Kidney cancer is an oncological disease that affects the organs of the excretory system in the first stages, and the whole organism in the later stages. This relatively rare type of cancer affects a quarter of a million people every year. Most of the sick are representatives of the stronger sex. Men are twice as likely to get this type of oncology as women. Gender plays a role in determining risk groups. Among cancer patients with a diagnosis of "Malignant neoplasm in the kidney," older people over 60 years old predominate.
The ICD-10 code for cancer of the right or left kidney and malignant formation inside the renal pelvis is C64, C65. Oncological urology is developing successfully, constantly improving the treatment of patients.
Causes of the disease
Risk groups are precisely defined, but doctors and scientists lack information to identify the main cause of the disease. A list of factors affecting the development of cancer is highlighted:
- Gender and age.
- Nicotine is considered a dangerous carcinogen, the smoking habit is called the most common cause of oncology. Smoking is most dangerous at risk of developing throat cancer, but nicotine dependence has been observed in most people diagnosed with cancer.
- Cancer is caused by hazardous chemicals and gases - and a number of professions show an increased risk of getting sick.
- Increased weight affects the development of cancer, and a diagnosis of obesity will increase the likelihood of an oncological pathology by 20%. But the mechanism of the weight factor has not yet been identified.
Often, neoplasms are provoked by mechanical damage to organs. A malignant tumor forms in the kidney after a fall or as a result of physical injuries of the organ.
- Long-term use of drugs is considered the cause of cancer. At risk are people with chronic diseases who take a lot of drugs. Of the diseases secrete arterial hypertension.
- Various hereditary factors provoke diseases: they contribute to the formation of tumors in young children and increase the chance of getting sick in adults.
- There is a high probability of developing kidney cancer if the patient has survived an organ disease. For example, acute renal failure is often a lesion that precedes a cancerous tumor.
Types of disease
Cancer develops in different ways. The main differences relate to the structure of malignant cells. According to the histological basis, the disease is divided into types:
- chromophilic kidney cancer, bearing the second name - papillary,
- chromophobic kidney cancer,
- clear cell cancer, also called “hypernephroid,”
- kidney cancer
- collecting duct cancer.
Names come from the characteristics of cancer cells. The terms describe the color of cells when viewed through a microscope, their ability to absorb dye. The name of the morphological subspecies of cancer is given by the form of cancers and defects caused by pathology in the cell.
To classify cancers, the TNM system is used, which records in brief the nature of the oncological process in the body. The classification was approved in the fifties of the twentieth century and made it possible to make a single review of malignant tumors, regardless of the first organ exposed to malignant cells. Based on the standards, detailed clinical recommendations have been made to identify the tumor and determine the degree of cancer.
The number after T indicates the size of the primary cancerous tumor, N - how much the lymph nodes are affected, M - distant metastases - whether secondary foci of the disease arose. The TNM system is used for staging cancer. The course of any oncological pathology is divided into four stages:
- At the first stage, the tumor shows a small size (up to 7 cm, usually up to 3 cm) and does not affect the capsule of the kidney. The TNM code is T1N0M0. If the disease is found at the initial stage, the patient has good prospects.
- At stage 2, the disease progresses, the total tumor volume exceeds 7 cm. It grows, capturing the organ, without leaving its limits. The TNM code is T2N0M0. This stage can only be diagnosed using instruments.
- At stage 3, lymph nodes and large vessels located next to the kidneys are affected. The TNM code is T2N1M0 or T3N1M0. More often the adrenal glands are also affected.
- At stage 4, the disease goes far beyond the region of the kidney - nearby tissues, blood vessels and lymph nodes are affected. The malignant process passes into the bloodstream and quickly spreads through the patient's body, forming metastases - secondary foci of the disease. The TNM code is T3N1M1. In patients with end-stage cancer, the chances of a successful recovery are reduced.
Metastases are more often formed in organs that are well supplied with blood. The most common places for the formation of secondary foci of the disease are the lungs, where the blood is saturated with oxygen, and the liver, which is involved in hormonal processes. Often the secondary focus of the disease is formed in the bone tissue, interfering with the patient's mobility.
Like most cancers, a kidney tumor has no symptoms in the initial stages of the disease. If the disease manifests itself, the symptoms are extremely minor or nonspecific. Specific symptoms are characteristic of various diseases of the organ, except for oncological formation in the kidney.
The first signs of a serious illness are like a slight malaise that anyone would prefer to endure without going to the doctor. The further the disease develops, the more specific the symptoms of kidney cancer become.
The main symptoms of the disease in the early stages are: pain, blood clots in the urine and a growing, palpable lump in the abdomen. A characteristic, but non-specific sign of kidney disease is called a white coating on the tongue.
- Hematuria - the presence of blood or blood clots in the urine. The symptom may not stay constant, but disappear and reappear: growing cancer cells cause damage to the tissues of the organ. In the early stages, the functionality of the organ is not damaged, the disease manifests itself in the form of blood in the urine and unclear symptoms. Blood loss is either imperceptible or large, and patients suffer from severe anemia. If blood clots clog the channels of the excretory system, a person will feel a sharp severe pain - renal colic.
- The larger the tumor, the easier it is to detect on palpation. It is especially simple to do this in patients with a fragile physique. The more weight and volume of adipose and muscle tissue, the more difficult it is to determine kidney cancer by simple palpation. If the tumor is not palpable, but other disturbing symptoms are present, this is not considered a refutation of the diagnosis. If cancer is suspected, all possible tests must be done to rule out the malignancy of the tumor.
- A growing tumor compresses the cells, pain syndrome manifests itself. The pain can be acute, in which case, probably, clogging of the urinary canals with blood clots occurred. The pain is dull and aching, it bothers the patient more in the evenings and at night. The process of urination will become painful. The localization of pain depends on the place of cancer formation, but more often a fuzzy localized abdominal pain or pain in the lumbar region is manifested.
With the growth of the tumor, the first manifestations of the disease described above become noticeable, disappearing less often, then arising with renewed vigor. Gradually, the symptoms become impossible to ignore. In addition, in the later stages of the disease, symptoms that are much more characteristic of oncological diseases appear, which will inevitably lead the patient to doctors:
- The general weakness of the body exhausted by the disease - a person slowly but steadily loses weight. Appetite is gradually reduced, as food and drink become an indirect cause of problems and pains. Blood loss of the patient increases, there are signs of anemia - pale skin, sharp pressure drops. A noticeable sign of a serious illness for the patient will be excessive sweating. To general weakness is added fever. The patient shakes, as if in a fever, the heat does not subside for a long time. The common name for this group of symptoms is oncological cachexia. This is a consequence of poisoning the body with substances processed by distorted cells, as well as the result of necrosis caused by tumor nodes, and damage to the tissue and organs around the tumor.
- When the tumor grows in size and penetrates into the vessels, the patient's legs swell, blood clots occur in the inferior vena cava and leg veins. The veins expand as with varicose veins, in the spermatic cord and in the abdominal wall, showing characteristic external signs.
- When malignant cells enter the bloodstream, a clear sign of the disease is noticeable: high blood pressure. The syndrome is called "secondary arterial hypertension" and is the result of the release of a number of substances from cancerous kidneys into the bloodstream or mechanical damage to blood vessels.
- Even if there are no metastases in the liver, the release of substances into the blood causes metabolic disturbances. This is expressed in an increase in temperature, an increase in calcium in the blood, a decrease in blood glucose and other pathological processes. The situation leads to serious damage to the liver, including cell death. The doctor reveals a specific picture in the blood test: an excess of bilirubin, alkaline products and a lack of albumin.
- Metastases add their own symptoms, causing disturbances in various organs of the body. With the penetration of metastases into the bone tissue, it becomes brittle, multiple bone fractures and pain in them are possible. If the lungs are affected by cancer, breathing difficulties are added to the signs of the disease, possibly blood spitting. If the liver is affected, there are signs of spillage of bile throughout the body - a sharp yellowing of the mucous membranes, skin and sclera. The patient will have pain in the liver (right hypochondrium), and the patient will feel characteristic bitterness in the mouth. The most unpredictable symptoms of brain damage are that they are associated with disorders of higher nervous activity, but they can vary greatly depending on broken brain connections. This can be expressed in speech defects, in problems with perception, up to hallucinations. More often, brain metastases are expressed by severe headaches and growing neuralgia. However, if symptoms appear, then the disease has entered the fourth stage, and the prognosis for the patient is extremely unfavorable.
Although the ailment is diagnosed simply, ultrasound, CT, MRI and intravenous urography are easily recognized, the disease is often caught only in the last stages, because in the first few people see a doctor. If you manage to catch the first, and often the second stage of the disease, this happens only with an accidental or planned examination, the purpose of which was to detect another pathology.
Diagnosis begins with a survey of the patient. It turns out how long disturbing symptoms are observed in a person, whether concomitant diseases of the excretory system are established. Then the localization of the disease is palpated. The tumor is often palpated and has a characteristic position on palpation. Blood pressure is measured. An increased rate indirectly favors the cancer hypothesis.
Further, the tumor is diagnosed using instrumental diagnostics. First of all, the patient is sent for an ultrasound scan. The study will reflect a violation of the structure of the organ. A number of other diagnoses with similar symptoms are precisely ruled out. Ultrasound examination reveals neoplasms in the epithelium of the organ, and the presence of confusing diseases (cystic fibrosis) is excluded or confirmed. The difficulty and disadvantage of this method is that the quality of the data is highly dependent on the weight of the patient. In people of large physique or suffering from a complete ultrasound analysis will give a minimum of important information.
CT and MRI give a clearer picture that allows you to determine the exact size of the cancer, to recreate the shape and appearance. It is clarified how affected the affected organ is, whether there is a threat to nearby organs and tissues, whether the tumor grows further. Sometimes these methods are combined with contrasting: a substance is injected into the patient’s bloodstream that is clearly visible with computed tomography or magnetic resonance imaging, which helps to quickly and efficiently stain the formation with a disturbed structure. It is reflected in the results of the study.
Contrasting is also used for x-rays: intravenous or excretory urography uses a similar technology. The substance, which is brightly reflected by X-ray, is launched into the bloodstream and the condition of the kidneys is evaluated by results. They look at how damaged the parts of the organ - the calyx or the pelvis, are the ureters and similar parts clogged to help clarify the patient’s illness. The method is actively used, with the exception of patients with diagnoses of renal failure and thrombosis. Then intravenous urography is replaced by MRI.
If the plan is surgery, doctors recommend a radioisotope scan. The mentioned type of analysis will not clarify the diagnosis, but will show violations or the absence of violations in the functionality of the kidney. This will help determine the correctness and possibility of surgical intervention, as well as the choice of the type of operation for the patient.
If there is a danger of metastases, it is necessary to check whether the lungs and bones are affected. The bones are checked by scintigraphy, and the lungs are checked with an ordinary X-ray.
In addition to the above measures, it is supposed to pass several tests to diagnose the current state of the body and the degree of danger. A biochemical blood test is proposed that reveals violations in the form of changes in the normal level of red blood cells, ESR, hemoglobin in the blood. The clinic (clinical analysis) of blood also provides important information. It is necessary to pass cytology to detect malignant cells. The patient will certainly pass a urinalysis, the study determines how strong hematuria is, whether impurities are present. The data will show how much the kidneys still have a natural function.
An unmistakable method for determining cancer is a tissue biopsy when cell malignancy is suspected. The histological picture during the analysis accurately shows whether the cells are malignant or represent a tumor that does not threaten the patient's life. The micropreparation provides information on how the cell is deformed under the influence of the disease, what form of cancer the patient has. But a biopsy is not always possible to take. It happens that doctors recommend an operation first and then a tissue biopsy and histology from a cut out tumor.
As medical methods for fighting a cancerous tumor in the kidneys, the following are used:
- radiation therapy
- hormone therapy
- targeted therapy.
In the late stages of the disease, symptomatic treatment replenishes the list, which makes life easier for the patient, improves the general condition, but does not increase the chances of fighting the disease. This is done in the last stages of the disease, in order to facilitate the patient's last days.
The faster the tumor is detected, the higher the likelihood that the patient will live five years or more. And most of the patients who went to the doctor in the first stage of cancer survived, avoiding metastases, complications and relapses of the tumor. The disease in the first stages is treatable, but kidney cancer in the last stage is fatal.
This type of medical service is recognized as the best method of control. Elimination of the focus of the disease helps the patient recover and overcome the disease. After surgery and before the intervention, the patient is supposed to undergo chemotherapy and radiation therapy. Treatment methods can reduce the size of a malignant tumor and slow its growth. With kidney cancer, a vivid result is not expected, but the patient's condition improves, and the life span increases. When the tumor is removed, the patient undergoes a course of treatment. The method prevents relapses and gives a small guarantee of curing the disease.
If the cancer is at an early stage, there is a good chance that you don’t have to remove the entire organ. With partial resection, most of the organ remains intact and retains functions. This is vital for patients who have lost a kidney and who retain a second in the fight against cancer.
In addition to resection, a surgical operation is performed - nephrectomy, which involves the removal of a whole kidney. The consequences are harder for the patient and require a longer recovery in the postoperative period than after resection.
With a small tumor, radiofrequency ablation is also performed. The method involves heating the affected area of the organ to a high temperature using radio waves. To prevent cancerous processes, it is sufficient to heat the cancer cells to 50 degrees, but by heating to 80-100 degrees, the possibility of cell division and reproduction is completely excluded.
Cancer is operable if the tumor has reached a large size, but metastases in nearby tissues and distant organs still do not grow. If surgery is possible, the tumor is removed.
Surgery is also allowed in the advanced stage of cancer. But the goal will be different. This is not the removal of an organ or tissue affected by cancer, but the restoration of the functioning of damaged organs. Partial excision of the tumor is also performed, reducing pressure on healthy tissues and organs. This will reduce pain and improve the well-being of the patient.
Before removing the kidney, the blood flow around the organ is blocked to reduce the volume of blood inside, affecting the size of the malignant neoplasm.
Sometimes surgical intervention is also applied to metastases, if this helps to normalize the patient's condition or transfer the disease to a controlled stage.
Before the operation, a course of examinations is conducted to accurately determine the position of the organ, to collect data on the pathology and health status of the patient. Information is required for a successful operation and for determining the specifics of surgical intervention.
Chemotherapy is the most effective method of medical fight against cancer after surgery, it is practically not used in kidney cancer. The method consists in introducing substances into the blood that slow down or stop the growth of a cancer tumor due to poisoning of cancer cells. It is used for most oncologies, but not for the described problem, because the kidneys secrete substances that create extremely strong resistance to drugs. Therefore, chemotherapy will have a negative effect. The toxins contained in the drugs will affect healthy cells, worsening the patient’s condition, but not affecting cancer cells protected by a protein substance produced by the renal tubules.
If metastases are detected, chemotherapy is used to combat the consequences. The method justifies the use in the fight against cancer cells in the blood. Purification of the bloodstream from malignant cells slows down the process of tumor metastasis. Effective drugs can block the nutrition of malignant neoplasms through the blood, preventing the disease from growing and progressing.
This type of treatment is rarely used, the tumor is often insensitive to radiation exposure. Radiation therapy is used in two ways. In the external type of radiation therapy, a device is placed next to the patient that emits radiation waves that, when they reach a cancerous formation, destroy cancer cells or greatly slow down their growth.
Internal radiation therapy consists in delivering radioactive elements directly to the tumor, in direct contact with the formation. In the latter case, the action is narrowly targeted and does not threaten healthy cells. But it is not possible to treat patients with the diagnosis under discussion, since the kidneys are protected from the penetration of many harmful substances. And radioactive elements among them.
Radiation therapy is used for cancer patients with advanced kidney cancer in order to reduce pain and improve the general condition of the patient. In the early stages, radiation therapy did not have a large effect on the tumor. A neoplasm in the kidney almost does not respond to radioactive effects.
Targeted therapy is often used to treat kidney cancer. The method invented at the beginning of the century is being used more and more often. The essence of the method lies in the effect not on cancer cells, but on proteins that help the indefatigable division of malignant cells. These drugs are expensive in Russia, but they are delivered to people for free abroad. Medicines stop the growth of cancer cells by acting on protein catalysts that stimulate the malignant process. If the drug works successfully, the sharp growth of the tumor stops, blocks the development of cancer and does not allow the tumor to spread and form metastases.
The described treatment has also negative aspects: the drugs cause strong allergic reactions, the patient tolerates them very poorly. In addition, the method does not work for a long time - cancer cells adapt to new conditions and develop resistance to the drug.
Due to the negative aspects of treatment, targeted therapy is rarely used alone. More often it works together with other cancer control agents, especially together with surgical intervention in the oncological process.
After the operation, a relapse of the disease often occurs. And the cancer that arose a second time is more aggressive. It actively interacts with cells, capturing new volumes. Such tumors quickly metastasize and pass into the terminal stage of the disease. Relapses occur in half of the patients who underwent surgery.
The prognosis of survival, as with any oncology, depends on the stage when the cancer was detected and when treatment was started. In the early stages, cancer is curable, so there is a great chance to overcome the disease. If it was discovered late, then rarely the patient survives with metastases for more than a year.
How many patients live with kidney cancer is an incorrect, albeit frequent question: the answer to it depends on a combination of a huge number of external factors and the patient's internal characteristics.
The chances of operated patients are not much higher. Survival after removal of the malignant area is 70% of patients, with half of the patients having cancer again. A healthy lifestyle, proper nutrition and diet reduces the risk of the disease, but they will not become guaranteed protection.
The statistics operate on encouraging, but not quite representative data: treatment at the first three stages of the disease guarantees a survival rate of over 50%. Among patients with stage 2 cancer, the survival rate is 70%, and from 1 - 80%. But if the patient is diagnosed with terminal cancer, the probability of survival is low - less than 10%. Without surgery and without treatment, the chances of patients are greatly reduced.
According to general statistics, in institutions whose activities are dedicated to the fight against cancer, after diagnosis, more than half of patients have a chance to live 5 years, and 40% of patients have a chance of ten-year survival after diagnosis. This means a painstaking and daily fight against the disease, but emphasizes that an oncological diagnosis is not a sentence, and the disease can be cured.
Causes of Kidney Cancer
To understand why kidney cancer comes from, you need to know that modern medicine puts forward several hypotheses at once, many of which are confirmed by serious scientific research:
- Genes - by studying the chromosomes of people with cancer, scientists discovered certain mutations, in addition, it was proved that a predisposition to kidney cancer can be inherited,
- Renal disease - a malignant tumor can also form due to chronic renal failure, kidney cysts, and nephrosclerosis. In addition, aggravating circumstances are diseases such as diabetes, heart disease, pyelonephritis,
- Lifestyle - a lot has been said about the dangers of smoking and obesity, these factors also affect the formation of malignant tumors, including in the kidneys. In addition, the abuse of drugs related to analgesics and diuretics also increases the risk of getting sick, as well as uncontrolled intake of hormones,
- External influences - the most dangerous external causes of kidney cancer are carcinogens and radiation. If a person’s work involves contact with substances such as asbestos, nitrates, wood dust or other carcinogens, it is necessary to monitor your health as carefully as possible,
- Injuries - as a result of a renal injury, statistics show that the likelihood of a tumor increases.
Note that the causes of kidney cancer in men and the causes of kidney cancer in women are practically the same, despite the differences in the genitourinary system.
Types of Kidney Cancer
There are several classifications of renal oncological diseases, however, the most common is the histological classification, in which the following types of kidney cancer are distinguished:
- Clear cell is the most common form, which is characterized by rapid progression and metastasis. According to statistics, 4 out of 5 patients with kidney cancer have this particular form of the disease,
- Papillary - a tumor is formed from the papillae and is mainly benign. In second place in prevalence - up to 15% of cases.
- Chromophobic - diagnosed in 5% of cases and is the least studied and predicted to date,
- Bellini (collecting tubes) is one of the rarest and most dangerous forms, as it is resistant to various types of therapies, therefore, it most often has an unfavorable prognosis,
- Eosinophilic adenoma - is not as common as the clear cell or chromophobic form, and is diagnosed only in women with excess body weight. It has a good prognosis with timely diagnosis, since the tumor cells have long been enclosed in a dense capsule and do not spread metastases throughout the body to the final stages.
It is worth emphasizing that this classification is not perfect, since there are tumors with unknown tissue affiliation.
How to identify kidney cancer
To understand how to detect kidney cancer, one can reason from the perspective of an ordinary person and from the perspective of a doctor. An ordinary person can focus on the above symptoms. The specialist also needs to make an accurate diagnosis in order to exclude similar renal diseases.
The Hello Association, together with oncologists, has developed a series of brochures from which patients and their families can receive up-to-date information on modern diagnostics and treatment: head and neck tumors, kidney cancer, lung cancer, breast cancer, melanoma, and immuno-immune capabilities. oncology, as well as psychological and legal support. Lifestyle recommendations during treatment. Targeted Therapy for Skin Melanoma Edition
Depending on the type of cells and the nature of the growth of the tumor, oncologists distinguish the following types of kidney cancer:
- Clear cell. It is observed in 70-80% of cases. The tumor cells contain lipids and a violation on the 3rd chromosome or mutation of the FLG gene is detected. The tumor has a good blood supply.
- Papillary renal cell. It is observed in 7-14% of cases. The neoplasm is characterized by weak blood supply and multicentric growth. Trisomy of the 7th and 17th chromosomes, loss of the Y chromosome are detected in the cells.
- Chromophobic renal cell. It is observed in 4-5% of cases. The tumor grows from the cortical section of the collecting tubules, and mucopolysaccharide vesicles are found in its cells.
- Cancer of the collecting ducts. It is observed in 1-2% of cases and more often in young people. The tumor grows from the brain layer of the kidney.
- Unclassifiable. It is observed in 2-5% of cases. Such tumors are still not well understood and do not resemble other types of kidney cancer in their structure.
The stages of the cancer process are determined by the TNM classification, in which T indicates the size of the neoplasm, N is the state of the lymph nodes, M is the presence of metastases. Specialists distinguish such stages of kidney cancer:
- Stage I (Т1N0M0) - the size of the neoplasm is up to 4 cm, it is within the kidneys, lymph nodes are not affected, and distant metastases are absent.
- Stage II (T2N0M0) - the neoplasm is located within the kidney and its size is not more than 7 cm, the lymph nodes are not affected and there are no distant metastases.
- Stage III (T1-3N0-1M0) - the size of the neoplasm is from 4 to 7 cm, it can germinate in nearby organs and tissues, but does not extend beyond the redistribution of Herot's fascia, metastases are detected only in one lymph node, distant metastases are absent.
- Stage IV (T1-4N0-1M0-1) - the size of the neoplasm is more than 7 cm and it grows beyond the redistribution of Gerot's fascia, metastases are detected in more than one lymph node, distant metastases appear.
With kidney cancer, a radical nephrectomy is often necessary, but if possible, surgeons tend to perform less traumatic organ-preserving operations. For this, such surgical innovations as CyberKnife, laparoscopic equipment, cryoablation, radiofrequency ablation, etc. can be applied. The following indicators affect the choice of surgical treatment:
- size and location of the neoplasm,
- patient age
- stage of the cancer process, etc.
In the early stages (I-II), stereotactic radiosurgical surgery on CyberKnife is possible. Such interventions are carried out under the control of robotic computer systems providing high accuracy. The tumor is removed by a beam of high-power ionizing radiation in several sessions, during which the DNA of the cancer cells is destroyed, causing their death. After treatment with CyberKnife, the patient does not need to undergo grueling chemotherapy courses.
In some cases, the least invasive procedures may be performed in the early stages:
- nephrectomy - removal of the kidney,
- partial nephrectomy - removal of only a tumor in the kidney.
Some organ-preserving surgical operations in the early stages can be performed laparoscopically, providing less trauma, less pain in the postoperative period, faster rehabilitation and a good cosmetic effect.
At later stages, kidney removal is indicated - radical nephrectomy. During such operations, the kidney, part of the surrounding fatty tissue and ureter is removed. An important aspect in surgical treatment is the removal of regional lymph nodes and tumor thrombi from the inferior vena cava and renal veins. If during the intervention a neoplasm is detected that has spread to the upper pole of the kidney, the surgeon also performs amputation of the adrenal gland.
In some cases, surgery for kidney cancer can also be performed if a single metastasis is detected.In the presence of tumor germination in the surrounding tissue and extensive metastases, the patient is considered inoperable and needs palliative and symptomatic treatment.
In some cases, patients after removal of the kidney are recommended hemodialysis, and subsequently kidney transplantation.
This treatment method is used to kill cancer cells with the help of the drug Interleukin-2 (IL-2), which causes lysis of the neoplasm. This tool not only causes the death of malignant cells, but also activates T-lymphocytes, which begin to independently produce IL-2. Treatment may be supplemented by the appointment of Interferon-alpha-2a, which increases the effectiveness of immune therapy.
Which doctor to contact
If you have pain in the lower back, blood in the urine, or probing a tumor in the kidney, you should contact a nephrologist. After a series of studies and signs of kidney cancer, the doctor may refer the patient to an oncologist. To confirm the diagnosis, ultrasound, CT, MRI, urography, renal angiography, puncture biopsy, etc. can be prescribed.
Kidney cancer is a dangerous and insidious disease, which in its early stages is almost asymptomatic. Such malignant tumors are prone to rapid metastasis. Various treatment regimens can be used to treat kidney cancer. Various methods may be included in the treatment plan: surgery, immune therapy, targeted therapy, chemotherapy, hormone therapy, and radiation treatment.
The first channel, the program “Live Healthy” with Elena Malysheva, a video on the topic “Kidney Cancer” (from 32:32 min.):
Species and sources of growth of malignant tumors of the kidneys
As you know, the kidneys are a paired organ located in the retroperitoneal space of the lumbar region. Their main functions are:the formation of urine and the removal of various metabolites and toxic products from it from the outside (drugs, for example), maintaining a normal level of blood pressure, the secretion of hormones, as well as participation in hematopoiesis.
Microscopically, the kidneys are built from a variety of vascular glomeruli, with the release of blood plasma from which the formation of so-called primary urine occurs. In the tubule system, starting from the glomerular capsule cavity, primary urine is freed from glucose, trace elements and other components necessary for the body, and secondary urine is formed, containing only nitrogen metabolism products and water to be removed. Such urine enters the renal calyx system, then into the pelvis, moves through the ureters into the bladder and is removed from the body.
The source of kidney cancer can be the epithelium of the convoluted tubules, collecting ducts (renal cell cancer) or the lining of the calyx and pelvis, represented by transitional epithelium, therefore cancer is here called transitional cell.
Classification of kidney cancer involves the isolation of various histological types based on the presence of features of the microscopic structure of the tumor. Oncologists use the system widely TNM, where T characterizes the features of the primary tumor, N - the nature of changes in regional lymph nodes, and M indicates the presence or absence of distant metastases.
Morphological variants of kidney cancer:
- Clear cell carcinoma of the kidney,
- Chromophilic (papillary cancer),
- Cancer of the collecting ducts.
More than 90% of all diagnosed renal epithelial tumors are clear cell variantSometimes called hypernephroid kidney cancer. This type of cancer grows in the form of a node, pushing away the surrounding tissue and sometimes reaching considerable size. In the early stages of development, the neoplasm has the likeness of a capsule, restricting it from surrounding tissues, which disappears as it grows. The presence of such a boundary distinguishes this type of cancer from other histological variants, which, even at the initial stages of their development, exhibit a tendency to infiltrate growth, invading and damaging the kidney parenchyma.
In addition to the TNM system and histological classification, isolation was suggested. kidney cancer stages (Robson, 1969), which is popular among physicians in the United States. According to this classification:
- The first stage of the tumor corresponds to its growth within the kidney, without spreading into the capsule.
- In the second stage, the tumor sprouts a capsule of the kidney, but does not extend beyond the borders of the renal fascia.
- The third stage involves the penetration of the tumor into the lymph nodes, renal and inferior vena cava.
- In the fourth stage of the disease, the tumor grows into neighboring organs and gives distant metastases.
Renal cancer metastasis occurs lymphogenously and hematogenously. When confirming the diagnosis of malignant neoplasm of the kidney, about a quarter of patients already have metastases, and their most frequent localization is the lungs, bones, liver, lymph nodes, etc.
The metastatic process and the course of the tumor in the kidney have some features, namely, the possibility of regression of metastases and stabilization of the growth of the primary node with the cessation of tumor dissemination in the absence of treatment. This feature is observed in almost a third of patients and should be taken into account in the presence of a high risk of surgical treatment or chemotherapy due to concomitant severe pathology, since it is proved that these patients can survive longer without intensive treatment.
Manifestations of kidney cancer
Like many other tumors, kidney cancer in the early stages can be asymptomatic or give mild nonspecific signs.
As the tumor node grows and the organ parenchyma is damaged, quite characteristic symptoms of kidney cancer arise:
- Hematuria - the presence of blood clots in the urine,
- Palpable abdominal mass
- Pain syndrome.
Hematuria manifested by the presence of blood clots in the urine, it may appear suddenly and just as suddenly disappear for a while, but later resume. Its presence is associated with hemorrhages and decay of tumor tissue, as well as damage to the renal parenchyma. With a significant amount of blood loss, patients suffer from severe anemia, and blockage by a clot of the ureter can lead to impaired emptying of the pelvis, the accumulation of urine in them with the appearance of symptoms of renal colic. Hematuria is considered one of the most common signs of kidney cancer.
Palpable formation in the abdominal cavity from the left or right side it is possible to detect at later stages of the disease, especially in thin patients. When the tumor reaches a significant size (sometimes hypernephroma reaches the size of the head of an adult), it is possible to probe through the abdominal wall. It is worth considering that the absence of a tumor formation in the presence of other characteristic symptoms does not exclude the likelihood of a malignant tumor.
With large sizes of the cancerous node, enlarged lymph nodes affected by metastases, and compression of the inferior vena cava, such signs of kidney cancer as swelling of the legs, varicose veins of the spermatic cord and abdominal wall, thrombosis of the deep veins of the legs and inferior vena cava appear.
Pain syndrome It is associated with compression of the surrounding tissues, neurovascular bundles, germination of the tumor mass of the kidney parenchyma. Most often, patients complain of dull aching pains in the abdomen and lumbar region. Over time, the severity of pain increases and they become permanent. When the ureter is closed with a blood clot, hemorrhage in the tumor tissue or a rupture of the cancerous node, acute and very intense pain may occur - renal colic.
Other characteristic manifestations of the disease include an increase in blood pressure (secondary arterial hypertension), which is associated with damage to the vascular bed or the release of vasopressor agents, renin, into the blood.
With the secretion of biologically active substances by the tumor tissue, various metabolic disorders appear (hypercalcemia, hypoglycemia, fever, etc.). In some patients, in the absence of metastases in the liver, changes in its parenchyma are found up to necrosis, which is manifested by changes in laboratory parameters (increase in alkaline phosphatase, bilirubin, decrease in the amount of albumin in the blood).
In the presence of metastasis in the bones, symptoms such as pain and pathological fractures, dyspnea and hemoptysis occur with lung damage, jaundice with liver metastases, and progressive neurological disorders will result from brain damage. These symptoms indicate the neglect of the process and determine an extremely unfavorable prognosis.
In stages 3 and 4 of the disease, common symptoms are clearly visible - weight loss, weakness, loss of appetite, anemia, prolonged fever. These manifestations form the picture of the so-called cancer cachexia, which occurs during intoxication of the body by the products of tumor exchange, during the decay and necrosis of tumor nodes, and damage to surrounding tissues and organs.
Cancer of the left kidney does not show any clinical features in comparison with the right-sided localization of the disease, however, metastasis may vary. So, with damage to the right kidney, lymphogenous metastases will be detected mainly in the lymph nodes of the portal vein region, while left-sided cancer is characterized by metastasis to the paraaortic (around the aorta) lymph nodes.
It is worth noting that in children the described typical symptoms of kidney cancer practically do not occur, and the presence of a disease can be suspected by the presence of a tumor-like formation, or suspicions arise during an examination for other diseases.
How to detect a tumor?
Diagnosis of kidney tumors in most cases does not cause significant difficulties, but since the disease may be asymptomatic in the early stages, tumors are often detected already in advanced stages.
When a patient visits a doctor, the latter will find out the nature of the complaints, the time of their appearance, the presence of any other diseases of the urinary system, as well as palpate the abdomen and lumbar region, measure blood pressure.
The main instrumental diagnostic methods are:
- Ultrasound procedure,
- Computed tomography (CT) scan,
- Intravenous urography
- Bone scintigraphy, radiography of the lungs with suspected presence of metastases.
Ultrasound procedure It is the most affordable and cheapest diagnostic method that allows you to detect bulk formations in the kidney parenchyma and distinguish them from cysts. The method is harmless and can be used as a screening. The disadvantage of ultrasound is low informational content in overweight individuals.
CT can be considered the main and most informative diagnostic method, and its accuracy reaches 95%. CT can be supplemented by intravenous contrast, which increases the diagnostic value of the study.
Excretory urography implies the intravenous administration of a contrast agent with subsequent x-ray assessment of the size, contours of the kidneys, the state of the pyelocaliceal system, ureters, etc. The method is good because it allows you to evaluate changes in both kidneys at once.
In the presence of contraindications to urography, patients with chronic renal failure, thrombosis of the inferior vena cava MRI.
To assess the functional state of the kidneys, radioisotope scanning. The study itself does not provide accurate data on the tumor, but allows to determine the function of the kidneys, which is important in choosing the tactics of surgical treatment afterwards.
In addition to the listed studies, the doctor will definitely prescribe general blood analysis with determination of hemoglobin, red blood cells, ESR, and Analysis of urine for hematuria and the presence of other impurities.
The most accurate method for diagnosing kidney cancer is puncture biopsy under the control of ultrasound, allowing you to take a fragment of tumor tissue for histological analysis. However, in some cases, if there are contraindications, the surgeon first removes the entire tumor, and only then its histological examination is performed.
It is important to remember that a visit to a doctor allows, as a rule, to promptly establish a diagnosis of cancer and choose an effective treatment tactic.
How to identify kidney cancer
The presence of high-precision equipment in our clinic in Moscow allows us to identify kidney oncology at the very beginning of the disease. Unfortunately, most often this happens during the examination for a completely different reason, because at the initial stages the incipient tumor does not manifest itself. If a malignant neoplasm is suspected after anamnesis, visual examination and palpation, the patient is assigned the following types of examinations:
- Instrumental. These include:
- Ultrasound examination
The internal organs, kidneys and retroperitoneal space are examined. Ultrasound determines the structure of the neoplasm in the kidney, the location and size. Differential diagnostics are carried out to determine the type of process. Ultrasound is well defined, a kidney tumor develops, there is a benign volumetric formation or cysts. The only drawback is that with an overweight patient, signs of kidney cancer on ultrasound are difficult to determine. The description of the study allows the attending physician to determine the treatment tactics in the future. The method is economical, informative and safe for the health of the patient, therefore it is widely used for diagnosis and screening.
- Computed tomography (CT) scan.
The accuracy of a layered x-ray examination reaches 95%. Of particular value is the additional intravenous contrast. Using this method allows us to determine the characteristics of the tumor in kidney cancer according to the tnm system (the size of the formation, the degree of damage to the lymph nodes and the presence of metastases).
- Magnetic resonance therapy (MRI).
On sections of the image of the affected organ obtained using the electromagnetic field, the location of the tumor, its structure, and the presence of metastases are clearly visible.
It is used as an additional remedy for suspected tumor formation in the bladder. A cystoscope is inserted through the urethra and the internal surface is examined to detect a tumor.
- Puncture biopsy.
A puncture needle is inserted into the tissue of the neoplasm under the control of the ultrasound apparatus, then with its help a piece of the affected tissue is taken out and a laboratory study is performed. With the help of IHC (immunohistochemistry), the classification of kidney cancer is determined.
- Urography of the kidneys.
Distinguish survey, retrograde and intravenous research methods. In the first case, contrast is not used, in the second, the contrast medium is introduced into the bladder through a catheter, in the third - intravenously. Then a series of x-rays is taken. Symptoms of a kidney tumor in urograms include a change in the contours, sizes and locations of the urinary system, as well as their functional state.
- Renal angiography.
The contrast medium is introduced through a special catheter into the aorta located above the branch of the renal arteries. In the presence of kidney cancer in the pictures, the tumor becomes clearly visible.
- Osteoscintigraphy (radioisotope scanning).
Bone tissue is scanned using radioisotopes, which tend to accumulate in places with a high level of metabolism, which are oncological formations.
- X-ray of the lungs.
Pictures are taken to identify distant metastases in the chest.
- General urine analysis.
The absence / presence of blood, protein, white blood cells in the urine, which indirectly may indicate the presence of a pathological process in the kidneys and ureters, is determined.
- General blood analysis.
It is prescribed to determine hemoglobin, white blood cell count, immature red blood cell count and other signs of a malignant process.
- Blood chemistry.
An increase in indicators such as creatinine, alkaline phosphatase, urea and uric acid is possible with the development of malignant tumors in the kidneys.
- Blood on tumor markers.
An tumor marker is a specific protein produced by tumor cells or by the body itself. In kidney cancer, different types of tumor markers are determined, but first of all, attention is drawn to the NSE marker. Exceeding its indicators indicates the presence of a pathological process, but to make a more accurate diagnosis, a number of additional studies should be carried out.
Our clinic is equipped with modern equipment, research on which is carried out by highly qualified specialists, which eliminates errors in diagnosis. The identification of the disease in the initial stages allows you to save the kidneys and the former quality of life without the use of drastic measures.
What is a kidney tumor?
Like any other tumor in the human body, a kidney tumor is a mass of cells whose progenitor has lost the ability to stop its own division. As a result, the cell began to divide uncontrollably and a cluster of cells appeared that also did not have mechanisms to stop division.
The second characteristic of a kidney tumor, as well as of most other tumors, is the loss of cell specification - since the cell divides quickly, it simply does not have time to specialize. Thus, in a first approximation, a kidney tumor can be characterized as a mass of cells that divide uncontrollably and lose their ability to specialize. The less specialized a tumor cell is to perform its function, the faster it divides, and the greater its ability to spread through the blood and lymph vessels, the more malignant the tumor.
Are all kidney tumors malignant?
Almost 90% of kidney tumors are malignant. The remaining 10 percent are accounted for by angiomyolipomas and other, much rarer, benign kidney tumors. Meanwhile, even benign kidney tumors may well be hazardous to health. For example, angiomyolipoma can damage the blood vessels of the kidney, causing bleeding. As for malignant tumors or kidney cancer, here we are faced with damage to functioning kidney tissue, its vessels and bleeding, with metastasis in the bones, lungs, brain and, accordingly, intolerable pains.
What is kidney cancer metastasis and what does it threaten?
Metastasis is the spread of a tumor through the blood or lymph vessels. Tumors, like all living things in the body, require food provided by the vessels. It is in these vessels that 1-2 cells from the main tumor fall, which spread to various organs. Kidney cancer is characterized by metastasis to the bones and lungs, as well as to the liver, adrenal glands and brain.
Kidney cancer metastasis, like the main tumor, disrupts the function of the organ where it develops. For example, kidney cancer metastasis to the lungs causes a persistent cough, bone metastasis - terrible, debilitating pains, from which only potent narcotic drugs help. Unfortunately, some patients who consult a doctor already have distant metastases in various organs. This sharply worsens the prognosis of the course of the disease, since it is necessary to fight not with one tumor, but, in fact, with tumors by many tumors in several organs.
What to do if an ultrasound scan reveals a kidney tumor?
If kidney cancer is suspected, the patient is prescribed a general urine test, general and biochemical blood tests.
One of the most informative methods for diagnosing kidney cancer is computed tomography. It helps to evaluate the size, shape and localization of a malignant neoplasm, to detect foci in the lymph nodes and other anatomical structures outside the kidneys. The study is often supplemented by intravenous contrast. The introduction of contrast is contraindicated in case of impaired renal function.
Magnetic resonance imaging is used less frequently than CT. It is indicated when a patient cannot be performed with computed tomography with contrast, if there is a suspicion of a tumor invading the inferior vena cava or other large vessels to detect metastatic foci in the brain and spinal cord.
Angiography - radiography with contrasting vessels, kidneys. It helps in diagnosing the disease and planning for surgical treatment.
Positron emission tomography helps detect secondary foci of cancer in various parts of the body. The essence of the method is that a substance is introduced into the patient’s body that has weak radioactivity and accumulates in tumor cells. Then take pictures using a special apparatus, and on them the tumor foci are clearly visible.
Unlike other oncological diseases, kidney cancer biopsy is rare. Usually the results of other studies are enough to decide on the need for surgical intervention. After the operation, the removed tumor is sent to the laboratory to confirm the diagnosis. A biopsy is carried out if other studies do not allow to determine whether the operation is indicated. In cases where surgical intervention is contraindicated, the study of tumor tissue helps determine the tactics of treatment.
Does kidney cancer always need surgery?
There are no categorical, one hundred percent answers in medicine. What is the purpose of kidney cancer surgery? Remove the tumor? Remove kidney with underlying structures? Remove only the primary tumor focus, and then fight metastases in one way or another? Will the patient undergo surgery, what is his general condition? Which surgery to choose for a particular patient? An oncourologist must answer these questions before offering surgical, conservative, or combination treatment. Basically, it depends on the stage of kidney cancer, the location of the tumor, the presence of metastases in the lymph nodes and the general health of the patient.
How does a doctor determine the stage of kidney cancer and what is it based on when proposing a particular treatment method?
The stage of kidney cancer depends on the size and location of the tumor. So, kidney cancer of the first stage is a tumor less than 7 cm, not going beyond the kidneys. Second stage kidney cancer is a tumor less than 10 cm, also not going beyond the kidney. But kidney cancer of the third stage is already a tumor of any size, limited by the kidney, or damaging the adrenal gland, renal vein, but having metastasis in the nearest lymph nodes. The fourth stage kidney cancer can be of any size, however, at this stage the tumor either extends beyond the renal fascia, there is more than one metastasis in the nearest lymph nodes, or there are metastases in the lungs, bones, liver or brain.
The stage of kidney cancer is determined in accordance with the international classification of TNM. Next to each of the three letters of the abbreviation indicate an index describing the characteristics of the primary tumor (T), the defeat of the regional lymph nodes (N), the presence of distant metastases (M):
T1 is a tumor located within the borders of the kidney and having the largest diameter of not more than 4 cm (T1a) or 4–7 cm (T1b).
T2 is a tumor located within the borders of the kidney and having the largest diameter of 7-10 cm (T2a) or more than 10 cm (T1b).
T3 - a malignant neoplasm extends to the renal vein and its branches, to the adrenal gland on the same side, perinephric tissue, without germinating the Gerotia fascia (T3a), to the inferior vena cava below (T3b) or above (T3c) of the diaphragm or grows into the wall of the vein.
T4 - the tumor extends beyond the fascia of Gerota.
N0 - tumor foci in regional lymph nodes are absent.
N1 - a tumor lesion is detected in one lymph node.
N2 - tumor foci are found in two or more regional lymph nodes.
M0 - there are no distant metastases.
M1 - distant metastases are present.
Depending on the values of T, N and M, four stages of kidney cancer are distinguished:
- Stage I: a tumor in the kidney is not more than 7 cm (T1), the lymph nodes are not affected, there are no distant metastases.
- Stage II: the primary tumor is more than 7 cm (T2), there are no lesions in the lymph nodes and distant metastases.
- Stage III: a malignant tumor spreads to neighboring structures (T3) and / or one regional lymph node (N1) is affected.
Stage IV: the tumor spreads to neighboring structures (T4), or 2 or more regional lymph nodes (N2) are affected, or distant metastases (M1) are found.
Why, in one case, with a kidney tumor of 2 cm in size, a kidney removal is proposed, and in the other case, the tumor reaches 5 cm, but the doctor says that only a tumor can be removed while preserving the kidney?
A 2 cm kidney tumor may be located near the renal vessels and its removal may technically be impossible. However, literature data indicate that if there are no metastases to the lymph nodes and distant organs, then a kidney tumor of up to 7 cm can be removed while preserving the kidney, which is certainly better than completely removing the kidney and disabling the patient.
What methods are there for treating kidney cancer?
Conventionally, methods can be divided into surgical and therapeutic. As for surgical methods, this is a traditional “open” surgery, when a surgeon gains access to a kidney by means of a large incision and removes either a tumor (resection of a kidney tumor) or a kidney with underlying structures (radical nephrectomy).
Introduced into our practice radiofrequency ablation of a kidney tumor - a method of treating kidney cancer in patients who, for one reason or another, will not tolerate an “open” or laparoscopic operation. The essence of the method is the introduction of a special tool into a kidney tumor under the control of ultrasound and the destruction of this tumor. To perform radiofrequency ablation, a large incision is not required, since the thickness of the instrument does not exceed 3-4 mm. This method allows you to get rid of the tumor of the so-called "inoperable" patients.