There are about 190,000 new cases of kidney cancer each year around the world, which means it accounts for about one in fifty cancers. In the UK and USA, it is about the tenth most common type of cancer. Estimated new cases and deaths from kidney (renal cell and renal pelvis) cancer in the United States in 2012: New cases: 64,770, Deaths: 13,570. Reports say even in India the incidence is increasing.
What is Kidney Cancer?
This is cancer that starts in the kidney. The most common type of kidney cancer is called Renal Cell Carcinoma (RCC). About 90 percent of all kidney cancers are renal cell carcinomas. The other 10 percent are made up of transitional cell carcinomas, Wilms tumours (found in children), and other rare tumours.
Why one needs to be aware?
Knowing the facts could save your life or the life of someone you love. Kidney Cancer is a rare cancer which does not respond to traditional chemotherapies or radiation. It is NOT something doctors typical check for. If found due to symptoms, it’s usually in the late stages. If found early, it’s usually found due to an scan/ultrasound/MRI being performed for another reason. There is always hope and the most important thing is find a doctor who specialises in renal cell carcinoma.
Do you fall in the high risk group?
- Renal cell carcinoma is the most common type of kidney cancer in adults. It occurs most often in men ages 50 - 70.
- Genetics: Genetic changes which predispose individual to probability of increased cancer risk
- Smoking: Cigarette Smokers are twice as likely as nonsmokers to develop kidney cancer. Chewing Tobacco also may increase the risk of this disease.
- High Blood Pressure
- Long-Term Dialysis
- Von Hippel-Lindau (VHL) Syndrome: An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body
- Occupation: Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk
However, many people with kidney cancer have no known risk factors. On the other hand, people who have one or more known risk factors may never get the disease
What are the common signs and symptoms?
In the early stages, kidney cancer often causes no symptoms. It is usually detected by imaging like ultrasonography and CT scan of abdomen done as health check up or for vague symptoms. As the cancer grows, symptoms may develop. These are the most common symptoms in people with kidney cancer:
- Blood in the urine
- Side or back pain
- A mass or lump in the side or lower back
- Fatigue, which is a chronic, unexplained tiredness
- Rapid weight loss without making an effort to lose weight
- Other symptoms, such as fever with no known cause, leg or ankle swelling, and high blood pressure
What are the other pathologies related to that organ?
- Angiomyolipoma (Benign Neoplasm)
- Lymphoma, Non-Hodgkin
- Metastasis from a distant primary lesion
- Oncocytoma (Benign Neoplasm)
- Acute and Chronic Pyelonephritis,
- Renal Cyst
- Wilms Tumour
What is the importance of screening?
When the number of small and incidentally detected RCCs is increasing; some of these tumours are amenable to nephron-sparing surgery, with 5 and 10-year survival rates comparable to those achieved with radical nephrectomy. Whether removed by nephrectomy or nephron-sparing surgery, the early detection of small, organ-confined RCCs should improve the long-term prognosis of the disease as it is insensitive to both chemotherapy and radiation. This makes RCC a logical candidate for a screening. RCC is often asymptomatic, and therefore, more commonly an incidental finding.
What are the various methods of management?
Surgery is the main treatment for kidney cancer. In addition targeted therapy or radiation therapy is considered for advanced disease.
- Surgery: This is done to remove the tumour from the kidney. The whole kidney may be taken out (Radical Nephrectomy), or only the part of the kidney (Partial Nephrectomy) with the tumour may be removed. If surgical margins are negative no additional treatment is needed. There are three ways of achieving surgical control - Open Surgery, Laparoscopic Method and most recently Robotic Surgery has gained widespread acceptance.
- Targeted Therapy: These drugs attack specific areas in the cancer cells or target the tumor’s blood supply. This is the most common treatment for more advanced kidney cancers.
What is the possible prognosis?
How well a patient does depends on how much the cancer has spread and how well treatment works. The survival rate is highest if the tumour is in the early stages and has not spread outside the kidney. If it has spread to the lymph nodes or to other organs, the survival rate is much lower.
For localised tumours, cure rates are well over 90%.The five year survival rate is around 90-95% for tumours less than 4 cm. For larger tumours confined to the kidney without venous invasion, survival is still relatively good at 80-85%.
For tumours that extend through the renal capsule and out of the local fascial investments, the survivability reduces to near 60%. If it has metastasised to the lymph nodes, the 5-year survival is around 5 % to 15 %. If it has spread metastatically to other organs, the 5-year survival rate is less than 5 %. For those that have tumour recurrence after surgery, the prognosis is generally poor.
Why Kokilaben Hospital?
As management of kidney cancer is multidisciplinary team approach, we have tumour board which consists of uro-ocnologist, medical oncologist, radiation oncologist and onco pathologist and radiologist where decision making is done according to the global standards. Uro-Oncology service of Centre for Cancer at our hospital has experience of managing more than 250 kidney cancers in last four years, and most recently, with Da Vinci Robotic surgeries with internationally acceptable outcomes