Kidney Cancer
Kidney cancer is one of most common cancers diagnosed with about 76,000 new cases each year. It is usually diagnosed incidentally with imaging done for another ailment and most of the time have no symptoms. Rarely it can have some associated symptoms such as blood in the urine or flank pain. Not all growths seen on the kidney are cancer. About 10-20% of growths could be benign in nature. Kidney tumors can be seen at birth and can arise at any time in life, however most are seen after the age of 50 and the older you are, the higher the chance of kidney cancer.
Symptoms:
- Most commonly- no symptoms
- Flank pain
- Blood in the urine- hematuria
- Flank mass
- Weight loss
- Loss of appetite
- Anemia- low blood counts
Risk Factors:
- Smoking
- Obesity
- High blood pressure
- Exposure to chemicals in the workplace
- Being on dialysis
- Genetics- if a blood relative has had it, it increases your risk
Evaluation and Diagnosis:
Most kidney cancers are found by chance, during a workup for another ailment or just general yearly screening. There are no specific screening tests or symptoms that are specific for kidney cancer.
Physical exams and history are important
Urinalysis- Looking for blood in the urine
Blood work- CBC, CMP- these look for anemia and kidney function abnormalities
Imaging- Renal ultrasound, CT scan or MRI- These are the best tests to know size and location of mass
Kidney biopsy- rarely used as the biopsy itself is not very accurate and there is a risk of spreading cancer as the needle comes out. Biopsies are saved for specific situations when someone only has one kidney or the risk of surgery is very high
Treatment:
The main treatment for kidney cancer is surgery. “Nephron sparing” or partial nephrectomy surgery is ideal- which means to save as much of the healthy kidney as possible. If the tumor is less than 5cm in size and is not in a location that can compromise blood flow to the rest of the kidney, we are able to just remove the tumor. This saves the rest of the kidney so that the overall kidney function is preserved. Sometimes during a partial nephrectomy there is more bleeding than anticipated or the tumor is larger than the X-rays have shown and we convert to a radical nephrectomy- removing the whole kidney.
If the tumor is larger than 5cm or is encroaching on the blood vessels, then a radical nephrectomy is performed- we remove the whole kidney. Humans can live with one kidney, however this is only if the other kidney is functioning well. It is important to protect the other kidney in these cases, so sometimes a Nephrologist gets involved to help manage medications and diet to optimize the other kidney.
In situations where the other kidney is not strong or the patient only has one kidney to begin with, then dialysis may be required.
Usually, partial nephrectomy or radical nephrectomy is the only treatment you will need. If the tumor invades surrounding tissue or recurs, then chemotherapy or immunotherapy will be used. In these cases, you will be referred to an oncologist (cancer doctor).
Ablation- if a patient is not a surgical candidate, then sometimes we use ablation or cryotherapy to kill the tumor. These procedures are not as successful as surgery and are only used when surgery is not an option. These can be done with light sedation thru a needle in the back.
Generally, your urologist will follow you closely for 5 years after treatment to make sure there is no recurrence. This will be done with X-rays, CT scans and blood work. Dr. Shaba will talk to you about follow up after the 5 years depending on your case.
For more information please visit: https://www.urologyhealth.org/urology-a-z/k/kidney-cancer
