Kidney cancer

Symptoms Of Kidney Cancer 

A person with kidney cancer may or may not have one or more of the symptoms in the early stages. With time, signs and symptoms may develop which include:

• Loss of appetite

• Blood in urine (hematuria)

• Lower back pain 

• A general feeling of poor health

• A mass (lump) on the side or lower back

• Fever that keeps coming and going 

• Feeling tired all the time

These signs and symptoms can be caused by kidney cancer (or another type of cancer), but more often caused by benign conditions. For example, blood in the urine is most often caused by a bladder or urinary tract infection or a kidney stone. Still, if you have any of these symptoms, medical advice is required so that the cause can be found and treated early, if needed. 

Causes Of Kidney Cancer 

Some of the common causes of kidney cancer include:

Mutation in genes 

Cancer is caused by changes in the DNA. DNA is the chemical in our cells that makes up our genes. Some genes that help control when our cells grow, divide into new cells, and stay alive are called oncogenes. Genes that help keep cell division under control or cause cells to die at the right time are called tumor suppressor genes. Cancer can be caused by DNA mutations (changes) that turn on oncogenes or turn off tumor suppressor genes, resulting in cells growing out of control.

Inherited gene mutation 

Certain inherited DNA changes can run in some families and increase the risk of kidney cancer. For example, a mutation in the tumor suppressor gene VHL is the gene that causes von Hippel-Lindau (VHL) disease. When the VHL gene is mutated, it is no longer able to control abnormal growth, and kidney cancer is more likely to develop.

Acquired gene mutation 

Some gene mutations occur during a person’s lifetime and are not passed on. They affect only cells that come from the original mutated cell. These DNA changes are called acquired mutations. Obesity, another risk factor for this cancer, alters the balance of some of the body’s hormones. Certain risk factors such as exposure to cancer-causing chemical like those found in tobacco smoke, probably play a role in causing these acquired mutations. 

Risk Factors Of Kidney Cancer

A risk factor is anything that increases your chance of getting a disease. Having a risk factor, or even several risk factors, does not mean you will get kidney cancer, but it may increase your risk.

Smoking is the most common cause of kidney cancer. Although many risk factors can increase the chance of developing renal cell cancer (RCC), it is not yet clear how some of these risk factors cause kidney cells to become cancerous. 

Non-modifiable risk factors

• Age: The incidence of kidney cancer increases with age, with a peak of incidence at approximately 75 years of age.

• Sex: The incidence of kidney cancer is two-fold higher in men compared with women. 

• Genetic risk factors: Certain rare inherited conditions like von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma or familial renal cancer may have an increased risk of kidney cancer.

• Family history of kidney cancer: The risk of kidney cancer increases if first line relatives or close family members have suffered from the condition.

Modifiable risk factors

• Overweight/obesity: Obese people are at a higher risk of developing kidney cancer as compared to people who are considered to have a healthy weight. Research shows that high body mass index (BMI) is estimated to be responsible for 26% of kidney cancer cases worldwide.

• Tobacco smoking: Smokers have a greater risk of kidney cancer than nonsmokers, with an approximate 30% increased risk in current smokers and a 15% increased risk in former smokers compared with never smokers. 

• Environmental and occupational exposure: Environmental exposures such as pesticides, arsenic, cadmium, and lead can increase the risk of kidney cancer. Aaristolochic acid (derived from Aristolochia plants, found in contaminated food, or used in herbal traditional remedies) and trichloroethylene (used as metal cleaner and greaser) are also associated with renal cancer.

Medical history

• High blood pressure (hypertension):Hypertension has been found to be associated with a considerable kidney cancer risk. Therefore, controlling the condition through the use of hypertensive medication may be an effective therapeutic intervention in the prevention of kidney cancer. 

• Chronic kidney disease and kidney stones: Chronic kidney disease increases the risk of kidney cancer two to three fold.

• Diabetes mellitus: Diabetes can leads to obesity and hypertension which predispose to renal cancer.

Types Of Kidney Cancer 

Renal cell carcinoma (RCC)

This is the most common type of kidney cancer in adults which often stays confined to the linings of tiny tubes in the kidney called renal tubules. Sometimes, cancer can spread to other parts of the body, most often the bones, lungs, or brain.

Clear cell renal cell carcinoma (ccRCC)

This is also called conventional renal cell carcinoma and is named after how the tumor looks under the microscope. The cells in the tumor look clear like bubbles. In adults, renal clear cell carcinoma makes up 80% of the cases while 2% to 6% of childhood and young adult kidney cancer cases.

Rare type of kidney cancer

• Papillary renal cell carcinoma (PRCC): The tumor is located in the kidney tubes and is found in 15% of all renal cell carcinomas.
• Translocation renal cell carcinoma (TRCC): It is a slow-growing tumor located in the kidney. This accounts for 1% to 5% of all renal cell carcinomas and 20% of childhood cases. 

Non cancerous kidney tumor 

• Oncocytoma: The tumor starts in the cells of the kidney collecting ducts and tumors can grow in one or both kidneys.
• Angiomyolipoma: It is a benign fatty tumor that can overgrow, destroy the surrounding tissues, and can cause internal bleeding. 

Stages of kidney cancer 

After someone is diagnosed with kidney cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging. The stages of kidney cancer range from stage I to IV. The lower the number, the less metastasis (spread) of cancer.  A higher number, such as stage IV, means the cancer has metastasized to other parts of the body. 

The staging system used for kidney cancer is based on the TNM system.

• The size and extent of the main tumor (T). Is it confined to the same area or has grown into nearby areas?

• The spread to nearby lymph nodes (N)

• The spread (metastasis) to distant sites (M). It has spread to nearby organs such as the brain, bones, or lungs.
  
  

Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, this information is combined in a process called stage grouping to assign an overall stage.

Diagnosis Of Kidney Cancer 

Kidney cancer might be diagnosed because of signs or symptoms a person is having, or it might be found because of lab tests or imaging tests a person is getting for another reason.

Medical history or physical exam 

If you have any signs or symptoms that suggest you might have kidney cancer, your doctor will take a complete medical history to check for risk factors to learn about your symptoms. A physical exam can provide information about signs of kidney cancer and other health problems. 

A general practitioner will ask about the medical history of a person: 

• Ask you about your symptoms

• Examine for any lumps or swelling

• Arrange for a blood test to check for signs of a kidney problem

These checks may help diagnose or rule out some possible causes of your symptoms such as a urinary tract infection (UTI).

Blood tests 

Lab tests cannot show for sure if a person has kidney cancer, but they can sometimes give the first hint that there may be a kidney problem. These tests can be done to get a sense of a person’s overall health and to diagnose if cancer might have metastasized (spread) to other areas.  

• Urine tests: In urine tests, small amounts of blood can also be detected which is usually not seen with the naked eye. About half of all patients with renal cell cancer will have blood in their urine. If the patient has transitional cell carcinoma (in the renal pelvis, the ureter, or the bladder), sometimes a special test of the urine sample (called urine cytology) will show actual cancer cells in the urine.

• Complete blood count (CBC):This test measures the number of different cells in the blood. This test result is often abnormal in people with kidney cancer. Anemia or too few red blood cells is very commonly seen in people with kidney cancer. Less often, a person may have too many red blood cells called polycythemia because the kidney cancer cells make a hormone (erythropoietin) that causes the bone marrow to make more red blood cells. 

• Blood chemistry tests: Kidney cancer can affect the levels of certain chemicals in the blood. Blood chemistry tests also measure kidney function, which is especially important, if certain imaging tests or if surgery is planned.

Imaging tests 

These tests can confirm or rule out kidney cancer. If you have cancer, they can help show whether it has spread to other parts of your body.

The tests you might have include:

• Magnetic resonance imagining (MRI) scan: A scan that uses strong magnetic fields and radiowaves to produce a detailed image of your kidneys.

• Positron emission tomography (PET) scan: A detailed body scan can be helpful for investigating confirmed cases of kidney cancer to see if cancer has spread and how well it's responding to treatment.

• Biopsy: A biopsy might be done to get a small sample of tissue from an area that may be cancerous when the imaging tests are not clear enough to permit surgery. A biopsy may also be done to confirm cancer if a person might not be treated with surgery. Fine needle aspiration (FNA) and needle core biopsy are 2 types of kidney biopsies that may be done. In cases, where the doctors think kidney cancer might have spread to other sites, they may take a biopsy of the metastatic site instead of the kidney.

• Ultrasound scan: It is a scan that uses high-frequency sound waves to create an image of your kidneys. Ultrasound can be helpful in finding a kidney mass and showing if it is solid or filled with fluid. Different ultrasound patterns can also help doctors tell the difference between some types of benign and malignant kidney tumors.

• Computed tomography (CT) scan: The CT scan uses x-rays to make detailed cross-sectional images of your body. It can provide precise information about the size, shape, and location of a tumor. It is also useful in checking, if cancer has spread to nearby lymph nodes or to organs and tissues outside the kidney.

• Angiography: In angiography, a contrast dye is injected into the renal artery, and the dye outlines the blood vessels. Angiography can also help diagnose renal cancers since the blood vessels usually have a special appearance with this test.

• Bone scan:This test is helpful to check if cancer has spread to the bones. A small amount of low-level radioactive material is injected into the blood which gets collected mainly in abnormal areas of bone. 

• Cystoscopy: Where a thin tube is passed up your urethra (the tube that carries urine out of your body) so that problems in the bladder can be detected.

• Chest x-ray: An x-ray may be done after kidney cancer has been diagnosed to check if the cancer has spread to the lungs. 

Prevention Of Kidney Cancer

In many cases, the cause of kidney cancer is not known. In some other cases (such as with inherited conditions), even when the cause is known it may not be preventable. It can include individuals with first-degree relatives such as a parent, brother, sister, or child. The risk also increases if other extended family members have also been diagnosed with kidney cancer including grandparents, aunts, uncles, nieces, nephews, grandchildren, and cousins. 

But there are some ways you may be able to reduce your risk of this disease. This include: 

• Obesity and high blood pressure are also risk factors for renal cell cancer. Maintaining a healthy weight by exercising and choosing a diet high in fruits and vegetables may also reduce your chance of getting this disease.

• Smoking is responsible for a large percentage of kidney cancer, so quitting smoking may lower the risk of cancer. 

• Avoiding exposure to harmful substances such as trichloroethylene at work may also reduce your risk for renal cell cancer. Avoiding the use of metallic elements such as cadmium, working with batteries, paints, or welding materials may decrease a person’s risk of kidney cancer. 

Specialist To Visit

A general practitioner can evaluate the symptoms and start the treatment. He can further refer to other doctors for assessment depending upon the organ affected. 

• Urologist: A urologist is a physician who specializes in diseases of the urinary tract. 
• Genitourinary (GU) medical oncologist: They are doctors dedicated to the treatment, research, and prevention of genitourinary cancers of the prostate, bladder, and kidney.
• Nephrologists: A nephrologist is a kidney specialist. They treat conditions related to the kidneys. 
• Oncosurgeon: They are specialized in cancer surgeries. 

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Treatment Of Kidney Cancer 

The treatment for kidney cancer depends on the size of the cancer and whether it has spread (metastatic) to other parts of the body. 

A complete cure may not be possible if cancer has spread, but it may be possible to slow its progression and treat the symptoms with surgery, medicines, and radiotherapy.

The main treatments are:

Surgery

The surgery for kidney cancer includes:
 

• Partial nephrectomy -- an operation to remove the part of the kidney containing cancer.

• Radical nephrectomy -- an operation to remove the entire kidney. 

A partial nephrectomy is usually done if the cancer is small, whereas radical nephrectomy is required for larger cancers or if cancer has spread beyond the kidney.

The surgery on the kidney can be done in two ways:
 

• Through a single large cut in the tummy or back, known as open surgery.

• Using surgical tools inserted through smaller cuts, known as keyhole surgery. This surgery tends to have a faster recovery time. 

Note: It's possible to live a normal life with only one kidney. There can be a number of reasons for having one kidney which includes:

• A person may be born with only one kidney

• Kidney transplantation

• One kidney was removed (nephrectomy) to treat a medical condition during surgery

• Donated a kidney to someone who required a transplant 

Having one kidney does not affect the length of your life nor does it affect the quality of life you will have. One kidney is enough to filter blood to keep your body functioning normally. 

Targeted therapies 

If a person is having cancer of the advanced stage, that person may be offered targeted therapies. These are medicines, usually taken once or twice a day, that help stop cancer from growing and spreading.

The medicines included in the targeted therapies are: 

• Everolimus

• Bevacizumab

• Nivolumab

• Tivozanib

• Sunitinib 

• Pazopanib

• Cabozantinib

• Axitinib

Medicines such as sunitinib, pazopanib, cabozantinib, axitinib, everolimus, nivolumab, and tivozanib are recommended for routine use. 

There can be possible side effects of medicines like sunitinib, pazopanib, cabozantinib, axitinib, and tivozanib which are all available as tablets. Possible side effects include:

• High blood pressure 

• Sore mouth

• Loss of appetite and weight loss

• Tiredness

• Infertility

Ablation therapies 

These treatments destroy cancer cells by either:

• Cryotherapy (freezing cancer cells)

• Radiofrequency ablation (heating cancer cells) 

These techniques may be recommended in circumstances to ensure your kidney keeps working, or if the tumor is small. Cryotherapy is done by inserting needles into the tumor. This can be done through a small cut, known as laparoscopic cryotherapy. Radiofrequency ablation is done by inserting a needle-like probe through your skin, so no large cuts are needed.

Radiotherapy 

If you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain, radiotherapy is recommended. It is a treatment where radiation is used to target or destroy cancerous cells. It cannot usually cure kidney cancer, but it can slow down its spread and help control your symptoms. The treatment is usually done for a few minutes every day, over a few weeks.

A few side effects of radiotherapy include:

• Reddening of the skin in the treatment area

• Tiredness

• Diarrhea

Embolisation 

Embolisation is a procedure to block the blood supply to the tumor, causing it to shrink. During embolization, a small tube called a catheter is inserted into a blood vessel in your groin and then guided to the blood vessel supplying the tumor.

Home-care For Kidney Cancer

Home remedies 

1. Echinacea: It is an immune-boosting plant. The root extract of this plant cleanses the kidneys from heavy metals like cadmium. The echinacea plant has anti-inflammatory effects on the body and is considered an effective herb against kidney cancer. 

2. Vitamin D3: A deficiency of Vitamin D is known as one of the risk factors for developing kidney cancer. Vitamin D3 is available in dairy, salmon, sardines, fish oil, cod liver oil, eggs, and mushrooms. 

3. Astragalus: It is one of the best herbs known as a kidney restorer but also one of the best anti-cancer immune-building herbs.

4. Korean Ginseng: The roots of this plant have been used for health and longevity for thousands of years in traditional chinese medicine. Ginseng reduced the risk of multiple types of cancer by up to 40%. It has been confirmed that ginseng directly inhibits the growth of kidney tumors. 

Diet for kidney cancer individuals 

A kidney cancer diet should include many of the same things found in any healthy diet, with some nutritional add-ons to combat the specific effects of cancer treatment. Daily nutrition should include:

1. A lot of whole grains: Whole grains may reduce cancer risk because of their high amounts of fiber, antioxidants, and minerals like Vitamin E and selenium. 

2. Fruits and vegetables: Research suggests that fruits and fiber-rich vegetables may have a protective effect against kidney cancer and its recurrence. 

3. High caloric intake: If a person is undergoing cancer treatment, include high-calorie foods like peanut butter, milkshakes, sauces, gravies, and meats. These foods are essential for maintaining the weight of a person as cancer treatment leads to weight loss. 

Complications Of Kidney Cancer 

The complications arising from kidney cancer are most likely regarding the patient’s mental health. Although it’s not impossible to detect it in somewhat earlier stages, this cancer is most commonly discovered in the considerably advanced ones when there is not much left to do for the person but relieve the pain. It's hard for a person to accept reality and stay in a state of grief, denial, anger, bargaining, depression, and acceptance. 

There are a number of complications that may occur due to kidney cancer including: 

High blood pressure

Kidneys play an important role in regulating blood pressure. Kidney cancer may result in persistent high blood pressure and at times, blood pressure that is very difficult to control. 

Liver insufficiency 

Kidney cancer may affect the liver by spreading cancer. The liver filters the blood, as does the kidney, the combination of liver and kidney dysfunction can result in the accumulation of toxins in the blood, leading to confusion, personality changes, and mood changes. 

Pleural effusion

When kidney cancer spreads to the lungs or the lining of the lungs, it may cause the build-up of fluid between the membranes lining the lungs called the pleura. Sometimes, a large amount of fluid (several liters) accumulates, causing significant shortness of breath. A procedure called thoracentesis is recommended in some cases, which involves placing a fine needle through the skin on the chest wall and into the pleural cavity to withdraw fluid.

Kidney failure

If a surgery leaves only one functioning kidney, the ongoing medication can put stress on the existing kidney which may lead to kidney failure. If kidney failure occurs, dialysis may be needed or a kidney transplant, if it is an early-stage kidney cancer. 

Alternative Therapies For Kidney Cancer 

Complementary and alternative medicine (CAM) refers to a range of treatments and practices that are not typically part of the standard medical care. It also helps in comforting themselves and easing the worries of cancer treatment and related stress. Alternative therapies help in coping with the side effects of cancer treatments such as nausea, pain, and fatigue. 

Mind therapies 

These combine mental focus, breathing, and body movements to help relax the body and mind. These include: 

• Meditation: It involves focused breathing or chanting of words or phrases to calm the mind.

• Yoga: It is a physical, mental, and spiritual practice that originated in ancient India. It helps in stretching and calming the body. 

• Tai Chi: It includes slow, gentle movements with focus on the breath and concentration.

Body-based practices 

• Massage: The purpose of massage is generally for the treatment of body stress or pain. The soft tissues of the body are kneaded, rubbed, tapped, and stroked.

• Chiropractic therapy: It is a branch of study that focuses on nerves, bones, and other parts of the neuro-musculoskeletal system. This is a good alternative to invasive alternatives like surgery or injections for treating short-term or chronic pain.

Biofield therapies 

Biofield therapies are non-invasive therapies in which the practitioner explicitly works with a client's biofield (interacting fields of energy and information that surround living systems) to stimulate healing responses in patients.

• Reiki: It is a Japanese technique for stress reduction and relaxation that also promotes healing. It is believed that improving the flow of energy around the body can enable relaxation, relieve pain, speed healing, and reduce other symptoms of illness.

• Therapeutic touch: This is a holistic, evidence-based practice that incorporates the intentional and compassionate use of universal energy to promote balance and well-being.

Whole medical system 

These are healing systems and beliefs that have evolved over time in different cultures and parts of the world. In India, the goal is to cleanse the body and restore balance to the body, mind, and spirit. Some examples are:

• Acupuncture: It is a common practice in Chinese medicine that involves stimulating certain points in the body to promote health or to lessen disease symptoms and treatment side effects.

• Naturopathic treatment: It involves various methods that help the body naturally heal itself. An example would be herbal treatment. 

Living With Kidney Cancer 

Watching for recurrence 

One goal of follow-up care is to check for a recurrence, which means that cancer has come back. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms.

During follow-up, a doctor will ask specific questions about your health and prescribe specific blood tests or imaging tests. Testing is done considering various factors such as type and stage of cancer first diagnosed and the types of treatment given.

Managing long-term and late side effects 

Most people experience side effects while receiving treatment. However, it is often that the side effects may linger beyond the treatment period. These are called long-term side effects. Other side effects called late effects may develop months or even years later. 

Long-term and late effects can include both physical and emotional changes. Cancer in itself is a serious condition and this can easily affect the mental health of the patient as well as the caregiver too. Stress, anxiety, or depression can both affect physically and mentally. In this case, supportive emotional and mental health care can be a great help for anyone struggling to cope with kidney cancer.

Keeping personal health records 

Doctors design a treatment plan for the cancer treatment and the survivor should also keep track of the cancer treatment received when treatment is completed. This helps the doctor and family to deal with the emergency condition and to look back at the medical history, treatment received, medications given and duration of treatment. 

Diet and nutrition 

A healthy diet and good nutrition are essential for kidney cancer patients to maintain strength, protect body tissues from breaking down, prevent infection, and promote tissue regeneration, especially while undergoing therapy. Dietary and nutritional needs may change over the course of kidney cancer depending on the stage, type of treatment, response, and other factors. Avoiding excess sugar, maintaining weight, and eating a well-balanced nutritious diet are of utmost significance.

Physical activity 

Exercise and physical activity can have a variety of benefits for kidney cancer patients from helping regain muscle tone following surgery to reducing and managing stress and promoting good cardiovascular health.