Kidney Cancer
Though called by the same name, cancer encompasses a myriad of diseases. Apart from the general traits each cancer has its own unique features. A cancer which highlights this diversity is kidney cancer. The uniqueness of kidney cancer is the extremes with which it can present and progress. It can occur in very young and in very old. It can remain totally asymptomatic for a long time or it can be directly present in an advanced stage. Treatment outcomes in certain cases are extremely good in some and very poor in others.
How does kidney cancer present ?
The way kidney cancer can present can put any con artist to shame. It can remain asymptomatic in quite a few and be detected only during a regular health check. In certain others it can present with very vague symptoms like fever, weight loss and lack of appetite. In others the manifestation may be directly as a result of spread like fracture because of spread to bone. Classical symptoms like blood in urine and mass in the abdomen is found only in a subset of people.
How is kidney cancer diagnosed?
The detection of kidney cancer is usually done by ultrasound and further confirmed by CT scan or MRI of the abdomen. Once confirmed assessment of spread to other areas is done by investigations like CT scan of the chest or chest x-ray and bone scan.
Is a biopsy required to confirm kidney cancer?
Most cancers require a biopsy to confirm the diagnosis. In kidney cancers however a biopsy is not considered mandatory by most oncologists. The reason for this is that the radiological investigations itself can diagnose kidney cancer with more than 90% accuracy. As kidney cancers are quite vascular there is some chance that spread of disease or bleeding might occur during the biopsy. When the diagnosis is uncertain after radiological investigations a fine needle aspiration cytology or biopsy is performed.
What are the types of kidney cancer?
There are many different types of kidney cancers but the two which are practically important are renal cell carcinoma which occurs from the area of the kidney which produces urine and urothelial carcinoma which occurs from the area which collects and conducts urine.
What are the risk factors for kidney cancer?
Most patients who suffer from kidney cancer are above the age of 40 years. Males have a higher possibility of getting it as compared to females. Smoking , obesity and high blood pressure are known to increase the chances of getting kidney cancer. People on long term dialysis because of kidney failure are also prone to get this cancer. There is a condition known as von hippel lindau disease in which kidney cancer can run in families and be transmitted from one generation to another.
How is kidney cancer treated?
The main treatment of kidney cancer is surgery. Traditionally the surgery involves not just removing the kidney but removing it with a fat coat around it. This usually includes removing the adrenals, the ureter and the lymph nodes around the kidney. This procedure is known as radical nephrectomy.
Can removal of the entire kidney be avoided in case of cancer?
In recent years the procedure of radical nephrectomy is not considered necessary in all cases. In tumours which are small or located on one pole of the kidney only the affected part of the kidney is removed with a rim of normal kidney. This procedure is known as nephron sparing surgery. The procedure may not be suitable in all cases and also requires a higher expertise
Is chemotherapy useful in case of kidney cancer?
Traditionally radiation and chemotherapy were not considered to have much of a role in the treatment of kidney cancer. With improvements in our understanding of cancer cells we have been able to develop more targets to attack them. A major beneficiary of this understanding has been kidney cancer. A new class of drugs known as targeted therapy is finding increasing use in kidney cancer. Some of these drugs available in the market are sunitinib, sorafenib and pazopanib. Though these drugs cannot cure kidney cancer they have certainly been able to improve survival in patients especially with metastatic disease.