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Kidney Cancer

Anatomical facts

The kidneys are two fist-size organs located on either side of the spine in the lower abdomen. The adrenal glands are attached to the top of each kidney. The kidneys are part of the urinary tract, and their main function is to produce urine by collecting wastes and extra water from the blood.

Diagram of kidney and cancers

Urine passes from the kidneys to the bladder through tubes called the ureters. It is stored in the bladder until it leaves the body through another tube called a urethra. It is possible to live with only one kidney.

Kidney cancer

The American Cancer Society estimates more than 52,000 new kidney cancer cases in the United States per year and 13,000 deaths. The disease is more common in men than in women, and most cases are diagnosed in people between 50 and 70. In early stages, tumors growing in the kidney produce vague symptoms that may be attributed to other conditions; as a result, the majority of new diagnoses occur after the cancer has already spread.

Risk factors for kidney cancer include exposure to cancer-causing substances in cigarettes and other chemicals. People who are obese, people on dialysis, and people taking medication for high blood pressure have an increased risk. Kidney cancer has a genetic factor: 25% to 45% of people with Von Hippel-Lindau (VHL) syndrome develop kidney cancer.

There are other forms of hereditary kidney cancer. People with a strong family history of the disease have a higher risk of tumors in the kidney.  90% are renal cell carcinomas, with 5% to 10% being transitional cell carcinomas, which have similar symptoms to renal cell, but their treatment is slightly different. Renal sarcomas are very rare and account for less than I % of all kidney tumors. Relevant information on renal sarcomas should be looked for in the soft tissue sarcoma information sources.

It is important to find out the exact cancer type. Many information sources provide data relevant only to renal cell carcinomas and some have separate sections for renal cell and transitional cell carcinomas.

Treatment of Kidney Cancer

Nephrectomy – surgical removal of the kidney – is the primary treatment for kidney cancer that is discovered before spreading to distant regions of the body. Early-stage kidney cancer is treated only with nephrectomy and has a 95% survival rate after ten years.

Nephrectomies can be performed as minimally invasive laparoscopic procedures instead of open surgery. In some early-stage cases, it may be possible to perform a partial nephrectomy and remove only a portion of the kidney.

Cancers that have spread beyond the kidney are typically treated with a combination of radiation therapy and chemotherapy. In recent years, the biologic therapy interleukin (IL-2) has produced longer remission periods in about 10% to 20% of patients.

Doctors are also testing and evaluating the drug thalidomide and other targeted and biological therapies. Encouraging results have been observed in an early trial utilizing stem cell transplants to treat advanced-stage renal cell carcinomas that failed to respond to other therapies.

Specific Treatments for kidney cancer

The treatment of kidney cancer depends on various factors like location and size of tumor, type of cancer, general health of the patient and the stage at which the disease has been diagnosed.

All these forms of treatment can be used alone or in combination.

Surgery
Surgery is the mainstay treatment for cancer in the kidney. There are various surgical procedures to treat kidney cancer. These are:

Simple nephrectomy

It refers to the surgical removal of the affected kidney. The surgery can be done either by an open surgery (which involves the removal of kidney through a large incision in the abdomen), or the use of a laparoscope (to remove the kidney through some small incisions) and performing the operation with the help of images shown in the monitor (laparoscopically). This surgery is done when the patient has been diagnosed at an early stage of cancer. This surgery is carried out when cancer is detected at an early stage.

Partial nephrectomy

It refers to the surgical removal of the tumour and some of the tissue around the tumour of the affected kidney. This surgery is recommended for patients who either have one functional kidney or for patients whose both kidneys are affected by cancer.

Radical nephrectomy

Radical nephrectomy refers not only to the removal of the affected kidney, but also a part of the healthy tissue around the kidney, the adrenals and the lymph nodes nearby.

Nephron – sparing surgery or Partial nephrectomy

It is a kind of surgery in which the whole kidney is not removed, rather only the affected part with the tumor and surrounding tissues are removed. Therefore, in this operation the kidney is allowed to stay at its position in the body. Patients with a small kidney or with a single kidney should be operated in this manner. This reduces the risk of later complications in the kidney that may lead to renal failure.

Arterial embolization

In this form of treatment the blood flow is cut off to the tumor. Since blood carries oxygen and nutrients to the tumor cells, cut off of blood supply to the tumor kills the cancer cells. A narrow tube (catherer) is placed inside the blood vessel connected to the kidney. Then a gelatin like substance is passed through the catherer into the blood vessels. This creates an obstruction to the flow of blood to the kidney. This technique may also be followed prior to surgery to make the treatment more effective.

After arterial embolization, you may have back pain or develop a fever. Other side effects include nausea and vomiting. These side effects go away soon after treatment.

Biological therapy

Biological therapy is a kind of systemic therapy in which the body’s immune system is activated with the help of some substances. The activated immune system helps to kill the cancer cells in the kidney.

For patients with advanced stage kidney cancer which has spread in the body, synthetic versions of interferon alpha or interleukin-2 (also called IL-2 or aldesleukin) are used. These substances normally combat infections in the body. There are side effects in this kind of treatment, but it is temporary. Side effects of these drugs include chills, fever, nausea, vomiting and loss of appetite.

Biological therapy is mostly done when the cancer is diagnosed at an advanced stage.

Targeted therapy

Targeted therapy helps in preventing the growth of tumor cells by blocking some of the enzymes required for cell growth. It is sometimes recommended for advanced stage kidney cancer when surgery is not possible. Several new targeted therapies have been developed recently.  Bevacizumab,  Axitinib,  Pazopanib, Sorafenib and   Sunitinib are some well know drugs used as targeted therapy drugs.

They inhibit the growth of blood vessels which supply blood to the cancer cells. Temsirolimus and everolimus interfere with signalling pathways that stimulate the growth of cancer cells. Temsirolimus works by blocking the actions of mToR, a substance that promote cancer growth. Side effects for targeted therapies are much less compared to systemic chemotherapy or radiation therapy.

Cryoablation

Cryoablation refers to the use of very low temperature to freeze and kill cells. During this process, a special needle or probe is inserted in the cancer cells. The needle is made cold with the help of a gas inside it which freezes the cells and kills them. Cryoablation is performed in advanced stage patients when surgery cannot be done.

Radiofrequency ablation

Radiofrequency ablation refers to the use of radiofrequency waves. The needle is inserted in the kidney tumor through the skin. When electric current is passed through this needle it gets heated up. The heat kills the cancer cells. Radiofrequency ablation is performed in advanced stage patients when surgery cannot be done. It can also be done for patients with very small kidney tumor.

Radiation therapy

Radiation therapy is usually done when the cancer is diagnosed at an advanced stage. It refers to the use of high-powered energy beams, such as X-rays, to kill cancer cells.

Radiotherapy can be used before or after surgery. Radiation decreases the chances that the disease may recur. Radiation can also be given to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones.

External beam radiation: A beam of radiation from a machine is aimed at the affected site of the patient’s body from outside the body.

Internal radiation therapy or brachytherapy: Radioactive substance sealed in small devices is placed near the affected region. Cancer cells are killed by the radiations emitted from the radioactive substances.

Chemotherapy

Chemotherapy is the use of drugs to treat cancer. It can be swallowed or administered through veins. Chemotherapeutic drugs have shown limited success against kidney cancer. However, many doctors are studying new drugs and new combinations that may prove more helpful.

Clinical trials

Clinical trials refer to those kinds of treatment which are not yet standardized. It is a part of research that aims to develop better strategies for the treatment of cancer. The patients may willingly participate in clinical trials, but treatment cannot be guaranteed. Side effects related to these trials are also a cause of concern.

References

George S, Pili R, Carducci MA, Kim JJ. Role of immunotherapy for renal cell cancer in 2011. J Natl Compr Canc Netw. 2011 Sep 1; 9(9):1011-8.

Eisen T, Sternberg CN, Robert C, Mulders P, Pyle L, Zbinden S, Izzedine H, Escudier B. Targeted therapies for renal cell carcinoma: review of adverse event management strategies. J Natl Cancer Inst. 2012 Jan 18; 104(2):93-113.

This article was originally published on 7/12/2014 and last revision and update of it was 9/14/2015.

 

Additional Resources:

CancerCare. Progress in the Treatment of Kidney Cancer This short booklet with color photographs and illustrations focuses on targeted treatments for kidney cancer. Includes frequently asked questions, a short glossary, and a list of resources. Access at: www.cancercare.org

Kidney Cancer Association.
A Closer Look at Renal Cell Carcinoma
We Have Kidney Cancer
 Kidney Cancer: Emotional vs. Rational
Access at: www.curekidneycancer.org. Free registration is needed to obtain the printable versions of these and other brochures concerning kidney cancer.

National Cancer Institute. What You Need to Know about Kidney Cancer. This booklet on kidney cancer discusses possible causes, symptoms, diagnosis, treatment, emotional issues, and questions to ask the doctor. Includes a glossary of terms and other resources. Access at: nci.nih.gov/cancertopics/types/kidney