What is kidney cancer?
Kidney cancer begins when healthy cells in one or both kidneys change and grow uncontrollably, forming a tumor. There are several types of kidney cancer, but renal cell carcinoma is the most common. There are also several types of kidney cancer cells. The most common are clear cells. Knowing which type of cell makes up a kidney tumor helps doctors plan treatment.
What is the function of the kidneys?
The kidneys are reddish-brown, bean-shaped organs located above the waist on either side of the spine. They filter blood and remove impurities, excess minerals and salts, and extra water to produce urine. These organs also produce hormones that help control blood pressure, red blood cell production, and other functions. Because each kidney works independently, one kidney can be removed while preserving the function of the other.
Cancer begins in cells, the building blocks that make up tissues. Tissues make up the kidneys and the other organs of the body.
Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.
Tumors in the kidney can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:
Benign tumors (such as cysts):
- are usually not a threat to life
- can be treated or removed and usually don’t grow back
- don’t invade the tissues around them
- don’t spread to other parts of the body
- maybe a threat to life
- usually can be removed but can grow back
- can invade and damage nearby tissues and organs
- can spread to other parts of the body
Kidney cancer cells can spread by breaking away from the kidney tumor. They can travel through lymph vessels to nearby lymph nodes. They can also spread through blood vessels to the lungs, bones, or liver.
After spreading, kidney cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section on page 11 for information about kidney cancer that has spread.
When you get a diagnosis of kidney cancer, it’s natural to wonder what may have caused the disease. Doctors usually can’t explain why one person gets kidney cancer and another doesn’t.
However, we do know that people with certain risk factors may be more likely than others to develop kidney cancer. A risk factor is something that may increase the chance of getting a disease.
Studies have found the following risk factors for kidney cancer:
- Smoking: Smoking tobacco is an important risk factor for kidney People who smoke have a higher risk than nonsmokers. The risk is higher for those who smoke more cigarettes or for a long time.
- Obesity: Being obese increases the risk of kidney
- High blood pressure: Having high blood pressure may increase the risk of kidney
- Family history of kidney cancer: People with a family member who had kidney cancer have a slightly increased risk of the Also, certain conditions that run in families can increase the risk of kidney cancer.
—Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It’s caused by changes in the VHL gene. People with a changed VHL gene have an increased risk of kidney cancer. They may also have cysts or tumors in the eyes, brain, or other parts of the body. Family members of those with VHL can have a test to check for a changed VHL gene.
Many people who get kidney cancer have none of these risk factors, and many people who have known risk factors don’t develop the disease.
Common symptoms of kidney cancer include
- Blood in your urine (which may make urine look rusty or darker red)
- Pain in your side that doesn’t go away
- A lump or mass in your side or abdomen
- Weight loss for no known reason
- Feeling very tired
These symptoms may be caused by kidney cancer or by other health problems, such as an infection or a kidney cyst. People with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.
The lab checks your urine for blood and other signs of
The lab checks your blood for several substances, such as creatinine. A high level of creatinine may mean the kidneys aren’t doing their job.
An ultrasound device uses sound waves that can’t be heard but make a pattern of echoes as they bounce off organs inside your abdomen. The echoes create a picture of your kidney and nearby tissues. The picture can show a kidney tumor.
An X-ray machine linked to a computer takes a series of detailed pictures of your abdomen. You may receive an injection of contrast material so your urinary tract and lymph nodes show up clearly the CT scan can show cancer in the kidneys, lymph nodes, or elsewhere in the abdomen.
A large machine with a strong magnet linked to a computer is used to make detailed pictures of your urinary tract and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in your kidneys, lymph nodes, or other tissues in the
You’ll receive an injection of dye into a vein in your arm. The dye travels through the body and collects in your kidneys. The dye makes them show up on X-rays. A series of X-rays then tracks the dye as it moves through your kidneys to your ureters and the X-rays can show a kidney tumor or other problems. (IVP is not used as commonly as CT or MRI for the detection of kidney cancer.)
The removal of tissue to look for cancer cells is an In some cases, your doctor will do a biopsy to diagnose kidney cancer. Your doctor inserts a thin needle through your skin into the kidney to remove a small sample of tissue. Your doctor may use an ultrasound or a CT scan to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue.
After surgery to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer
If kidney cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on the size of the kidney tumor and whether the cancer has invaded nearby tissues or spread to other parts of the body.
Your doctor may order one or more tests:
- Blood tests: Your doctor can check for substances in your blood. Some people with kidney cancer have high levels of calcium or LDH. A blood test can also show how well your liver is
- Chest x-ray: An x-ray of the chest can show a tumor in your
- CT scan: CT scans of your chest and abdomen can show cancer in your lymph nodes, lungs, or elsewhere.
- MRI: MRI can show cancer in your blood vessels, lymph nodes, or other tissues in the abdomen
When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells.
The disease is metastatic kidney cancer, not lung cancer. It’s treated as kidney cancer, not as lung cancer. Doctors sometimes call the new tumor a “distant” disease.
These are the stages of kidney cancer:
- Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters). Cancer cells are found only in the
- Stage II: The tumor is bigger than a tennis ball. But cancer cells are found only in the
- Stage III: The tumor can be any It has spread to at least one nearby lymph node. Or it has grown through the kidney to reach nearby blood vessels.
- Stage IV: The tumor has grown through the layer of fatty tissue and the outer layer of fibrous tissue that surrounds the Or cancer cells have spread to nearby lymph nodes or to the lungs, liver, bones, or other tissues.
Kidney Cancer Treatments
Common Kidney Cancer Treatment options for people with kidney cancer are surgery, targeted therapy, and biological therapy. You may receive more than one type of treatment.
Kidney Cancer Treatments in Omaha that’s right for you depends mainly on the following:
- The size of the tumor
- Whether the tumor has invaded tissues outside the kidney
- Whether the tumor has spread to other parts of the body
- Your age and general health
You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral.
You may want to see a urologist, a surgeon who specializes in treating problems of the urinary tract. Other specialists who treat kidney cancer include:
- urologic oncologists (surgeons who specialize in cancers of the urinary tract)
- medical oncologists
- radiation oncologists
Your health care team may also include an oncology nurse and a registered dietitian.
Your health care team can describe your Kidney Cancer Treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common.
Before Kidney Cancer Treatments
Before kidney cancer treatments start, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.
At any stage of the disease, supportive care is available to control pain and other symptoms, to relieve the side effects of Kidney Cancer Treatments, and to ease emotional concerns. Information about such care is available on NCI’s Web site at http://www.cancer.gov/cancertopics/coping.
Kidney Cancer Surgery
Surgery is the most common kidney cancer treatment for people with kidney cancer. The type of surgery depends on the size and stage of kidney cancer, whether you have two kidneys, and whether the cancer was found in both kidneys.
You and your surgeon can talk about the types of surgery and which may be right for you:
- Removing all of the kidney (radical nephrectomy): The surgeon removes the entire kidney along with the adrenal gland and some tissue around the Some lymph nodes in the area may also be removed.
- Removing part of the kidney (partial nephrectomy): The surgeon removes only the part of the kidney that contains the People with a kidney tumor that is smaller than a tennis ball may choose this type of surgery.
There are two approaches to removing the kidney.
The surgeon may remove the tumor by making a large incision into the body (open surgery). Or the surgeon may remove the tumor by making small incisions (laparoscopic surgery). The surgeon sees inside your abdomen with a thin, lighted tube (a laparoscope) placed inside a small incision. Sometimes a robot is used. The surgeon uses handles below a computer display to control the robot’s arms.
The surgeon may use other Kidney Cancer treatment methods such as radiation therapy to destroy cancer cells in the kidney. For people who have a tumor smaller than 4 centimeters and who can’t have surgery to remove part of the kidney because of other health problems, the surgeon may suggest:
- Cryosurgery: The surgeon inserts a tool through a small incision or directly through the skin. The tool freezes and kills the kidney tumor.
- Radiofrequency ablation: The surgeon inserts a special probe directly through the skin or through a small incision. The probe contains tiny electrodes that kill the cancer cells with heat.
It takes time to heal after surgery, and the time needed to recover is different for each person. It’s common to feel weak or tired for a while.
Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.
Your health care team will watch you for signs of bleeding, infection, or other problems. They will keep track of how much fluid you take in and how much urine passes out of your body.
If one kidney is removed, the remaining kidney is usually able to do the work of both kidneys. However, if your remaining kidney isn’t doing a good job cleaning your blood, you may need dialysis. Some people may need a transplant with a healthy kidney from a donor.
People with kidney cancer that has spread may receive a type of drug called targeted therapy. Many kinds of targeted therapy are used for kidney cancer. This Kidney Cancer Treatment may shrink a kidney tumor or slow its growth.
Usually, targeted therapy is taken by mouth. You may feel very tired while taking targeted therapy for kidney cancer. Other side effects may include diarrhea, nausea, vomiting, sores on the lips or in the mouth, and high blood pressure. You may want to read the NCI fact sheet Targeted Cancer Therapies.
People with kidney cancer that has spread may receive biological therapy. Biological therapy for kidney cancer is a treatment that may improve the body’s natural defense (the immune system response) against cancer. Kidney Cancer Treatments can slow the growth of tumors or shrink them. The biological therapy is injected intravenously or under the skin. The treatment may be given at the hospital or a doctor’s office.
Other drugs may be given at the same time to prevent side effects. The side effects differ with the biological therapy used, and from person to person. Biological therapy commonly causes a rash or swelling. You may feel very tired during treatment. The treatment may also cause a headache, muscle aches, a fever, or weakness.
You may find it helpful to read the NCI booklet Biological Therapy. You may also wish to read the NCI fact sheet Biological Therapies for Cancer.
What is a kidney biopsy?
A biopsy is a diagnostic test that involves collecting small pieces of tissue, usually through a needle, for examination with a microscope. A kidney biopsy can help in forming a diagnosis and in choosing the best course of treatment. A kidney biopsy may be recommended for any of the following conditions:
- hematuria, which is blood in the urine
- proteinuria, which is an excessive protein in the urine
- impaired kidney function, which causes excessive waste products in the blood
A pathologist will look at the kidney tissue samples to check for unusual deposits, scarring, or infecting organisms that would explain a person’s condition. The doctor may find a condition that can be treated and cured.
If a person has progressive kidney failure, the biopsy may show how quickly the disease is advancing. A biopsy can also help explain why a transplanted kidney is not working properly.
Patients should talk with their doctors about what information might be learned from the biopsy and the risks involved so the patients can help make a decision about whether a biopsy is worthwhile.
What are the preparations for a kidney biopsy?
Patients must sign a consent form saying they understand the risks involved in this procedure. The risks are slight, but patients should discuss these risks in detail with their doctors before signing the form.
Doctors should be aware of all the medicines a patient takes and any drug allergies that the patient might have. The patient should avoid aspirin and other blood-thinning medicines for 1 to 2 weeks before the procedure.
Some doctors advise their patients to avoid food and fluids before the test, while others tell patients to eat a light meal. Shortly before the biopsy, blood and urine samples are taken to make sure the patient doesn’t have a condition that would make doing a biopsy risky.
What are the procedures for a kidney biopsy?
Kidney biopsies are usually done in a hospital. The patient is fully awake with light sedation. A local anesthetic is given before the needle is inserted.
Patients lie on their stomachs to position the kidneys near the surface of their backs. Patients who have a transplanted kidney lie on their backs. The doctor marks the entry site, cleans the area, and injects a local painkiller. For a biopsy using a needle inserted through the skin, the doctor uses a locating needle and x-ray or ultrasound equipment to find the kidney and then a collecting needle to gather the tissue.
Patients are asked to hold their breath as the doctor uses a spring-loaded instrument to insert the biopsy needle and collect the tissue, usually for about 30 seconds or a little longer for each insertion. The spring-loaded instrument makes a sharp clicking noise that can be startling to patients. The doctor may need to insert the needle three or four times to collect the needed samples.
The entire procedure usually takes about an hour, including the time to locate the kidney, clean the biopsy site, inject the local painkiller, and collect the tissue samples.
Patients who are prone to bleeding problems should not have a biopsy through the skin. These patients may still undergo a kidney biopsy through an open operation in which the surgeon makes an incision and can see the kidney to collect tissue samples.
What happens after a kidney biopsy?
After the test, patients lie on their backs in the hospital for a few hours. Patients who have a transplanted kidney lie on their stomachs. During this time, the staff will monitor blood pressure and pulse and take blood samples to assess for blood loss. On rare occasions when bleeding does not stop on its own, a transfusion may be necessary to replace lost blood. Most patients leave the hospital on the same day. Patients may notice some blood in their urine for 24 hours after the test.
A rare complication is an infection from the biopsy.
Patients should tell their doctors or nurses if they have any of these problems:
- bloody urine more than 24 hours after the test
- inability to urinate
- worsening pain in the biopsy site faintness or dizziness
How are kidney biopsy results reported?
After the biopsy, the doctor will inspect the tissue samples in the laboratory using one or more microscopes, perhaps using dyes to identify different substances that may be settled in the tissue. Electron microscopes may be used to see small details. Getting the complete biopsy results usually takes a few days. In urgent cases, a preliminary report may be given within a few hours.
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