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Urology Resources
Kidney Cancer
Several types of cancers can develop in the kidney. The most common is renal cell cancer which develops from the kidney tissue. The other variety is transitional cell cancer which develops in the lining of the urinary tract. In childhood, a different type called Wilms’ tumour can occur. This article will deal with renal cell cancer only.
Stages
Kidney cancer produces no symptoms at the early stage, especially when it is less than 7 cm size (Stage 1). If the cancer grows inwards, it can cause blood in the urine. In most cases, it grows outwards to cause symptoms, eg. loin ache (Stage 2). Later, it invades the surrounding fat, and nearby organs, spreads to the lymph nodes and vein of the kidney (Stage 3). Distant spread finally occurs and this is usually to the lungs and bones (Stage 4).
Causes
Most of the renal cancers develop without any underlying cause. In a small number of patients, the cancer runs in the family. People who have an inherited disorder called Von Hippel Lindau disease are at greater risk of developing renal cell cancer. Patients on long term dialysis for chronic renal failure are also at higher risk.
Symptoms
In the early stages, kidney cancer produces no symptoms. As the cancer grows the following symptoms may occur:
- Blood in the urine (haematuria)- either gross or microscopic
- Pain in the loin
- Weight loss, appetite loss, recurrent fever and tiredness
Diagnosis
Urine test may detect the presence of blood. Kidney ultrasound may detect it if it is beyond 2 cm size. Nowadays, more kidney cancers are picked up incidentally during ultrasound screening of the abdomen.
Such incidental cancers tend to be small and allow for partial removal with good cure rate. The most important diagnostic test is the CT scan which will confirm if it is a cancerous mass and if there is any spread to the renal vein, lymph nodes and adjacent organs. Usually, the CT scan appearance of a kidney cancer is good enough. Only if the tumour has invaded the renal vein or main abdominal vein (IVC) is MRI needed.
A renal biopsy is not often indicated as most abnormal solid appearing masses in the kidney are invariably cancerous. There is also a theoretical risk of seeding the cancer cells along the needle track.
Lastly, a chest X-ray is done to exclude spread to the lungs.
Management
Treatment for kidney cancer depends on the stage of the disease, the patient’s general health, age and other factors. A high cure rate is only possible for Stage 1 and 2 of the disease. The mainstay treatment is surgery to remove the whole kidney and its surrounding fat (radical nephrectomy). In the event that the tumour is small (< 4 cm) and technically feasible, a partial nephrectomy can be be offered. This type of operation has the advantage of preserving kidney function and especially if the patient has only one kidney or has impaired function.
Interruption of the blood supply to the kidney (renal arterial embolisation) is sometimes considered before an operation to shrink a very large and bleeding tumour prior to surgery. This procedure is carried out by the interventional radiologist, who uses a special gelatin sponge or metal coil injected to seal the supplying artery.
Radiotherapy is ineffective in curing the primary kidney cancer, and is used more often to treat recurrence after nephrectomy or painful tumour spread to the bones.
In patients who have advanced, disseminated kidney cancer, the prognosis is poor. Various therapies can be employed but all have limited effectiveness. Biologic therapy (immune modulation) using Interferon or Interlelukin-2 have a limited response rate ( < 15%). New oral chemotherapy drugs (tyrosine kinase inhibitors) target the blood supply to the tumour and shown to be effective in controlling large or remnant / recurrent kidney cancer. However, they are very expensive and need to be given indefinitely.
