KIDNEY CANCER

What is it?

Renal cell cancer is a cancer of the lining of the tubules in the kidney. A cancer in the part of the kidney that collects urine and drains it to the ureters (the renal pelvis) is not considered 'kidney cancer' and is treated somewhat differently. Like most cancers, renal cell cancer is best treated when it is found (diagnosed) early.

What are the symptoms?

You should see your doctor if you have one or more of the following: blood in your urine, a lump (mass) in your abdomen, or a pain in your side that doesn't go away. If you have cancer of the kidney, you may also feel very tired or have loss of appetite, weight loss without dieting, or anemia (too few red blood cells).

What tests will the doctor want to do?

If you have signs of cancer, your doctor will usually feel your abdomen for lumps.

Your doctor may order a special x-ray called an intravenous pyelogram (IVP). During this test, a dye containing iodine is injected into your bloodstream. This allows your doctor to see the kidney more clearly on the x-ray.

Your doctor may also do an ultrasound, which uses sound waves to find tumors, or a special x-ray called a CT or CAT scan to look for lumps in the kidney. CT scan also involve injection of the same dye as IVPs. CT scans are used to confirm the findings of the IVP and also to help determine the extent or spread of the cancer in and around the kidney. A special scan called magnetic resonance imaging (MRI), which uses magnetic waves to find tumors, may also be done.

On rare occasions, we will ask the radiologist to do a needle biopsy of a suspected kidney tumor to find out if the lump or mass or cyst seen on the other tests is benign or malignant. We do very few needle biopsies of kidney tumors because of the danger of bleeding and other problems. The diagnosis can usually be made with the X-rays and other tests mentioned above.

Once the diagnosis of kidney cancer is made, your chance of recovery (prognosis) and choice of treatment depend on the stage of your cancer (whether it is just in the kidney or has spread to other places in the body) and your general state of health.

The staging system for renal cell cancer is based upon the degree of tumor spread beyond the kidney. This will be determined by the various tests that will give us some idea of the spread of the tumor before most therapy is offered. These tests may include, although not necessarily all:

1. CT or MRI scans of abdomen, chest and head
2. Bone scans
3. Chest X-ray or chest tomograms (special X-ray type)
4. Arteriogram or venacavagram (X-rays of arteries and veins to and from the kidney)
5. Blood tests

When all staging information that is necessary is available, a stage of the cancer will be given.

What is the treatment?

There are treatments for most patients with renal cell cancer. Five kinds of treatment are used:

1. Surgery (taking out the cancer in an operation)
2. Chemotherapy (using drugs to kill cancer cells)
3. Radiation therapy (using high-dose x-rays or other high-energy rays to kill cancer cells)
4. Hormone therapy (using hormones to stop cancer cells from growing)
5. Biological therapy (using your body's immune system to fight cancer).

Surgery

Surgery is a common treatment for renal cell cancer. Your doctor may take out the cancer using one of the following: Radical nephrectomy removes the kidney with the tissues around it. Some lymph nodes in the area may also be removed.

Partial nephrectomy removes the cancer and part of the kidney around the cancer. This is usually done only in special cases, such as when the other kidney is damaged or has already been removed.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. Chemotherapy may be taken by pill, or it may be put into the body by a needle in a vein or muscle.

Chemotherapy is called a systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body. Unfortunately, our success using chemotherapy for kidney cancer has been limited but new drugs are being tested actively around the country.

Radiation therapy

Radiation therapy uses x-rays or other high-energy rays to kill cancer cells and shrink tumors.

Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that contain radiation through thin plastic tubes (internal radiation therapy) in the area where the cancer cells are found. Radiation can be used alone or before or after surgery and/or chemotherapy.

Radiation as primary treatment for kidney cancer has not met with great success. Radiation's most common uses are to treat areas of cancer spread, such as to bone or brain. On occasion we will treat the kidney directly if the cancer cannot be removed and is causing symptoms such as pain or bleeding.

Hormone therapy

Hormone therapy uses hormones (taken by pill or injected with a needle) to stop cancer cells from growing. We are not sure why hormones work on kidney cancer, but there does appear to be some limited action against the cancers in some patients.

Biological therapy

Biological therapy tries to get your own body to fight cancer. It uses materials made by your own body or made in a laboratory to boost, direct, or restore your body's natural defenses against disease.

Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. That is, we use the body's own immune system to fight the kidney cancer like it would fight an infection. Some limited successes have been obtained using immunotherapy and we continue to research this exciting field looking for better answers.

Other treatment options

Sometimes a special treatment called arterial embolization is used to treat renal cell cancer. A narrow tube (catheter) is used to inject small pieces of a special gelatin sponge into the main blood vessel that flows into the kidney to block the blood cells that feed the tumor. This prevents the cancer cells from getting oxygen or other substances they need to grow.