Kidney Cancer – Risk Factors, Symptoms, Investigations, Staging, Treatment

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kidney-cancer

How a Patient with Kidney Cancer Presents?

To further understand the disease in a better way, have a look at the video below where CancerBro meets Mr. Kenny who has recently being diagnosed with kidney cancer.

To understand the disease better, we’ll meet Mr. Kenny, who has recently been diagnosed with kidney cancer.

Mr. Kenny was having pain in abdomen and red coloured urine for last few days. For these complaints, he consulted his doctor and was admitted in hospital for treatment, lets meet him.

CancerBro: Hi Mr. Kenny, how are you feeling today?

Mr. Kenny: CancerBro, I was very worried when I was diagnosed with kidney cancer, but after talking to you, I am feeling better.

CancerBro: What work do you do Mr. Kenny?

Mr. Kenny: I work in a factory where I am continuously exposed to organic compounds.

CancerBro: Do you have a habit of smoking?

Mr. Kenny: Yes CancerBro, I smoke almost a pack daily for more than last 15 years.

CancerBro: Did you have any kidney problem previously, or underwent treatment for the same?

Mr. Kenny: I was on long term dialysis for end-stage kidney disease.

CancerBro: Did you receive any long term treatment with painkillers, or any blood pressure reducing medicines previously?

Mr. Kenny: Yes CancerBro, I was on hypertensive medications for past many years.

CancerBro: Have anyone in your family been diagnosed with kidney or any other cancer previously?

Mr. Kenny: No, I am the first person in my family to have cancer.

CancerBro: Okay Mr. Kenny, thank you very much. I think you people must have got an idea how a patient of kidney cancer presents, and what are the risk factors for the disease.

What are the Risk Factors for Kidney Cancer?

Kidney cancer is slightly more commonly seen in American Indians, Alaskan natives, and African Americans, especially in obese males.
 
Smoking is a risk factor for the disease, and incidence increases with duration and intensity of smoking.
 
Industrial exposure to certain heavy metals and organic compounds also increases the risk for kidney cancer.
 
People with advanced kidney disease, specially those needing repeated dialysis or kidney transplant are at higher risk of kidney cancer.
 
History of kidney cancer in family may also increase the risk in other family members. So these were the risk factors for kidney cancer.
 
These factors, if keep in mind, may help in reducing the risk of the disease.
 

Kidney Cancer Risk Factors

What are the Symptoms of Kidney Cancer?

The most common symptoms of kidney cancer are the passage of blood in the urine, abdominal pain, or abdominal mass.
 
Sometimes, it may also cause loss of weight and appetite, or excessive fatigue and anemia.
 
And rarely, a spread of the disease to the other parts of the body, like lungs or bone, may cause a cough, breathlessness and bone pain.
 
So these were the symptoms of kidney cancer. These factors if kept in mind may help to diagnose the disease at the early stage before it becomes very advanced.
 
Kidney Cancer Symptoms Infographic

What are the Symptoms of Advanced Stage Kidney Cancer?

Symptoms of advanced disease may be caused due to local involvement of nearby structures and metastasis to distant sites.
 
Local spread may cause:
  • Abdominal lump or swelling
  • Reddish urine due to presence of blood
  • Discomfort or pain in abdomen
Distant spread may cause:
  • Back pain or pain at one/more bony sites
  • Cough, breathlessness, chest pain or discomfort
  • Yellowish discoloration of eyes and/or urine
  • Headache, altered sensorium, nausea./vomiting
Most common sites of spread of kidney cancer are adrenal gland, bone, brain, liver and lung. 

What are the Investigations for Diagnosis and Staging of Kidney Cancer?

The investigations required to confirm and stage the disease are imaging, urine analysis, and biopsy.
Ultrasound and CT scan or MRI of abdomen help us to see the extent of the tumor.
 
X-ray or CT scan of the chest may be done if required.
 
Rarely, MRI brain or bone scan may be done if clinically indicated. Urinalysis may help in looking for the presence of blood or cancer cells in the urine.
 
Biopsy from the tumor may be required in certain cases, such as when the imaging is doubtful or when we are not planning surgery for the patient.
 
So these investigations help us to confirm and stage the disease.
 
kidney cancer diagnosis

What is the TNM Staging for Kidney Cancer?

 
Now let us discuss the kidney cancer T staging.
 
It is called as T1 when the tumor is 7 cm or less in the greatest dimension and is limited to the kidney.
 
T1, tumor is 7 cm or less It is called as T2 when the tumor is greater than 7 cm in the greatest dimension and is limited to the kidney.
 
T2, tumor is more than 7 cm T3 includes cases in which the tumor extends to renal vein and its segmental branches, or renal sinus fat.
 
T3, tumor extends to renal vein or renal sinus fat T3 also includes cases in which the tumor extends into the perirenal fat, but not beyond Gerota’s Fascia, as you can see in this figure.
 
T3, tumor extends into the perirenal fat Extension of the tumor into inferior vena cava is also T3.
 
T3, extends to inferior vena cava And when the tumor extends beyond the Gerota’s Fascia, as you can see in the figure, it is called as T4.
 
T4, extends beyond Gerota’s fascia Infiltration of the adrenal gland is also T4.
 
T4, ipsilateral adrenal gland involvement
 
  The infographic below summarizes the T Staging of Kidney Cancer
 
T staging
 
Now, lets come to the N-staging or nodal staging of kidney cancer. Involvement of regional lymph nodes of the kidney, as you can see in this figure, is called as N1.
 
N staging - extends to regional nodes And lastly, we come to the M-staging or the metastatic staging of kidney cancer.
 
This figure shows multiple metastatic deposits in the liver.
 
metastasis to liver And here cancer has spread to the lungs in form of multiple nodular deposits.
 
metastasis to lungs It may also spread to the peritoneum in the form of peritoneal deposits, as you can see in this figure.
 
metastasis to peritoneum Metastatic deposits in the adrenal gland without direct extension of a tumor may also be seen.
 
Metastatic deposits in the adrenal gland Sometimes, it may also spread to the brain or bones.
 
N and M Staging

T Staging

T1 – Tumor is limited to kidney and measures </=7 cm in largest dimension.
 
T2 – Tumor is limited to kidney and measures >7 cm in largest dimension.
 
T3 – Tumor has extended up to a renal vein (or its branches) or has spread to inferior vena cava; or the fatty tissue around the kidney, but not to the adrenal gland or beyond Gerota’s fascia.
 
T4 – The tumor has extended beyond the Gerota’s fascia and may be up to the adrenal gland.

N Staging

N0 – No spread of disease to nearby lymph nodes or distant body organs.
 
N1 – Cancer has spread to regional lymph nodes

M Staging

M0 – Cancer has not spread to distant body organs.
 
M1 – Cancer has spread to distant body organs like the brain, bones, lungs, liver, peritoneum, etc.

What is the Treatment of Kidney Cancer?

Treatment of Localised and Locally Advanced Kidney Cancer

 
Now, lets come to the treatment of non-metastatic kidney cancer.
 
It is called as T1 when the tumor is 7 cm or less in greatest dimension and is limited to the kidney.
 
T1, tumor is 7 cm or less Surgical resection of the tumor in the form of partial or radical nephrectomy is the mainstay of treatment for T1 disease.
 
It is called as T2 when the tumor is more than 7 cm in greatest dimension and is limited to the kidney.
 
T2, tumor is more than 7 cm T3 includes cases in which the tumor extends into the renal vein or its segmental branches, or into the renal sinus fat.
 
T3, tumor extends to renal vein or renal sinus fat It also includes cases in which the tumor extends into the perirenal fat but not beyond gerota’s fascia, as you can see in this figure.
 
T3, tumor extends into the perirenal fat Extension of the tumor into inferior vena cava is also T3.
 
T3, extends to inferior vena cava And when the tumor extends beyond the Gerota’s fascia, it is called as T4.
 
T4, extends beyond Gerota’s fascia Infiltration of the ipsilateral adrenal gland is also T4.
 
T4, ipsilateral adrenal gland involvement Involvement of regional lymph nodes of the kidney as you can see in this figure is called as N1.
 
 
 
N staging - extends to regional nodes Surgical resection of the tumor in the form of radical nephrectomy is the mainstay of treatment for T2, T3, T4 or node-positive disease. The decision to do surgery and the type of surgery is taken by oncologist after assessing the exact content of the tumor along with the performance status and the comorbidities of the patient.
 
Non Metastatic Kidney cancer treatment infographic

Treatment of Metastatic Kidney Cancer

 
And lastly, we come to the M staging or metastatic staging for kidney cancer. This figure shows multiple metastatic deposits in the liver.
 
metastasis to liver And here cancer has spread to the lungs in form of multiple nodular deposits.
 
metastasis to lungs It may also spread to the peritoneum in form of peritoneal deposits as you can see in the figure.
 
metastasis to peritoneum Metastatic deposits in the adrenal gland without direct extension of the tumor may also be seen.
 
Metastatic deposits in the adrenal gland Sometimes, it may also spread to the brain or bones. Chemotherapy is the mainstay of treatment for patients with metastatic disease. Nowadays, a lot of oral medications are available for treatment of kidney cancer. In a patient with metastatic disease anytime after starting chemotherapy, if the surgeon feels that the disease can be surgically resected, then surgical resection may be was done in metastatic disease also. And rarely, upfront surgical resection may be done in metastatic disease, with or without chemotherapy later.
 
metastatic disease treatment But the final decision whether to start chemotherapy or to do surgery is taken by oncologists on an individual patient basis, after assessing the exact conditions of the patient, comorbidities, performance status, along with other factors.

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