Kidney Cancer (Renal Cell Carcinoma)

Kidney cancer is also known as nephrocarcinoma, renal cell carcinoma, hypernephroma, and Grawitz's tumor. It usually occurs in older adults, with about 85% of tumors originating in the kidneys and others resulting from metastasis from other primary sites. Renal pelvic tumors and Wilms' tumor occur primarily in children.

Kidney tumors, which usually are large, firm, nodular, encapsulated, unilateral, and solitary, can be separated histologically into clear cell, granular, and spindle cell types. The prognosis, which sometimes seems better for the clear cell type, probably depends on the cancer stage. The 5-year survival rate for kidney cancer is about 50%; the 10-year survival rate is lower.

Causes

The exact cause of kidney cancer is unknown. However, there are certain risk factors that are linked to it. These risk factors, according to the American Cancer Society, are: smoking, exposure to asbestos, cadmium exposure, family history of kidney cancer, gender (men are twice as likely to get kidney cancer as are women) diet (a high-fat diet increases a person's risk of kidney cancer), weight/obesity, and long-term dialysis. It's twice as common in men as in women and usually strikes after age 40.

Signs and symptoms

The following are the most common symptoms of renal cell cancer. However, each individual may experience symptoms differently. Symptoms may include:

blood in the urine
rapid, unexplained weight loss
low back pain (not caused by an injury)
loss of appetite
swelling of ankles and legs
mass or lump in the belly
fatigue
recurrent fever (not caused by a cold or the flu)
high blood pressure (less frequently)
anemia (less frequently)
unrelieved pain in the side

The symptoms of renal cell cancer may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Diagnosis

Studies to identify kidney cancer usually include computed tomography scans, excretory urography and retrograde pyelography, ultrasound, cystoscopy (to rule out associated bladder cancer), and nephrotomography or renal angiography to distinguish a kidney cyst from a tumor.

Related tests include liver function studies showing increased levels of alkaline phosphatase, bilirubin, alanine aminotransferase, and aspartate aminotransferase, as well as prolonged prothrombin time. Such results may point to liver metastasis, but if metastasis hasn't occurred, these abnormalities reverse after the tumor has been resected.

Routine laboratory findings of hem aturia, anemia (unrelated to blood loss), polycythemia, hypercalcemia, and increased erythrocyte sedimentation rate call for more testing to rule out kidney cancer. A bone scan should also be performed to rule out skeletal metastasis.

Treatment

Radical nephrectomy, with or without regional lymph node dissection, offers the only chance of cure. Because the disease is radiation-resistant, radiation is used only if the cancer spreads to the perinephric region or the lymph nodes, or if the primary tumor or metastatic sites can't be fully excised. In such cases, high radiation doses are used. Chemotherapy has been only erratically effective against kidney cancer. Chlorambucil, fluorouracil, cyclophosphamide, vinblastine, lomustine, vincristine, cisplatin, tamoxifen, teniposide, interferons, and hormones, such as medroxyprogesterone and testosterone, have been used, usually with poor results. Biotherapy (lymphokine-activated killer cells with recombinant-interleukin-2) shows promise but causes adverse reactions. Interferon is somewhat effective in advanced disease.

Prevention

The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. However, because a strong association between kidney cancer and tobacco has been shown, avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet may also help prevent kidney cancer.

Diseases & Conditions

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