidney is recommended. If surgery is recommended based on the results of other medical tests, such as the CT scan, many doctors will examine the tumor after it is removed during surgery, rather than a separate procedure beforehand. The patient should carefully discuss the reasoning for a recommended biopsy option with his or her doctor or health care provider.
Imaging tests
Intravenous pyelogram (IVP). A dye is injected into the patient’s bloodstream to highlight the kidney, urethra, and bladder when an x-ray (see below) is taken. The picture produced can show changes in these organs and in the nearby lymph nodes.
Bone scan. A bone scan uses a radioactive tracer to look at the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer or a fracture (break), appear dark.
CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture.
Positron emission tomography (PET). A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. Recent research studies suggest that PET scanning may be helpful to monitor tumor shrinkage during treatment of kidney cancer that has spread. However, it is still considered experimental, and health insurance does not often cover the scan because most types of kidney cancer do not absorb the radioactive substance.
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
Cystoscopy/nephro-ureteroscopy. Rarely, a special test called a cystoscopy and nephro-ureteroscopy may be done for renal (kidney) pelvic cancer. During these procedures, the patient is sedated while a tiny, lighted tube is inserted into the bladder through the urethra and up into the kidney. The device can remove samples of cells and, in some cases, small tumors.
Health: Staging Kidney Cancer (Carcinoma)
To plan the best treatment, the doctor needs to know the stage (extent) of
the disease. The stage is based on the size of the tumor, whether the cancer has
spread and, if so, to what parts of the body.
Staging may involve imaging tests such as an ultrasound or a CT scan. The doctor also may use an MRI. For this test, a powerful magnet linked to a computer makes detailed pictures of organs and blood vessels.
Doctors describe kidney cancer by the following stages:
- Stage I is an early stage of kidney cancer. The tumor measures up to 2 3/4 inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.
- Stage II is also an early stage of kidney cancer, but the tumor measures more than 2 3/4 inches. The cancer cells are found only in the kidney.
- Stage III is one of the following: The tumor does not extend beyond the kidney, but cancer cells have spread through the lymphatic system to one nearby lymph node; or The tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue. Cancer cells may be found in one nearby lymph node; or The cancer cells have spread from the kidney to a nearby large blood vessel. Cancer cells may be found in one nearby lymph node.
- Stage IV is one of the following: The tumor extends beyond the fibrous tissue that surrounds the kidney; or cancer cells are found in more than one nearby lymph node; or The cancer has spread to other places in the body such as the lungs.
- Recurrent cancer is cancer that has come back (recurred) after treatment. It may come back in the kidney or in another part of the body.
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Natural Alternative Treatment: NATURAL CANCER TREATMENT
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Health: Conventional Treatment for Kidney Cancer (Carcinoma)
At any stage of disease, people with kidney cancer may have treatment to
control pain and other symptoms, to relieve the side effects of therapy, and to
ease emotional and practical problems. This kind of treatment is called
supportive care, symptom management, or palliative care. Information about
supportive care is available on NCI's Web site at http://cancer.gov and from
NCI's Cancer Information Service at 1-800-4-CANCER. A patient may want to talk to the doctor about taking part in a clinical
trial, a research study of new treatment methods.
Surgery If the cancer has not spread beyond the
kidneys, surgery to remove the tumor, part or all of the kidney, and
possibly nearby tissue and lymph nodes may be the only treatment
necessary. The types of surgery used for kidney cancer include the
following procedures: Radical nephrectomy. Surgery to remove the tumor, the entire
kidney, and surrounding tissue is called a radical nephrectomy. If
nearby tissue and surrounding lymph nodes are also affected by the
disease, a radical nephrectomy and lymph node dissection (removal of
the lymph nodes affected by the cancer) is performed. If the cancer has
spread to the adrenal gland or nearby blood vessels, the surgeon may
remove the adrenal gland, called an adrenalectomy, and parts of the
blood vessels. Partial nephrectomy. A partial nephrectomy is the surgical
removal of a tumor while preserving kidney function and lowering the
risk of kidney disease after surgery (called hyperfiltration injury).
It is used most often for a small tumor, even when the other kidney
functions normally. Laparoscopic surgery. In laparoscopic surgery, the surgeon
makes several small incisions, instead of one larger incision in the
abdomen used in traditional surgery. The surgeon uses telescoping
equipment to remove the kidney completely or perform a partial
nephrectomy. This surgery may take longer, but it is less painful
afterward and patients recover more quickly. Radiofrequency ablation. Radiofrequency ablation is the use
of a needle inserted into the tumor to destroy the cancer with an
electrical current. The procedure is performed by a radiologist or
urologist. The patient is sedated and given local anesthesia to numb
the area. Cryoablation. Cryoablation (also called cryotherapy or
cryosurgery) is the freezing of cancer cells with a metal probe
inserted through a small incision. The metal probe is placed into the
cancerous tissue using a CT scan and ultrasound as guidance. The
procedure requires general anesthesia for several hours. The U.S. Food
and Drug Administration (FDA) approved this treatment for kidney
cancer, but more research studies are needed to determine how effective
this treatment is in the long term..
What type of surgery your doctor recommends will be based on your
cancer and its stage, as well as your health and personal preferences.
Surgery carries a risk of bleeding and infection.
It takes time to heal after surgery, and the time needed to recover is different for each person. Patients are often uncomfortable during the first few days. However, medicine can usually control their pain. Before surgery, patients should discuss the plan for pain relief with the doctor or nurse. After surgery, the doctor can adjust the plan if more pain relief is needed.
It is common to feel tired or weak for a while. The health care team watches the patient for signs of kidney problems by monitoring the amount of fluid the patient takes in and the amount of urine produced. They also watch for signs of bleeding, infection, or other problems requiring immediate treatment. Lab tests help the health care team monitor for signs of problems.
If one kidney is removed, the remaining kidney generally is able to perform the work of both kidneys. However, if the remaining kidney is not working well or if both kidneys are removed, dialysis is needed to clean the blood. For a few patients, kidney transplantation may be an option. For this procedure, the transplant surgeon replaces the patient's kidney with a healthy kidney from a donor.
Treatments when surgery isn't possible
For some people, surgery may be too risky. These people have other options for treating their kidney cancers, including:
- Blocking blood flow to the tumor (embolization). In this procedure, a special material is injected into the main blood vessel leading to the kidney. By clogging this vessel, the tumor is deprived of oxygen and other nutrients. Arterial embolization also may be used before an operation or to relieve pain and bleeding when an operation isn't possible. Side effects may include temporary nausea, vomiting or pain.
- Treatment to freeze cancer cells (cryoablation). Recent studies show cryoablation may be useful for treating kidney tumors that can't be removed through surgery. During cryoablation, one or more special needles (cryoprobes) are inserted through small incisions in your skin and into the tumor. Gas in the needles creates extreme cold that causes the cells around the point of each needle to freeze. Doctors use CT scans to monitor the procedure and to ensure that all of the visible cancer tissue and some of the surrounding healthy tissue is frozen. Another type of gas in the needles creates warmth to thaw the frozen tissue. Then the process is repeated. The cycles of freezing and thawing cause cancer cells to die. You may experience some pain after the procedure. Rare side effects may include bleeding, infection and damage to tissue surrounding the tumor.
Treatments for advanced and recurrent kidney cancer
Kidney cancer that recurs and kidney cancer that spreads to other parts
of the body may be curable. In these situations, treatments may
include:
- Surgery to remove as much of the kidney tumor as possible. Even when surgery can't remove all of your cancer, in some cases it may be helpful to remove as much of the cancer as possible.
- Drugs that use your immune system to fight cancer (biological therapy). Biological therapy (immunotherapy) uses your body's immune system to fight cancer. Drugs in this category include interferon and interleukin-2, which are synthetic versions of chemicals made in your body. These biological therapy drugs have serious side effects, including chills, fever, nausea, vomiting and loss of appetite. Biological therapy drugs are sometimes used alone, in combination or after surgery.
- Treatment that targets specific aspects of your cancer (targeted therapy). Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate. These drugs have shown promise in treating kidney cancer that has spread to other areas of the body. Two targeted drugs, sorafenib (Nexavar) and sunitinib (Sutent), block signals that play a role in the growth of blood vessels that provide nutrients to cancer cells and allow cancer cells to spread. Temsirolimus (Torisel), another targeted drug, blocks a signal that allows cancer cells to grow and survive. Targeted therapy drugs can cause side effects, such as a rash that can be severe, diarrhea and fatigue. Targeted drugs can also be very expensive, sometimes costing over $1,000 a treatment.
- Treatments for distant tumors. Kidney cancer cells that travel to other parts of the body (metastasize) can sometimes be treated. This depends on the number of distant tumors, their locations and your general health. Treatment options vary based on where your cancer has spread. Options might include surgery for brain metastasis or radiation for kidney cancer that has spread to bones.
- Clinical trials. Clinical trials are studies of new treatments and new techniques for treating kidney cancer and other diseases. Participating in a clinical trial may give you a chance to try the latest treatments, but it can't guarantee a cure. Discuss the available clinical trials with your doctor and carefully weigh the benefits and risks. Many kidney cancer clinical trials are studying new and existing targeted therapies to determine the best ways to use this new class of drugs.
Treatment for transitional cell cancer
Treatment for transitional cell cancer typically involves an extensive
operation to remove the tumor, ureter, kidney and a portion of the
bladder. Surgery to remove only the tumor may be an option in some
cases.
Chemotherapy may be useful in treating transitional cell cancer that
has spread or that recurs. Chemotherapy is a drug treatment that uses
chemicals to kill quickly growing cells, such as cancer cells. Other
rapidly growing cells, such as those in your gastrointestinal tract and
your hair follicles, also are killed by chemotherapy drugs, which can
cause side effects including nausea, vomiting and hair loss.
Kidney cancer treatment side effects:
Because treatment may damage healthy cells and tissues, unwanted side effects are common. These side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each person, and they may change from one treatment session to the next. Before treatment starts, the health care team will explain possible side effects and suggest ways to help the patient manage them.
The NCI provides helpful booklets about cancer treatments and coping with side effects, such as Radiation Therapy and You, Chemotherapy and You, and Eating Hints for Cancer Patients. See the sections "National Cancer Institute Information Resources" and "National Cancer Institute Booklets" for other sources of information about side effects.
Arterial embolization
After arterial embolization, some
patients have back pain or develop a fever.
Other side effects are nausea and vomiting. These health problems soon go away.
Radiation therapy
The side effects of radiation therapy depend mainly on the amount of
radiation given and the part of the body that is treated. Patients are likely to
become very tired during radiation therapy, especially in the later weeks of
treatment. Resting is important, but doctors usually advise patients to try to
stay as active as they can.
Radiation therapy to the kidney and nearby areas may cause nausea, vomiting, diarrhea, or urinary discomfort. Radiation therapy also may cause a decrease in the number of healthy white blood cells, which help protect the body against infection. In addition, the skin in the treated area may sometimes become red, dry, and tender. Although the side effects of radiation therapy can be distressing, the doctor can usually treat or control them.
Biological therapy
Biological therapy may cause flu-like symptoms, such as chills, fever, muscle
aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients also
may get a skin rash. These problems can be severe, but they go away after
treatment stops.
Chemotherapy
The side effects of chemotherapy depend mainly on the specific drugs and the
amount received at one time. In general, anticancer drugs affect cells that
divide rapidly, especially:
- Blood cells: These cells fight infection, help the blood to clot, and carry oxygen to all parts of the body. When drugs affect blood cells, patients are more likely to get infections, may bruise or bleed easily, and may feel very weak and tired.
- Cells in hair roots: Chemotherapy can cause hair loss. The hair grows back, but sometimes the new hair is somewhat different in color and texture.
- Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Many of these side effects can be controlled with drugs.
Nutrition
Patients need to eat well during
cancer therapy. They need enough calories to maintain a good weight and protein
to keep up strength. Good nutrition
often helps people with cancer feel better and have more energy.
But eating well can be difficult. Patients may not feel like eating if they are uncomfortable or tired. Also, the side effects of treatment, such as poor appetite, nausea, or vomiting, can be a problem. Some patients find that foods do not taste as good during cancer therapy.
The doctor, dietitian, or other health care provider can suggest ways to maintain a healthy diet. Patients and their families may want to read the National Cancer Institute booklet Eating Hints for Cancer Patients, which contains many useful ideas and recipes. The "National Cancer Institute Booklets" section tells how to get this publication.
Health: Prevention of Kidney Cancer (Carcinoma)
Take the following steps to reduce the risk of kidney cancer below:
- Quit smoking. If you smoke, quit. Many options for quitting exist, including support programs, medications and nicotine replacement products. Tell your doctor you want to quit and discuss your options together.
- Eat more fruits and vegetables.
Add more fruits and vegetables to your diet. A variety of fruits and
vegetables helps ensure that you're getting all the nutrients that your
body needs. Replacing some of your snacks and side dishes with fruits
and vegetables may help you lose weight.
- Exercise regularly. Aim for at least 30 minutes of exercise on most days. If you haven't been active before, get your doctor's permission. Start out slowly, and gradually increase the amount of time you exercise. Consider exercises such as walking or riding a bike.
- Maintain a healthy weight. Work to maintain a healthy weight. If you're overweight or obese, reduce the amount of calories you eat each day and try to exercise most days of the week. Ask your doctor about other healthy strategies to help you lose weight.
- Control high blood pressure. Ask your doctor to check your blood pressure at your next appointment. If your blood pressure is high, you can discuss options for lowering your numbers. Lifestyle measures, such as exercise, weight loss and diet changes, can help. Some people may need to add medications to lower their blood pressure. Discuss your options with your doctor.
- Reduce or avoid exposure to environmental toxins. If you work with toxic chemicals, take special precautions such as wearing a mask and heavy gloves. In the United States, your employer is required to tell you what chemicals you may be exposed to on the job. Follow your employer's safety procedures and ask your doctor if there are other ways to protect yourself from chemical exposure.
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Disclaimer: This information is not presented by a medical practitioner. Therefore any content of this site is strictly intended for educational and informational purpose only. Any access to this site is strictly on a voluntary basis and at the sole discretion of the user. No content of this site is intended as a substitute for medical advice, diagnosis or treatment, nor constitute the practice of any medical profession or health care provider. The information provided on this site is here to educate visitors on health issues that may affect their lives. Otherwise, always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. And never disregard professional medical advice or delay in seeking it because of something you have read.
Sources: NIH News In Health/National Institutes of Health/National Library of Medicine/Dept of Health and Human Services_______________________________________________________________________________________________________
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