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Kidney cancer is a malignant tumor that is located in the kidney tubules. The disease often shows no symptoms for a long time, which is why it is particularly dangerous. The greatest number of cases of kidney cancer is recorded in men over 40 years of age.
Kidney cancer – causes
The causes of kidney cancer are hereditary and environmental factors: smoking, exhaust fumes, smoke, asbestos, obesity and contact with chemicals. Cancer can also result from the treatment of other diseases, such as hormone therapy for prostate cancer. It is also favored by acquired cystic kidney disease, which can develop in people on dialysis.
Kidney cancer – symptoms
Symptoms of kidney cancer appear relatively late after the disease is advanced. But the first abnormality that is easy to spot and requires careful diagnosis is usually haematuria. It may reappear occasionally or continuously. Together with kidney cancer, hypertension and anemia can also develop. Tumor metastases to the bone are signaled by high levels of calcium in the blood, i.e. hyperkaclemia. Often, ESR is elevated and the white blood cell count is significantly elevated in morphology.
One of the classic symptoms of a tumor developing within the kidneys is the so-called Virchow’s triad, which includes hematuria, back pain in the lumbar region, the presence of a tumor palpable through the abdominal wall. Unfortunately, the classic triad of symptoms occurs in less than 5 percent of cases and is often associated with a high advancement of the neoplastic process, which is an unfavorable prognosis for the patient. Other symptoms that may suggest the development of neoplastic disease are: weight loss and lack of appetite, malaise and weakness, periodic increase in body temperature and fever accompanied by night sweats, sudden decrease in urine output, leg swelling and varicose veins in men, enlarged lymph nodes lymph nodes due to metastasis.
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Paraneoplastic syndrome
This is a symptom or set of symptoms that precedes or accompanies the development of kidney cancer. They are not related to direct tumor activity or the formation of metastases. The symptom of paraneoplastic syndrome can be ectopic hormone production (that is, hormone production outside of the place where they are normally produced). When the body is attacked by cancer, it may produce in the wrong places, for example, insulin, prolactin, aldosterone or a substance similar to vitamin D3.
Kidney cancer diagnosis
When any abnormalities in the urinary system and kidneys are suspected, the basic examination is a general urinalysis, complete blood count and biochemical blood test. Before the diagnosis is made, it is also necessary to perform an ultrasound of the kidneys.
If the results are unfavorable to the patient, the doctor issues a referral for a CT scan of the abdominal cavity and pelvis. The examination is not only to exclude or confirm the earlier diagnosis, but also to show the extent, size of the tumor and the presence of metastases. Before the examination, the patient takes a contrast agent, which allows to see the tumor infiltration into the renal vein and the inferior vena cava.
The information collected during the tomography also allows the decision to pre-operatively shrink the tumor. This can be done by blocking the blood supply to the vessels that the tumor feeds on. In colloquial language, this method is called starvation of the tumor.
Your doctor may also order a renal arteriography, which is a contrast test of the kidney arteries. Urography is another test that shows changes in the kidney’s calico-pelvic system.
Magnetic resonance imaging is used to search for renal cancer metastases to the adrenal glands.
Primary tumor biopsy is rarely performed, mainly when the risk of surgery is very high.
Kidney cancer – Treatment
The basic method of fighting kidney cancer is resection of the diseased kidney, i.e. nephrectomy. Along with the tumor and kidney, the surrounding lymph nodes are removed (lymphadenectomy) and the neoplastic plug in the case of infiltration and ingrowth into the renal vein and inferior vena cava (thrombectomy) with the possibility of their reconstruction. In the case of small tumor foci on both kidneys, it is possible to perform the so-called sparing nephrectomy. The operation consists in removing the tumor itself, leaving a healthy part of the kidneys. However, in any case, the patient’s future depends on whether or not surgery was performed at an early stage of the disease. When there are metastases (most often to bones, lungs, brain, spinal cord, liver, lymph nodes, adrenal glands or the second kidney), the procedure itself is not enough – pharmacological treatment is also needed. Classic chemotherapy and radiotherapy are ineffective.
The hope for patients is targeted therapy. This is a treatment that uses the so-called monoclonal antibodies and preparations that can locate tumor cells in the body on the basis of specific receptors present on their surface. Thanks to this method, it is possible to minimize the risk of side effects that always accompany classic chemotherapy. In addition, targeted therapy is much more effective and, most importantly, spares healthy tissues and the patient’s immune system.
Drugs used in targeted therapy can distinguish a healthy cell from a sick one. Such a skill is possessed by monoclonal antibodies that, like a remote-controlled missile, flawlessly hit the target or are a transporter that transports ammunition to the vicinity of a degenerated cell. If we know markers characteristic for a given tumor or know the receptors on the surface of cancer cells, drugs from the targeted therapy group can be used as a key. Get inside the cancer cell and destroy it without wreaking havoc around it. But not all tumors can be treated with this method due to the lack of these specific receptors.
The use of targeted therapy in kidney cancer increases the average survival time by about 44 percent, or in the case of kidney cancer by up to 2-3 years.