What are Kidneys?
The kidneys are two bean-shaped organs located on either side of the spine in the lower back. They are a vital part of the urinary system and are responsible for filtering and removing waste and excess fluid from the body. The kidneys also help regulate the body’s electrolyte balance, blood pressure, and production of red blood cells. The waste and excess fluid that is filtered out of the blood by the kidneys is then eliminated from the body in the form of urine. Kidneys are essential organs for maintaining overall health and well-being.
What is Kidney Cancer?
Kidney cancer is developed when healthy cells in one or both kidneys start changing and growing uncontrollably, resulting in the formation of a mass called a renal cortical tumour. A tumour is an abnormal growth of cells in the body that can be either benign (non-cancerous) or malignant (cancerous). Benign tumours are usually harmless and do not spread to other parts of the body. They can often be removed with surgery and may not require further treatment. Malignant tumours are cancerous and can invade and damage nearby tissues and organs, as well as spread to other parts of the body.
Types of Kidney Cancer
There are several types of kidney cancer as follows –
Renal cell carcinoma (RCC):
This is the most common type of kidney cancer, accounting for about 90% of all cases. RCC can be further classified into subtypes based on the appearance of the cancer cells under a microscope. The most common subtypes are clear cell RCC, papillary RCC, and chromophobe RCC.
Transitional cell carcinoma (TCC):
This type of kidney cancer is also called Urothelial carcinoma. It starts in the lining of the renal pelvis and ureter, which are the tubes that connect the kidney to the bladder. TCC is less common than RCC, accounting for about 5-10% of kidney cancers.
Wilms' tumour:
This is a rare type of kidney cancer that primarily affects children. It usually develops in children between the ages of 2 and 5 and is more common in girls than in boys. It makes up about 1% of kidney cancers.
Renal sarcoma:
This is a rare type of kidney cancer that starts in the connective tissue of the kidney. It accounts for less than 1% of all kidney cancers.
Other less common types of ovarian cancer include borderline tumours (also known as low malignant potential tumours) and primary peritoneal carcinoma, which develops in the lining of the abdomen.
Risk Factors of Kidney Cancer
The following are the risk factors for kidney cancer –
Age
The risk of kidney cancer increases as people age, with most cases diagnosed in people over the age of 60.
Gender
Men are more likely to develop kidney cancer than women.
Smoking
Smoking is a major risk factor for kidney cancer. Cigarette smoke contains toxic chemicals that can damage the DNA in kidney cells and increase the risk of mutations.
Obesity
Being overweight or obese is a risk factor for many types of cancer, including kidney cancer. Excess weight can increase inflammation in the body and lead to changes in hormone levels, both of which can contribute to the development of cancer.
High Blood Pressure
Chronic high blood pressure can damage the blood vessels in the kidneys and increase the risk of kidney cancer.
Family History
Having a family history of kidney cancer increases the risk of developing the disease, as some genetic mutations can be inherited.
Toxic Chemicals
Exposure to certain chemicals and substances in the workplace, such as cadmium, asbestos, and organic solvents, has been linked to an increased risk of kidney cancer.
It’s
important to note that having one or more of these risk factors does not
necessarily mean that an individual will develop kidney cancer. However, it’s
important to be aware of these risk factors and to speak with a healthcare
professional about ways to reduce the risk of developing kidney cancer.
Symptoms of Kidney Cancer
In the early stages, kidney cancer may not cause any noticeable symptoms, and cancer may only be detected during routine imaging tests for other conditions. However, as cancer grows and spreads, it can cause a range of symptoms, including
- Blood in the urine (hematuria): This is one of the most common symptoms of kidney cancer. The urine may appear pink, red, or cola-coloured.
- Pain in the side or lower back: Kidney cancer can cause persistent pain on one side of the body, usually in the back or side.
- A lump or mass in the abdomen: A growing kidney tumour can sometimes be felt as a lump or mass in the abdomen.
- Weight loss and fatigue: Advanced kidney cancer can cause weight loss, fatigue, and a general feeling of weakness and lethargy.
- Fever and night sweats: In some cases, kidney cancer can cause fever, night sweats, and other flu-like symptoms.
- Swelling in the legs and ankles: Kidney cancer can sometimes cause fluid to accumulate in the legs and ankles, leading to swelling.
These symptoms can also be caused by other conditions, and not all cases of kidney cancer will trigger these symptoms. If you’re experiencing any of these symptoms or have concerns about your health, it’s important to see a doctor for an evaluation. Early detection and treatment can improve the chances of a good outcome.
Diagnoses of Kidney Cancer
The following are the common methods used to diagnose kidney cancer:
Blood and urine tests:
The doctor may recommend having a blood test to check the number of red blood cells in the blood. A urine test may be recommended to look for blood, bacteria, or cancer cells. These tests may suggest that kidney cancer is present, but they cannot be used to make a definite diagnosis.
Biopsy:
A biopsy is the removal of a small amount of tissue for examination under a microscope. This is usually performed as an outpatient procedure using local anaesthesia by an interventional radiologist. Anesthesia is a medicine that blocks the awareness of pain. Other tests can propose that cancer is present, but only a biopsy can result in an assured diagnosis. A pathologist then analyzes the sample(s) and writes a pathology report. The pathology report identifies the type of cell involved in kidney cancer which is important in planning treatment.
Biomarker testing of the tumour:
Your doctor may recommend running laboratory tests on a tumour to identify specific genes, proteins, and other factors unique to the tumour. This may also be called molecular testing of the tumour. The results of these tests can help determine your treatment options.
Computed tomography (CT) scan:
A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumours. A CT scan can be used to measure the tumour’s size. For patients being evaluated for a renal mass, a non-contrast CT scan is done first to evaluate for any non-cancerous types of disorders like a kidney stone or bleeding cyst.
Preventions and Treatments for Kidney Cancer
Preventions to be considered are as follows
While there is no guaranteed way to prevent kidney cancer, there are several steps that may help reduce the risk –
- Quit smoking: Smoking is a major risk factor for kidney cancer, so quitting smoking can help reduce the risk.
- Maintain a healthy weight: Being overweight or obese can increase the risk of kidney cancer, so maintaining a healthy weight through diet and exercise may help reduce the risk.
- Control high blood pressure: Chronic high blood pressure can increase the risk of kidney cancer, so taking steps to control blood pressure through diet, exercise, and medication may help reduce the risk.
- Limit exposure to harmful chemicals: Exposure to certain chemicals and substances in the workplace, such as cadmium, asbestos, and organic solvents, has been linked to an increased risk of kidney cancer, so taking steps to limit exposure to these substances may help reduce the risk.
- Stay hydrated: Drinking plenty of water and staying hydrated may help reduce the risk of kidney cancer.
- Manage underlying medical conditions: Certain medical conditions, such as von Hippel-Lindau disease and hereditary papillary renal cell carcinoma, increase the risk of kidney cancer, so managing these conditions through regular checkups and screenings may help reduce the risk.
Treatments required for Kidney Cancer
The treatment for kidney cancer can vary depending on the stage of cancer, the size and location of the tumour, and the overall health of the patient. The main treatments for kidney cancer include:
Surgery is the removal of the tumour and some surrounding healthy tissue during an operation. If cancer has not spread beyond the kidneys, surgery to remove the tumour may be the only treatment needed. Surgery to remove the tumour may mean removing part or all of the kidney, as well as possibly nearby tissue and lymph nodes.
The following are the types of surgery used for kidney cancer –
- Radical nephrectomy: Surgery to remove the tumour, 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 are performed.
- Partial nephrectomy: A partial nephrectomy is the surgical removal of the tumour. This type of surgery preserves kidney function and lowers the risk of developing chronic kidney disease after surgery.
- Laparoscopic and robotic surgery: During laparoscopic surgery, the surgeon makes several small cuts in the abdomen, rather than the one larger cut used during a traditional surgical procedure. The surgeon then inserts telescoping equipment into these small keyhole incisions to completely remove the kidney or perform a partial nephrectomy. Sometimes, the surgeon may use robotic instruments to operate.
Sometimes, the doctor may recommend closely monitoring the tumour with regular diagnostic tests and clinic appointments. This is called “active surveillance.” Active surveillance may be recommended in older adults and people who have a small renal tumour and other serious medical conditions, such as heart disease, chronic kidney disease, or severe lung disease. Younger people who have small kidney masses (smaller than 5 cm) may also be recommended to undergo active surveillance due to the low likelihood of the tumour spreading.
Targeted therapy is a treatment that targets cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Immunotherapy uses the body’s natural defences to fight cancer by improving your immune system’s ability to attack cancer cells.
- Denvax Immunotherapy: Denvax is a type of cancer immunotherapy. It works to boost the immune system against cancer, mostly solid tumours. Denvax is targeted therapy and comes under the 4th modality of cancer treatment called cancer Immunotherapy. Dendritic cells are cells of the immune system that help in the fight against cancer. Denvax treatment is customized dendritic cell-based cancer immunotherapy.
- Interleukin-2 (IL-2, Proleukin): IL-2 is a type of immunotherapy that has been used to treat later-stage kidney cancer. IL-2 is a cytokine, which is a protein produced by white blood cells and is important in immune system function, including the destruction of tumour cells. High-dose IL-2 can cause severe side effects, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attack, bleeding, chills, and fever. Patients may need to stay in the hospital for up to 10 days during treatment. However, some symptoms may be reversible. Only centres with expertise in high-dose IL-2 treatment for kidney cancer should recommend IL-2. High-dose IL-2 can cure a small percentage of people with metastatic kidney cancer. Some centres use low-dose IL-2 because it has fewer side effects, but it is not as effective.
- Alpha-interferon: Alpha-interferon is used to treat kidney cancer that has spread. Interferon appears to change the proteins on the surface of cancer cells and slow their growth. Although it has not been proven to be as beneficial as IL-2, alpha-interferon has been shown to lengthen lives when compared with an older treatment called megestrol acetate (Megace).
- Immune checkpoint inhibitors: A type of immunotherapy called immune checkpoint inhibitors is being studied in kidney cancer. The FDA has approved the following treatments using immune checkpoint inhibitors for the treatment of kidney cancer:
- (Opdivo) and ipilimumab (Yervoy) for certain patients with advanced renal cell carcinoma that has not been previously treated.
- in combination with cabozantinib (see “Anti-angiogenesis therapy,” above) as a first-line treatment for advanced renal cell carcinoma.
- Avelumab (Bavencio) plus axitinib as a first-line treatment for people with advanced renal cell carcinoma.
References:
What are Kidneys?
The kidneys are two bean-shaped organs located on either side of the spine in the lower back. They are a vital part of the urinary system and are responsible for filtering and removing waste and excess fluid from the body. The kidneys also help regulate the body’s electrolyte balance, blood pressure, and production of red blood cells. The waste and excess fluid that is filtered out of the blood by the kidneys is then eliminated from the body in the form of urine. Kidneys are essential organs for maintaining overall health and well-being.
What is Kidney Cancer?
Kidney cancer is developed when healthy cells in one or both kidneys start changing and growing uncontrollably, resulting in the formation of a mass called a renal cortical tumour. A tumour is an abnormal growth of cells in the body that can be either benign (non-cancerous) or malignant (cancerous). Benign tumours are usually harmless and do not spread to other parts of the body. They can often be removed with surgery and may not require further treatment. Malignant tumours are cancerous and can invade and damage nearby tissues and organs, as well as spread to other parts of the body.
Types of Kidney Cancer
There are several types of kidney cancer as follows –
Renal cell carcinoma (RCC):
This is the most common type of kidney cancer, accounting for about 90% of all cases. RCC can be further classified into subtypes based on the appearance of the cancer cells under a microscope. The most common subtypes are clear cell RCC, papillary RCC, and chromophobe RCC.
Transitional cell carcinoma (TCC):
This type of kidney cancer is also called Urothelial carcinoma. It starts in the lining of the renal pelvis and ureter, which are the tubes that connect the kidney to the bladder. TCC is less common than RCC, accounting for about 5-10% of kidney cancers.
Wilms' tumour:
This is a rare type of kidney cancer that primarily affects children. It usually develops in children between the ages of 2 and 5 and is more common in girls than in boys. It makes up about 1% of kidney cancers.
Renal sarcoma:
This is a rare type of kidney cancer that starts in the connective tissue of the kidney. It accounts for less than 1% of all kidney cancers.
Other less common types of ovarian cancer include borderline tumours (also known as low malignant potential tumours) and primary peritoneal carcinoma, which develops in the lining of the abdomen.
Risk Factors of Kidney Cancer
The following are the risk factors for kidney cancer –
Age
The risk of kidney cancer increases as people age, with most cases diagnosed in people over the age of 60.
Gender
Men are more likely to develop kidney cancer than women.
Smoking
Smoking is a major risk factor for kidney cancer. Cigarette smoke contains toxic chemicals that can damage the DNA in kidney cells and increase the risk of mutations.
Obesity
Being overweight or obese is a risk factor for many types of cancer, including kidney cancer. Excess weight can increase inflammation in the body and lead to changes in hormone levels, both of which can contribute to the development of cancer.
High Blood Pressure
Chronic high blood pressure can damage the blood vessels in the kidneys and increase the risk of kidney cancer.
Family History
Having a family history of kidney cancer increases the risk of developing the disease, as some genetic mutations can be inherited.
Toxic Chemicals
Exposure to certain chemicals and substances in the workplace, such as cadmium, asbestos, and organic solvents, has been linked to an increased risk of kidney cancer.
It’s
important to note that having one or more of these risk factors does not
necessarily mean that an individual will develop kidney cancer. However, it’s
important to be aware of these risk factors and to speak with a healthcare
professional about ways to reduce the risk of developing kidney cancer.
Symptoms of Kidney Cancer
In the early stages, kidney cancer may not cause any noticeable symptoms, and cancer may only be detected during routine imaging tests for other conditions. However, as cancer grows and spreads, it can cause a range of symptoms, including
- Blood in the urine (hematuria): This is one of the most common symptoms of kidney cancer. The urine may appear pink, red, or cola-coloured.
- Pain in the side or lower back: Kidney cancer can cause persistent pain on one side of the body, usually in the back or side.
- A lump or mass in the abdomen: A growing kidney tumour can sometimes be felt as a lump or mass in the abdomen.
- Weight loss and fatigue: Advanced kidney cancer can cause weight loss, fatigue, and a general feeling of weakness and lethargy.
- Fever and night sweats: In some cases, kidney cancer can cause fever, night sweats, and other flu-like symptoms.
- Swelling in the legs and ankles: Kidney cancer can sometimes cause fluid to accumulate in the legs and ankles, leading to swelling.
These symptoms can also be caused by other conditions, and not all cases of kidney cancer will trigger these symptoms. If you’re experiencing any of these symptoms or have concerns about your health, it’s important to see a doctor for an evaluation. Early detection and treatment can improve the chances of a good outcome.
Diagnoses of Kidney Cancer
The following are the common methods used to diagnose kidney cancer:
Blood and urine tests:
The doctor may recommend having a blood test to check the number of red blood cells in the blood. A urine test may be recommended to look for blood, bacteria, or cancer cells. These tests may suggest that kidney cancer is present, but they cannot be used to make a definite diagnosis.
Biopsy:
A biopsy is the removal of a small amount of tissue for examination under a microscope. This is usually performed as an outpatient procedure using local anaesthesia by an interventional radiologist. Anesthesia is a medicine that blocks the awareness of pain. Other tests can propose that cancer is present, but only a biopsy can result in an assured diagnosis. A pathologist then analyzes the sample(s) and writes a pathology report. The pathology report identifies the type of cell involved in kidney cancer which is important in planning treatment.
Biomarker testing of the tumour:
Your doctor may recommend running laboratory tests on a tumour to identify specific genes, proteins, and other factors unique to the tumour. This may also be called molecular testing of the tumour. The results of these tests can help determine your treatment options.
Computed tomography (CT) scan:
A CT scan takes pictures of the inside of the body using x-rays taken from different angles. A computer combines these pictures into a detailed, 3-dimensional image that shows any abnormalities or tumours. A CT scan can be used to measure the tumour’s size. For patients being evaluated for a renal mass, a non-contrast CT scan is done first to evaluate for any non-cancerous types of disorders like a kidney stone or bleeding cyst.
Preventions and Treatments for Kidney Cancer
Preventions to be considered are as follows
While there is no guaranteed way to prevent kidney cancer, there are several steps that may help reduce the risk –
- Quit smoking: Smoking is a major risk factor for kidney cancer, so quitting smoking can help reduce the risk.
- Maintain a healthy weight: Being overweight or obese can increase the risk of kidney cancer, so maintaining a healthy weight through diet and exercise may help reduce the risk.
- Control high blood pressure: Chronic high blood pressure can increase the risk of kidney cancer, so taking steps to control blood pressure through diet, exercise, and medication may help reduce the risk.
- Limit exposure to harmful chemicals: Exposure to certain chemicals and substances in the workplace, such as cadmium, asbestos, and organic solvents, has been linked to an increased risk of kidney cancer, so taking steps to limit exposure to these substances may help reduce the risk.
- Stay hydrated: Drinking plenty of water and staying hydrated may help reduce the risk of kidney cancer.
- Manage underlying medical conditions: Certain medical conditions, such as von Hippel-Lindau disease and hereditary papillary renal cell carcinoma, increase the risk of kidney cancer, so managing these conditions through regular checkups and screenings may help reduce the risk.
Treatments required for Kidney Cancer
The treatment for kidney cancer can vary depending on the stage of cancer, the size and location of the tumour, and the overall health of the patient. The main treatments for kidney cancer include:
Surgery is the removal of the tumour and some surrounding healthy tissue during an operation. If cancer has not spread beyond the kidneys, surgery to remove the tumour may be the only treatment needed. Surgery to remove the tumour may mean removing part or all of the kidney, as well as possibly nearby tissue and lymph nodes.
The following are the types of surgery used for kidney cancer –
- Radical nephrectomy: Surgery to remove the tumour, 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 are performed.
- Partial nephrectomy: A partial nephrectomy is the surgical removal of the tumour. This type of surgery preserves kidney function and lowers the risk of developing chronic kidney disease after surgery.
- Laparoscopic and robotic surgery: During laparoscopic surgery, the surgeon makes several small cuts in the abdomen, rather than the one larger cut used during a traditional surgical procedure. The surgeon then inserts telescoping equipment into these small keyhole incisions to completely remove the kidney or perform a partial nephrectomy. Sometimes, the surgeon may use robotic instruments to operate.
Sometimes, the doctor may recommend closely monitoring the tumour with regular diagnostic tests and clinic appointments. This is called “active surveillance.” Active surveillance may be recommended in older adults and people who have a small renal tumour and other serious medical conditions, such as heart disease, chronic kidney disease, or severe lung disease. Younger people who have small kidney masses (smaller than 5 cm) may also be recommended to undergo active surveillance due to the low likelihood of the tumour spreading.
Targeted therapy is a treatment that targets cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Immunotherapy uses the body’s natural defences to fight cancer by improving your immune system’s ability to attack cancer cells.
- Denvax Immunotherapy: Denvax is a type of cancer immunotherapy. It works to boost the immune system against cancer, mostly solid tumours. Denvax is targeted therapy and comes under the 4th modality of cancer treatment called cancer Immunotherapy. Dendritic cells are cells of the immune system that help in the fight against cancer. Denvax treatment is customized dendritic cell-based cancer immunotherapy.
- Interleukin-2 (IL-2, Proleukin): IL-2 is a type of immunotherapy that has been used to treat later-stage kidney cancer. IL-2 is a cytokine, which is a protein produced by white blood cells and is important in immune system function, including the destruction of tumour cells. High-dose IL-2 can cause severe side effects, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attack, bleeding, chills, and fever. Patients may need to stay in the hospital for up to 10 days during treatment. However, some symptoms may be reversible. Only centres with expertise in high-dose IL-2 treatment for kidney cancer should recommend IL-2. High-dose IL-2 can cure a small percentage of people with metastatic kidney cancer. Some centres use low-dose IL-2 because it has fewer side effects, but it is not as effective.
- Alpha-interferon: Alpha-interferon is used to treat kidney cancer that has spread. Interferon appears to change the proteins on the surface of cancer cells and slow their growth. Although it has not been proven to be as beneficial as IL-2, alpha-interferon has been shown to lengthen lives when compared with an older treatment called megestrol acetate (Megace).
- Immune checkpoint inhibitors: A type of immunotherapy called immune checkpoint inhibitors is being studied in kidney cancer. The FDA has approved the following treatments using immune checkpoint inhibitors for the treatment of kidney cancer:
- Nivolumab (Opdivo) and ipilimumab (Yervoy) for certain patients with advanced renal cell carcinoma that has not been previously treated.
- Nivolumab in combination with cabozantinib (see “Anti-angiogenesis therapy,” above) as a first-line treatment for advanced renal cell carcinoma.
- Avelumab (Bavencio) plus axitinib as a first-line treatment for people with advanced renal cell carcinoma.
References:
