Introduction

Kidneys are two bean-shaped organs.  each about the size of a fist. They are located behind the abdominal organs, with one kidney on each side of spine. The kidneys’ main job is to remove excess water, salt, and waste products from blood coming from the renal arteries. These substances become urine.

A tumor, or mass, is an abnormal growth in the body. A kidney mass, or tumor, is an abnormal growth in the kidney. Some kidney masses are benign (not cancerous), and some are malignant (cancerous). In adults, renal cell carcinoma is the most common type of kidney cancer. 

Types of kidney cancer

  • Renal cell carcinomas (RCC): These are the most common malignant kidney tumors. They are found in main substance of the kidney, where the filtering occurs. RCC may form as a single tumor within a kidney or as two or more tumors in one kidney.
  • Benign kidney tumors: About 20% of tumors removed from kidneys are benign. There are about nine named tumors in this class. Some can grow quite large, but they are almost always non-cancerous and do not spread to other organs.
  • Wilms tumors: Wilms tumors almost always occur in children and are rarely found in adults.

Stages of kidney Cancer

The staging system most often used for kidney cancer is TNM system

The size and extent of the main tumor (T): How large is the tumor? Has it has grown into nearby areas?

The spread to nearby lymph nodes (N): Has the cancer spread to nearby lymph nodes?

The spread (metastasis) to distant sites (M): Has the cancer spread to other organs such as the bones, brain, or lungs?

Stage I 

The tumor is 7 cm across or smaller and is only in the kidney (T1). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage II 

The tumor is larger than 7 cm across but is still only in the kidney (T2). There is no spread to lymph nodes (N0) or distant organs (M0).

OR

The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland or beyond Gerota’s fascia (T3). There is no spread to lymph nodes (N0) or distant organs (M0).

Stage III 

The main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia. The cancer has spread to nearby lymph nodes (N1) but has not spread to distant lymph nodes or other organs (M0).

Stage IV

The main tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland on top of the kidney (T4). It may or may not have spread to nearby lymph nodes (any N). It has not spread to distant lymph nodes or other organs (M0). 

OR

The main tumor can be any size and may have grown outside the kidney (any T). It may or may not have spread to nearby lymph nodes (any N). It has spread to distant lymph nodes and/or other organs (M1).

Risk factors

  • Older age: Your risk of kidney cancer increases as you age.
  • Obesity:body mass index (BMI) of 30 or more 
  • Smoking: the more you smoke, the greater the risk
  • High blood pressure (hypertension): High blood pressure increases your risk of kidney cancer.
  • Family history of kidney cancer: The risk of kidney cancer is higher if close family members have had the disease.
  • Some inherited genetic conditions: such as those who have von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma or familial renal cancer.
  • Treatment for kidney failure: People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.
  • Certain medicines: Acetaminophen Some studies have suggested that acetaminophen, a common pain medicine, may be linked to an increase in the risk of RCC.
  • Race: African Americans have a slightly higher rate of RCC than do whites.

Symptoms

  • Blood in the urine (hematuria)
  • Low back pain on one side (not caused by injury)
  • A mass (lump) on the side or lower back
  • Fatigue (tiredness)
  • Loss of appetite
  • Weight loss not caused by dieting
  • Fever that is not caused by an infection and that doesn’t go away
  • Anemia (low red blood cell counts)

Diagnosis

  • Medical history and physical exam – If symptoms or the results of the physical exam suggest you might have kidney cancer, more tests will probably be done. 
  • Blood tests – Complete blood count (CBC) to check the blood for signs of disease. Serum creatinine levels or other kidney function tests to check if the kidneys are getting rid of waste
  • Urinalysis (urine testing) – Urinalysis to check for infection, blood and protein in urine
  • Ultrasound scan – To get images of your kidneys. Different ultrasound patterns can also help doctors tell the difference between some types of benign and malignant kidney tumors.
  • CT scan It can provide precise information about the size, shape, and location of a tumor and spread to nearby lymph nodes or to organs and tissues outside the kidney.
  • MRI scan – MRI scans may be done if there’s a chance that the cancer has grown into major blood vessels in the abdomen because they provide a better picture of blood vessels than CT scans and to look at abnormal areas in the brain and spinal cord due to cancer spread.
  • Cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of your body) so your doctor can see any problems in your bladder
  • Biopsy – where a needle is inserted into your kidney to remove a small tissue sample for analysis in a laboratory; local anesthetic is used to numb the area so the procedure should not hurt
  • PET scan – a detailed body scan that can be helpful for investigating confirmed cases of kidney cancer to see if the cancer has spread and how well it’s responding to treatment
  • Bone scan and chest x-ray – to find out if the cancer has spread to bones and lungs 

Treatment

surgical treatments

  • Partial nephrectomy– the surgeon removes the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. 
  • Radical nephrectomy– A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures.

Nonsurgical treatments

  • Treatment to freeze cancer cells (cryoablation) Very cold gases are passed through a probe to destroy the tumor cells.
  • Treatment to heat cancer cells (radiofrequency ablation)- An electric current is passed through the tip of the probe placed on the skin to heat the tumor and destroy the cells. 
  • Active Surveillance Some small kidney tumors are benign. And most (3 out of 4) small kidney cancers are slow growing.  One option for some people with these small kidney tumors (less than 4 cm may be to give no treatment at first and watch the tumor carefully to see if it grows. This is usually done by imaging tests (ultrasound, CT or MRI scan) every 3 to 6 months. If it grows quickly or gets larger than 4 cm, the tumor is removed or treated another way.
  • Targeted therapy- Most of the targeted drugs used to treat kidney cancer work by blocking growth of the new blood vessels that feed cancers or important proteins in cancer cells (called tyrosine kinases) that help them grow and survive.  Some targeted drugs affect both.
  • ImmunotherapyImmunotherapy is the use of medicines to boost a person’s own immune system to recognize and destroy cancer cells more effectively.
  • Radiation therapy- Radiation therapy uses high-energy rays or particles to kill cancer cells. Radiation is sometimes used to treat kidney cancer if a person is not healthy enough to have surgery or has only one kidney
  • Chemotherapy Chemotherapy (chemo) uses anti-cancer drugs that are given into a vein (IV) or taken by mouth (as pills). These drugs enter your blood and reach nearly all areas of the body, which makes this treatment potentially useful for cancer that has spread (metastasized) to organs beyond the kidney.

Coping and support

  • Learn enough about kidney cancer to feel comfortable making treatment decisions. Ask your doctor for details of your diagnosis, such as what type of cancer you have and the stage. This information can help you learn about the treatment options.
  • Take care of yourself. Take care of yourself during cancer treatment. Eat a healthy diet full of fruits and vegetables, be physically active when you feel up to it, and get enough sleep so that you wake feeling rested each day.
  • Take time for yourself. Set aside time for yourself each day. Time spent reading, relaxing or listening to music can help you relieve stress. 
  • Gather a support network. Your friends and family are concerned about your health, so let them help you when they offer. Talking about your feelings with close friends and family also can help you relieve stress and tension.
  • Get mental health counseling if needed. If you feel overwhelmed, depressed or so anxious that it’s difficult to function, consider getting mental health counseling. From a certified social worker, psychologist or psychiatrist.

Disclaimer: All contents on this site are for general information and in no circumstances, information be substituted for professional advice from the relevant healthcare professional, Writer does not take responsibility for any damage done by the misuse or use of the information.

References

https://www.mayoclinic.org/     – (mayoclinic)

https://www.nhs.uk/      – (nhs.uk)

https://www.urologyhealth.org/     – (urology care foundation)

https://www.cancer.org/     –    (American cancer society)