Kidney Cancer

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.

• 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.
• Obesity
• 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

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:

Warning signs

• 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

Risk factors

• Age more than 40
• Smoking
• Risk is more in men than women
• Obesity
• Long-term pain medication (over-the-counter drugs and prescription drugs
• Genetic conditions like von Hippel-Lindau (VHL) disease or inherited papillary renal cell carcinoma
• Family history of kidney cancer
• Exposure to chemicals like asbestos, cadmium, benzene, organic solvents, or certain herbicides
• High blood pressure
• Risk in blacks is slightly higher than in whites.
• For an unknown reason, there is an increased risk of kidney cancer in patients with lymphoma.

• Abscess
• Angiomyolipoma (Benign Neoplasm)
• Lymphoma, Non-Hodgkin
• Metastasis from a distant primary lesion
• Oncocytoma (Benign Neoplasm)
• Acute and Chronic Pyelonephritis,
• Renal Cyst
• Sarcoma
• Wilms Tumour

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.

Progression

Kidney cancer often spreads to the lungs and surrounding organs. The good news is that most of kidney cancers are found before they spread (metastasize) to distant organs. And cancers caught early are easier to treat successfully.

Diagnosis

• Primary diagnosis : An ultrasound scan of the kidney for symptom or health check
• Advanced diagnosis : Computerised tomography (CT)

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.

• 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.

Treatment in a nutshell

There are different types of treatment for patients with renal cell cancer.

Surgery : Surgery is performed to remove part of the kidney or the entire kidney. Two types of surgeries can be performed – Partial Nephrectomy and Radical Nephrectomy. Surgery can be done by Open/ Laparoscopic and Robotic approach. Robotic approach is the minimally invasive way of treating prostate cancers which carries with its significant benefits.

Biological therapy : Biologic therapy is a treatment that uses the patients immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the bodys natural defences against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Targeted therapy : Targeted therapy uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Targeted therapy with Antiangiogenic agents are used to treat advanced renal cell cancer. Antiangiogenic agents keep blood vessels from forming in a tumour, causing the tumour to starve and stop growing or to shrink.

Top tips

• Leading a healthy lifestyle may help reduce your chances of developing the condition.
• Combining a healthy diet and regular exercise will help you avoid becoming overweight or obese, which are both significant risk factors for kidney cancer.
• If youre overweight or obese, you can lose weight and maintain a healthy weight by combining regular physical activity with a calorie-controlled diet.
• If you smoke, giving up is the most effective way of preventing kidney cancer
• Control high blood pressure.

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.