Kidney Cancer

Definition:
Kidney cancer is usually defined as a cancer that originates in the kidney.

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The two most common types of kidney cancer, reflecting their location within the kidney, are renal cell carcinoma (RCC) and urothelial cell carcinoma (UCC) of the renal pelvis.
The distinction between these two types (RCC and UCC) is important because their prognosis, staging, and management, i.e. treatment (e.g. surgery, chemotherapy etc.), are different.

Renal cell carcinoma (RCC) is the most common type in adults, responsible for approximately 80 per cent of cases.

Types:
In addition to renal cell carcinoma and renal pelvis carcinoma, other, less common types of kidney cancer include:

*Squamous cell carcinoma
*Juxtaglomerular cell tumor (reninoma)
*Angiomyolipoma
*Renal oncocytoma
*Bellini duct carcinoma
*Clear-cell sarcoma of the kidney
*Mesoblastic nephroma
*Wilms’ tumor, usually is reported in children under the age of 5.
*Mixed epithelial stromal tumor

Rarely, some other types of cancer and potentially cancerous tumors that more usually originate elsewhere can originate in the kidneys. These include:

*Clear cell adenocarcinoma
*Transitional cell carcinoma
*Inverted papilloma
*Renal lymphoma
*Teratoma
*Carcinosarcoma
*Carcinoid tumor of the renal pelvis

Cancer in the kidney may also be secondary, the result of metastasis from a primary cancer elsewhere in the body.

Around 208,500 new cases of kidney cancer are diagnosed in the world each year, accounting for just under 2% of all cancers. The highest rates are recorded in Northern America and the lowest rates in Asian and African regions.

In the United States in 2008, these two types together are estimated to cause 54,390 new cases and 13,010 deaths.

2005. The most recent estimates of incidence of kidney cancer suggest that there are 63,300 new cases annually in the EU25. In Europe, kidney cancer accounts for nearly 3% of all cancer cases.

In the UK kidney cancer is the eighth most common cancer in men, with 4,622 new cases diagnosed in 2005. This compares to 2,758 new cases of kidney cancer in women, giving a male:female ratio of 1.5:1. In women it is the fourteenth most common cancer. Male kidney cancer incidence rates increased by more than 85% from 7.1 per 100,000 in 1975 to 13.4 per 100,000 in 2005. In women the rates have more than doubled over the same period from 3.2 to 6.6 per 100,000. Most of the increase has occurred in older men and women, with rates more than doubling between 1975 and 2005 for men in their 70s and early 80 and women aged 65 and over. The incidence of the disease in Britain has an aspect ratio of 50.6% of the final exitus( quote by Welsh Cancer Intelligence, 2005 ).

The incidence of kidney cancer is increasing also in the United States, and this increase is thought to be real, at least in part, not due only to changes in diagnostic practices.

Some types of kidney cancer have a known hereditary or familial risk, and to date five hereditary syndromes have been associated with renal cell carcinoma

Symptoms:
Many people with kidney cancer have no symptoms at first, especially when the cancer is small. The affected kidney will become larger and in time, the tumour may grow through the wall of the kidney and invade nearby tissues and organs, such as the muscles around the spine, liver and nearby large blood vessels.

As the cancer develops, the following may occur:

•Blood in the urine, which is usually painless and may ‘come and go’ as the tumour bleeds (the first symptom in 60 per cent of cases)
•Pain in the back or side
•Swelling in the abdomen
•High blood pressure
•Feeling generally unwell or tired
•Loss of appetite
•Polycythaemia (too much blood in body) or anaemia (too little)
•Varicocele (tangled network of veins in the scrotum)
•Hip fracture, owing to spread of the cancer to bone
•Excessive hair growth in females
•Feeling thirsty
•Night sweats
•Severe weight loss

Causes:
Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Doctors can seldom explain why one person develops kidney cancer and another does not. However, it is clear that kidney cancer is not contagious. No one can “catch” the disease from another person.

Research has shown that people with certain risk factors are more likely than others to develop kidney cancer. A risk factor is anything that increases a person’s chance of developing a disease.

Studies have found the following risk factors for kidney cancer:

•Smoking: Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as nonsmokers to develop kidney cancer. Cigar smoking also may increase the risk of this disease.
•Obesity: People who are obese have an increased risk of kidney cancer.
•High blood pressure: High blood pressure increases the risk of kidney cancer.
•Long-term dialysis: Dialysis is a treatment for people whose kidneys do not work well. It removes wastes from the blood. Being on dialysis for many years is a risk factor for kidney cancer.
•Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It is caused by changes in the VHL gene. An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body. Family members of those with this syndrome can have a test to check for the abnormal VHL gene. For people with the abnormal VHL gene, doctors may suggest ways to improve the detection of kidney cancer and other diseases before symptoms develop.
•Occupation: Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk.

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Diagnosis:-

If a patient has symptoms that suggest kidney cancer, the doctor may perform one or more of the following procedures:

•Physical exam: The doctor checks general signs of health and tests for fever and high blood pressure. The doctor also feels the abdomen and side for tumors.
•Urine tests: Urine is checked for blood and other signs of disease.
•Blood tests: The lab checks the blood to see how well the kidneys are working. The lab may check the level of several substances, such as creatinine. A high level of creatinine may mean the kidneys are not doing their job.
•Intravenous pyelogram (IVP): The doctor injects dye into a vein in the arm. The dye travels through the body and collects in the kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through the kidneys to the ureters and bladder. The x-rays can show a kidney tumor or other problems.
•CT scan (CAT scan): An x-ray machine linked to a computer takes a series of detailed pictures of the kidneys. The patient may receive an injection of dye so the kidneys show up clearly in the pictures. A CT scan can show a kidney tumor.
•Ultrasound test: The ultrasound device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram. A solid tumor or cyst shows up on a sonogram.
•Biopsy: In some cases, the doctor may do a biopsy. A biopsy is the removal of tissue to look for cancer cells. The doctor inserts a thin needle through the skin into the kidney to remove a small amount of tissue. The doctor may use ultrasound or x-rays to guide the needle. A pathologist uses a microscope to look for cancer cells in the tissue.
•Surgery: In most cases, based on the results of the CT scan, ultrasound, and x-rays, the doctor has enough information to recommend surgery to remove part or all of the kidney. A pathologist makes the final diagnosis by examining the tissue under a microscope.

Treatment:
Treatment options which may be considered include:

•Surgery to remove all (or part) of the affected kidney. This is the most common treatment and can be done as a keyhole operation in some cases. If the cancer is at an early stage and hasn’t spread, surgery alone may be enough. If the cancer has spread, surgery to remove the affected kidney may still be advised, often in addition to further surgery to remove a secondary kidney tumour (one which has spread to another part of the body).
•Radiotherapy may be advised to kill any cancerous cells left behind following an operation.
•Arterial embolisation may be used instead of surgery, where the artery to the kidney tumour is blocked. The blood supply to the tumour is then cut off, and the tumour dies.
•Medications such as sunitinib, temsirolimus, bevacizumab, interferon-alpha have improved the outlook for kidney cancer patients. Speak to your specialist about what may be best for you.
Chemotherapy doesn’t work as well as it does for other types of cancer. The type of treatment depends on the type and how large the cancer is, whether it has spread and general health.

If a cure is not realistic, in some cases treatment aims to control the cancer, limiting the growth or spread so it progresses less rapidly. This may limit the amount of symptoms for some time.

If the cancer is confined to the kidney without spreading, and the patient is in otherwise good general health, the outlook is good, with around 95 per cent of patients surviving five years after diagnosis (if the tumour is less than 4 cm). Surgical removal of an affected kidney in this situation gives a good chance of cure.

However, many people with kidney cancer are diagnosed when the cancer has already spread, so a cure is less likely. However, treatment can often slow down the progression of the cancer.

Follow-up care:-

Follow-up care after treatment for kidney cancer is important. Even when the cancer seems to have been completely removed or destroyed, the disease sometimes returns because cancer cells can remain in the body after treatment. The doctor monitors the recovery of the person treated for kidney cancer and checks for recurrence of cancer. Checkups help ensure that any changes in health are noted. The patient may have lab tests, chest x-rays, CT scans, or other tests.

Support for people with kidney cancer

Living with a serious disease such as kidney cancer is not easy. People with kidney cancer may worry about caring for their families, keeping their jobs, or continuing daily activities. Concerns about treatments and managing side effects, hospital stays, and medical bills are also common. Doctors, nurses, and other members of the health care team can answer questions about treatment, working, or other activities. Meeting with a social worker, counselor, or member of the clergy can be helpful to those who want to talk about their feelings or discuss their concerns. Often, a social worker can suggest resources for financial aid, transportation, home care, or emotional support.

Support groups also can help. In these groups, patients or their family members meet with other patients or their families to share what they have learned about coping with the disease and the effects of treatment. Groups may offer support in person, over the telephone, or on the Internet. Patients may want to talk with a member of their health care team about finding a support group.

The Cancer Information Service at 1-800-4-CANCER begin_of_the_skype_highlighting 1-800-4-CANCER end_of_the_skype_highlighting can provide information to help patients and their families locate programs, services, and publications.

The promise of cancer research:

Doctors all over the country are conducting many types of clinical trials. These are research studies in which people volunteer to take part. In clinical trials, doctors are testing new ways to treat kidney cancer. Research has already led to advances, and researchers continue to search for more effective approaches.

Patients who join these studies have the first chance to benefit from treatments that have shown promise in earlier research. They also make an important contribution to medical science by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers do all they can to protect their patients.

Researchers are studying surgery, biological therapy, chemotherapy, and combinations of these types of treatment. They also are combining chemotherapy with new treatments, like stem cell transplantation. A stem cell transplant allows a patient to be treated with high doses of drugs. The high doses destroy both cancer cells and normal blood cells in the bone marrow. Later, the patient receives healthy stem cells from a donor. New blood cells develop from the transplanted stem cells.

Other approaches also are under study. For example, researchers are studying cancer vaccines that help the immune system to find and attack kidney cancer cells.

Patients who are interested in being part of a clinical trial should talk with their doctor.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:
http://www.bbc.co.uk/health/physical_health/conditions/in_depth/cancer/typescancer_kidney.shtml
http://en.wikipedia.org/wiki/Kidney_cancer
http://www.medicinenet.com/kidney_cancer/page7.htm
http://www.doctortipster.com/1788-kidney-cancer-diagnosis-and-tratment.html

http://www-cancer.us/320/kidney-cancer-treatment/

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