General Health

Kidney Cancer: The Secret Killer

The human kidneys are bean-shaped organs, situated in the lower abdomen and play essential roles in purifying blood, eliminating toxins and waste products from the body, forming urine, regulating salt-water balance and Vitamin D metabolism, and blood pH control.

In India, the incidence of kidney cancer is around 2/100,000 population (males) and roughly 1/100,000 population (females). Kidney (or renal) cancers, if detected early can be treated successfully. Among kidney cancers, renal cell carcinoma (RCC) is the most common type. Other kidney cancers include transitional cell carcinoma and Wilm’s tumor.

Renal cancer develops when healthy cells mutate in an excessive, uncoordinated, and uncontrolled manner, resulting in an abnormal tumor mass or ‘neoplasm’. Kidney cancers can be fatal as the human body reveals associated clinical signs in late stages after substantial cancer progression.

Moreover, there are no approved specific screening tests for renal cancers, unlike for other malignancies/cancers such as cervical, breast, or prostate. Therefore, renal cancers can go unreported, warranting the need for increased knowledge on renal cancers- symptoms, prevention measures, and, most importantly, treatment choices.

Obesity, hypertension, smoking habits, exposure to excessive radiation, family history, and genetic mutations are important risk factors for renal cancers. Conditions such as Von Hippel-Lindau disease and tuberous sclerosis are also predisposing risk factors.

Symptoms of kidney cancer

Some of the important signs and symptoms of renal cancer

  • hematuria (blood in urine),
  • swelling in ankles or legs,
  • unexplainable loss of body weight,
  • hypertension (increased blood pressure),
  • presence of a lump-like growth in the side of the abdomen,
  • persistent unilateral pain, anemia,
  • hypercalcemia symptoms,
  • loss of appetite,
  • persistent fever lasting for weeks,
  • night sweats,
  • severe fatigue,
  • malaise.

Dissemination and spread of cancer cells to other parts of the human body could lead to symptoms such as bone pain, coughing blood, or shortness of breath. In some cases, a varicocele may form on the left side of the abdomen because of testicular vein obstruction.

Diagnosis

Specific markers have not been authorized for a kidney cancer diagnosis. However, several laboratory tests may help to assess kidney function which include

  • urinalysis (UA),
  • complete blood cell (CBC) count and differential blood counts,
  • serum electrolytes (such as sodium, potassium, calcium, chlorides),
  • renal function tests such as creatinine,
  • plasma proteins (albumin, globulin, etc)
  • glomerular filtration rate (GFR).

In addition, imaging studies such as excretory urography, computed tomography (CT), and positron emission tomography (PET) could be useful in detecting and evaluating tumor masses. Ultrasound imaging, magnetic resonance imaging (MRI), arteriography, and venography are other diagnostically useful imaging modalities.

Treatment options for kidney cancer

Kidney cancer treatments include surgical removal, radiation therapy, cryotherapy, Radiofrequency ablation, arterial embolization, and immunotherapy. Important considerations for choice of treatment include the patient’s age, gender, size of the tumor, and stage of cancer.

The type of surgery depends on the stage of the cancer. Radical nephrectomy is the most commonly performed surgery for kidney cancer and involves removing the kidney, adrenal gland, and surrounding tissues. In addition, the nearby lymph nodes may also be excised. On the other hand, simple nephrectomy involves the removal of only the kidney and partial nephrectomy involves the removal of the cancerous growth in the kidney with some surrounding tissue. Radiation therapy uses highly-powered energy beams (protons or X-rays) to destroy the tumor cells.

Cryotherapy uses extreme cold to destroy the tumor cells whereas radiofrequency ablation uses high-energy radio waves to eradicate the tumor. Arterial embolization is the insertion of a material into an artery that supplies/leads to the kidney thereby blocking blood flow to the tumor mass. Arterial embolization is performed for shrinking the tumor mass prior to surgery.

Immunotherapy recruits the body’s immune system to combat cancer cells. The body’s immune system may not attack cancer cells since they produce proteins that make them undetectable by immune cells and this is known as immune evasion. Immunotherapy works by making the cancer cells recognizable to immune cells and their subsequent destruction by the immune system. Further, immunological memory developed by this approach could train immune cells and provide long-term benefits.

Author

Pooja Toshniwal Paharia

Dr. Pooja Toshniwal Paharia is a Consultant Oral and Maxillofacial Physician and Radiologist, M.DS (Oral Medicine and Radiology) from Mumbai. She strongly believes in evidence-based radiodiagnosis and therapeutic regimens for benign, potentially malignant, or malignant lesions and conditions either arising from the oral and maxillofacial structures or manifesting in the associated regions.

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