Kidney Tumors

Kidney cancer is cancer that originates in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdominal organs, with one kidney on each side of your spine.

In adults, the most common type of kidney cancer is renal cell carcinoma. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms' tumor.

The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) are being used more often. These tests may lead to the accidental discovery of more kidney cancers

Symptoms

Kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, kidney cancer signs and symptoms may include:

• Blood in your urine, which may appear pink, red or cola colored
• Back pain just below the ribs that doesn't go away
• Weight loss
• Fatigue
• Intermittent fever

When to see a doctor

Make an appointment with your doctor if you have any persistent signs or symptoms that worry you.

CAUSES

t's not clear what causes renal cell carcinoma. Doctors know that kidney cancer begins when some kidney cells acquire mutations in their DNA. The mutations tell the cells to grow and divide rapidly. The accumulating abnormal cells form a tumor that can extend beyond the kidney. Some cells can break off and spread (metastasize) to distant parts of the body.

Risks

Factors that can increase the risk of kidney cancer include:

• Older age. Your risk of fkidney cancer increases as you age.
• Smoking. Smokers have a greater risk of kidney cancer than nonsmokers do. The risk decreases after you quit.
• Obesity. People who are obese have a higher risk of kidney cancer than do people who are considered average weight.
• High blood pressure (hypertension). High blood pressure increases your risk of kidney cancer.
• Treatment for kidney failure. People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.
• Von Hippel-Lindau disease. People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, kidney cancer.
• Hereditary papillary renal cell carcinoma. Having this inherited condition makes it more likely you'll develop one or more kidney cancers

• Diagnosing kidney cancer

  Tests and procedures used to diagnose kidney cancer include:
  • Blood and urine tests.Tests of your blood and your urine may give your doctor clues about what's causing your signs and symptoms.
  • Imaging tests. Imaging tests allow your doctor to visualize a kidney tumor or abnormality. Imaging tests might include ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI).
  • Removing a sample of kidney tissue (biopsy). In certain cases, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer.

  Kidney cancer staging

  Once your doctor diagnoses kidney cancer, the next step is to determine the extent, or stage, of the cancer. Staging tests for kidney cancer may include additional CT scans or other imaging tests your doctor feels are appropriate.
  Then your doctor assigns a number, called a stage, to your cancer. Kidney cancer stages include:
  • Stage I. At this stage, the tumor can be up to 2 3/4 inches (7 centimeters) in diameter. The tumor is confined to the kidney.
  • Stage II. A stage II kidney cancer is larger than a stage I tumor, but is still confined to the kidney.
  • Stage III. At this stage, the tumor extends beyond the kidney to the surrounding tissue and may also have spread to a nearby lymph node.
  • Stage IV. Cancer spreads outside the kidney, to multiple lymph nodes or to distant parts of the body, such as the bones, liver or lungs.
  Treatment
  Together, you and your treatment team will discuss your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment.

  Surgery

  Surgery is the initial treatment for the majority of kidney cancers. Surgical procedures used to treat kidney cancer include:
  • Removing the affected kidney (nephrectomy). Radical nephrectomy involves the removal of the kidney, a border of healthy tissue and the adjacent lymph nodes. The adrenal gland also may be removed.
    
    Nephrectomy can be an open operation, meaning the surgeon makes one large incision to access your kidney. Or nephrectomy can be done laparoscopically, using several small incisions to insert a video camera and tiny surgical tools. The surgeon watches a video monitor to perform the nephrectomy.
  • Removing the tumor from the kidney (nephron-sparing surgery). During this procedure, also called partial nephrectomy, the surgeon removes the tumor and a small margin of healthy tissue that surrounds it, rather than removing the entire kidney.
    
    Nephron-sparing surgery can be an open procedure, or it may be performed laparoscopically. In some cases, this surgery can be done robotically, which means the surgeon uses hand controls that tell a robot how to maneuver surgical tools to perform the operation.
    
    Nephron-sparing surgery is a common treatment for small kidney cancers. It may also be an option if you have only one kidney. When nephron-sparing surgery is possible, it's generally preferred over radical nephrectomy since retaining as much kidney tissue as possible may reduce your risk of later complications, such as kidney disease and the need for dialysis.
  The type of surgery your doctor recommends will be based on your cancer and its stage, as well as your health. Surgery carries a risk of bleeding and infection.

  Treatments when surgery isn't possible

  For some people, surgery isn't an option. In these situations, kidney cancer treatments may include:
  • Treatment to freeze cancer cells (cryoablation). During cryoablation, a special needle is inserted through your skin and into your kidney tumor using X-ray guidance. Gas in the needle is used to cool down or freeze the cancer cells.
    
    There are few long-term data about the safety and efficacy of cryoablation for kidney cancer. It's typically reserved for people who can't undergo other surgical procedures and those who have small kidney tumors.
  • Treatment to heat cancer cells (radiofrequency ablation).During radiofrequency ablation, a special needle is inserted through your skin and into your kidney tumor using X-ray guidance. An electrical current is run through the needle and into the cancer cells, causing the cells to heat up or burn.
    
    There are few long-term data about the safety and efficacy of radiofrequency ablation for kidney cancer. Radiofrequency ablation may be an option for people who can't undergo other surgical procedures and those with small kidney tumors.

  Treatments for advanced and recurrent kidney cancer

  Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may not be curable, but may be controlled with treatment. In these situations, treatments may include:
  • Surgery to remove as much of the kidney tumor as possible. Even when surgery can't remove all of your cancer, in some cases it may be helpful to remove as much of the cancer as possible. Surgery may also be used to remove cancer that has spread to another area of the body.
  • Drugs that use your immune system to fight cancer (biological therapy). Biological therapy (immunotherapy) uses your body's immune system to fight cancer. Drugs in this category include interferon and aldesleukin (Proleukin), which are synthetic versions of chemicals made in your body. Side effects of these drugs include chills, fever, nausea, vomiting and loss of appetite.
  • Treatment that targets specific aspects of your cancer (targeted therapy). Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to proliferate. These drugs have shown promise in treating kidney cancer that has spread to other areas of the body.
    
    The targeted drugs axitinib (Inlyta), bevacizumab (Avastin), pazopanib (Votrient), sorafenib (Nexavar) and sunitinib (Sutent) block signals that play a role in the growth of blood vessels that provide nutrients to cancer cells and allow cancer cells to spread.
    
    Temsirolimus (Torisel) and everolimus (Afinitor) are targeted drugs that block a signal that allows cancer cells to grow and survive.
    
    Targeted therapy drugs can cause side effects, such as a rash that can be severe, diarrhea and fatigue.
  • Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones.