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Kidney Cancer

The kidneys are a pair of kidney-shaped organs located above the waist on either side of the spine, that filter and clean the blood and produce urine. Weighing around 150 grams each, the kidneys are protected from injury by a large pad of fat, lower ribs, and several muscles. While the kidneys are constantly separating the non-recyclable waste from the recyclable wastes in the body, they also clean the blood.

What is kidney cancer?


Kidney cancer (also known as renal cancer) is a disease in which kidney cells become malignant (cancerous) and grow out of control and form a tumor. So kidney cancer is caused by abnormal growth of cells in the kidneys. Almost all kidney cancers first arise in the lining of the small tubes (tubules) in the kidney. This type of kidney cancer is called renal cell carcinoma.


Renal cell carcinomas (RCCs) account for about 90 percent of kidney cancer cases. Other types of kidney cancer are:

  • Transitional cell carcinoma, or cancer of the renal pelvis that begins on the inner surface of the renal pelvis

  • Wilms tumor (nephroblastoma), the most common cancer in children aged 14 years and younger

  • A rare renal sarcoma develops in the soft tissue of the kidney.


Kidney cancer, which constitutes approximately 2-3% of cancer types, occurs as a result of the growth of malignant cells in the kidneys. Early diagnosis of kidney cancer is very important. In this disease, successful results can be obtained with early diagnosis and appropriate treatment methods.


What are benign (non-cancerous lesions in the kidney) kidney tumors?


Benign kidney tumors can be treated by destroying them using many of the same treatments used for kidney cancers, such as surgery or radiofrequency ablation. The choice of treatment depends on many factors, such as the size of the tumor and whether it is causing any symptoms, the number of tumors, whether the tumors are in both kidneys, and the person's general health.


Angiomyolipoma


Angiomyolipomas are the most common benign kidney tumor. They are more common in women. They can develop in people with tuberous sclerosis, a genetic condition. These tumors are made up of different types of connective tissues (blood vessels, smooth muscle, and fat). If they are not causing any symptoms, they can usually be watched closely. If they start to cause problems (such as pain or bleeding…) they may need to be treated.


Oncocytoma


Oncocytomas are uncommon, benign kidney tumors that can sometimes grow quite large. It is more common in men and does not spread to other organs.


What causes kidney cancer?


Kidney cancers make up about 2.5 percent of all cancers. Kidney cancer is twice as common in men than women. The risk of kidney cancer increases with advancing age. Indeed, most cases of kidney cancer occur in people over the age of 50. Although the exact cause of kidney cancer is not known, the factors listed below may increase the risk of developing kidney cancer. 

Smoking: Smokers have almost twice the risk of developing kidney cancer than non-smokers. About one-third of all types of kidney cancers are thought to be related to smoking. 

Obesity: Obesity can cause changes in certain hormones that can lead to kidney cancer. 

High blood pressure: High blood pressure can increase the risk of kidney cancer. 

Kidney failure: People with kidney failure have a higher risk of developing kidney cancer. 

Family history of cancer: People with a parent, brother, or sister (first-degree relative) of kidney cancer are at increased risk. 

Hereditary conditions: About 2-3 percent of kidney cancers develop in people with certain inherited syndromes, including von Hippel-Lindau disease, hereditary papillary RCC, Birt-Hogg-Dubé syndrome, and Lynch syndrome. 

Radiation exposure: The risk of developing kidney cancer may be increased in people who have previously undergone radiation therapy for treatment or have been exposed to long-term radiation for other reasons. 

Exposure to toxic substances in the workplace: There may be a higher risk of developing kidney cancer after regular exposure to chemicals such as some metal degreasers, arsenic or cadmium used in mining, farming, welding and painting.


What are the symptoms of kidney cancer?


Kidney cancer usually causes no obvious or bothersome symptoms in its early stages. Small-sized tumors in the early stage can be detected by chance, especially in abdominal ultrasonography or tomography performed for another disease.


As the kidney tumor grows, the symptoms listed below may occur:

  • In some cases, blood may be seen in the urine. In other cases, traces of blood are detected in the urinalysis, which is a laboratory test usually performed as part of a regular medical examination.

  • A lump or mass in the kidney area

  • Non-severe, persistent pain, especially in the lumbar region

Less common symptoms of kidney cancer may include:

  • Tiredness

  • Loss of appetiteweight loss

  • High feverHigh blood pressure or a lower than normal red cell count (low RBC) in the blood (anemia) can also indicate a kidney tumor. These symptoms are less common.

On the other hand, if the tumor has spread to organs such as bones and lungs, symptoms related to cough, bloody sputum, and bone pain may also be seen depending on this spread.


How is kidney cancer diagnosed?


Because kidney cancer is usually asymptomatic, that is, it may not cause symptoms, the tumor is most often detected when the patient undergoes medical testing for another reason. In other words, in the ultrasound and computerized tomography examinations performed in any complaint of the patient, a kidney tumor that he is not aware of can be detected while the disease is still in its early stages. For example; When the patient consults a doctor with a complaint of gallbladder and is directed to ultrasound by an internist, the probability of detecting a developing kidney tumor during the ultrasound is quite high.


Computed Tomography (CT) and MRI scans are often the only tests doctors need to diagnose kidney cancer. Sometimes doctors also perform what's known as a percutaneous biopsy if they need more information about a tumor before recommending a treatment. During this procedure, the doctor numbs the skin using local anesthesia. It then uses a small needle to pull out some of the tissue.​


Doctors may use CT scans or ultrasound (using sound waves to create images on a computer monitor) to locate the tumor and guide needle insertion and withdrawal. A pathologist, a doctor who studies diseases in the laboratory, examines tissue samples under a microscope for signs of cancer.​


Urine tests do not diagnose kidney cancer; however, the doctor may want to see if there is blood in the urine, which is a common sign of advanced kidney cancer. On the other hand, blood tests help doctors determine whether the kidneys are working properly; however, it is not used to diagnose kidney cancer.


What are the stages of kidney cancer?


Staging is an important part of diagnosis and the process of determining how extensive the cancer is. Because the most appropriate treatment options are determined according to the stage of the cancer. The stages of kidney cancer range from Stage I (least severe stage) to Stage IV. Once patients are confirmed to have kidney cancer, the doctor will discuss staging.​


Stage I (Least severe stage)


The tumor is 7 cm or smaller and is found only in the kidney. It has not spread to lymph nodes or distant organs.


Stage II


The tumor is larger than 7 cm and is found only in the kidney. It has not spread to lymph nodes or distant organs.


Stage III


In stage III, the tumor extends to surrounding tissues other than the kidney and may have spread to regional lymph nodes.


Stage IV


The tumor has spread to areas outside of Gerota's fascia, the connective tissue layer that compresses the kidneys and adrenal glands, and extends into the adrenal gland. Cancer can spread to multiple lymph nodes or to distant areas of the body, such as the bones, liver, or lungs.


How is kidney cancer treated?


Treatment options for kidney cancer may depend on a number of factors, including the patient's general health, the type of kidney cancer they have, whether the cancer has spread, and treatment choices. The standard method in the treatment of kidney cancers is surgery. The goal of the surgical procedure is to remove the cancer while preserving normal kidney function whenever possible. Considering the stage of the cancer, the size of the mass, the region of the kidney and the number of the mass, the entire kidney or only the mass is removed by closed method. If the cancer has spread beyond the kidney, additional treatments may be recommended.


Removal of the affected kidney (nephrectomy)


A complete (radical) nephrectomy involves removing the entire kidney, the margin of healthy tissue, and sometimes additional nearby tissue such as lymph nodes, adrenal gland, or other structures.The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic or robotically assisted laparoscopic nephrectomy).


Removal of the tumor from the kidney (partial nephrectomy)


This procedure, also called kidney-sparing or nephron-sparing surgery, is a common treatment for early-stage tumors. In kidney-sparing surgery, it is aimed to preserve kidney function as much as possible and to reduce the risk of later complications such as kidney disease and need for dialysis.


Non-surgical treatments such as chemotherapy and radiation therapy are less effective in the treatment of kidney cancer.


Immunotherapy works to strengthen your body's own immune system. Immunotherapy is a treatment option for people with advanced kidney cancer. Cytokines (proteins that activate the immune system) can be given intravenously or orally and can shrink the cancer. In addition, targeted therapies can be applied for advanced kidney cancers. Targeted therapies target specific molecules. Targeted therapy drugs are usually given in tablet form or intravenously. Tyrosine kinase inhibitors (TKIs) have been tested in people with advanced kidney cancer and have been found to cause fewer side effects than chemotherapy drugs.


Note: Da Vinci Robotic Surgery provides great advantages to the patient in kidney tumor surgeries. In cases such as partial removal of the kidney or removal of the tumor part in the kidney, the problem is resolved without compromising oncological and surgical principles, without the need for major surgical incisions, by entering through 4-5 holes through the abdomen, separating the tumor tissue.


FREQUENTLY ASKED QUESTIONS ABOUT KIDNEY CANCER

What is embolization that can be applied in the treatment of kidney cancer?


The surgeon inserts a catheter and threads a synthetic material into the blood vessel. This material blocks blood flow to the kidney, which deprives the tumor of oxygen and nutrients and causes it to shrink.


Can kidney cancer be prevented?


Since the causes of kidney cancer are not fully known, it is not possible to prevent the disease one hundred percent; however, maintaining a healthy lifestyle, a healthy diet, and a combination of regular exercise will help prevent obesity, a major risk factor for kidney cancer.


Is Kidney Cancer Curable?


Recovery status in the process of kidney cancer varies according to the stage of the cancer. Although the average life expectancy of kidney cancer cases is determined by the stages of the cancer, this situation may differ from person to person. 

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