Kidney cancer treatment
Kidney cancer is not very common but is a malignant disease in the kidney. Most often, the doctor detects it with ultrasound by accident. Currently, there are many effective treatments: surgery (including da Vinci robotic surgery) remains the primary approach, chemotherapy (systemic and local), radio-, immuno-, targeted, proton and ablation therapy.
Kidney cancer is an abnormal growth of malignant renal cells. A malignant kidney tumour is a cell mass that divides without control and can penetrate surrounding tissues. The quicker the cells divide, the faster they spread through the lymphatic and blood vessels. As a result, the formation becomes more malignant and distant metastases occur. There are different types of kidney cancer, including:
- Renal cell carcinoma (RCC) makes up around 90% of all kidney tumours and usually originates in the cells of the urinary canal (tubular system).
- Transitional cell cancer is similar to malignant bladder and ureter tumours in their tissue structure. It is therefore treated differently from kidney cancer.
- Renal sarcoma is a rare type of kidney cancer that originates in the connective tissues and can spread to nearby organs and bones.
- Wilms tumour occurs almost exclusively in children under five.
Renal cancer is dangerous because noticeable symptoms can appear at a late stage of the disease, making early diagnosis and effective surgical intervention impossible.
The disease is relatively rare however is hard to treat. Young people are somewhat rarely affected. Cancer in the kidneys frequently occurs between the ages of 60 and 70. The mean age at onset is around 68 years for men and 72 years for women.
What is the cause of cancer in kidneys?
The causes of the development of kidney cancer have not yet been clarified. However, certain facts are known to increase the risk of the disease:
- According to statistics, kidney malignancy is more often diagnosed in men. These are primarily people over 50 years old.
- Smoking increases the chances of developing oncology almost three times.
- High blood pressure can cause the development of cancerous changes in the kidneys.
- Long-term use of drugs that stimulate the formation and excretion of urine can increase cancer risk.
- Obesity disrupts the patient's hormonal background, increasing the risk.
- After kidney transplantation or long-term renal treatment, that happens due to taking drugs that suppress our immune system to prevent organ failure.
- According to medical statistics, the risk of developing oncological processes in the kidneys is higher in those patients whose relatives had some cancer.
- Working with toxic exposition and constant inhalation of harmful substances increases the risk several times.
Kidney cancer symptoms
Kidney carcinomas rarely cause symptoms in the early stages. They are almost always discovered by accident, for example, during preventive ultrasound examinations.
With the development of the illness, hematuria occurs (discharge of blood clots during urination). The release of blood in the urine can be both a single case and a long-term phenomenon. Unfortunately, painful symptoms do not accompany hematuria, so it often goes unnoticed. The following signs or complaints can indicate kidney cancer:
- Unwanted weight loss;
- Loss of appetite;
- Persistent low-grade fever;
- Bloody or very dark urine;
- Dull pain in the lateral back area (flank pain);
- High blood pressure;
- Swollen legs.
In men, a kidney tumour can trigger a ruptured varicose vein in the testicles.
In the late stages, renal cell cancer manifests as severe aching pain. Sharp pain outbursts indicate the death of kidney tissue. Also, at stages 3 and 4, a specialist can detect a tumour during palpation, which means that its size has reached its maximum.
How is cancer in the kidney diagnosed?
In some cases, kidney cancer does not show any symptoms. It is often discovered by chance - during a usual kidney check-up or an ultrasound examination of the abdominal cavity organs due to other concerns. Only an experienced specialist (urologist or nephrologist) can detect the disease early or confirm its absence.
Laboratory tests are routinely performed, but there are no specific tumour markers that would be suitable for the detection of kidney tumours. The blood and urine tests show the function of the kidneys and other organs such as the liver, heart, and lungs.
Imaging tests are essential for accurate diagnosis. First, healthcare providers should see the tumour to understand its location and size. The kidney ultrasound examination is a required examination method for detecting kidney carcinoma. Experienced doctors use it to distinguish a tumour from a benign cyst in over 90% of cases. In addition, ultrasound scans are painless and do not expose the patient to harmful radiation. Computed tomography of the abdomen and pelvis is a unique X-ray method for layer-by-layer body examination. CT offers the highest accuracy in distinguishing between a benign and a malignant kidney tumour. It also precisely determines the spread of the tumour. The typical CT picture of a renal cell carcinoma justifies the immediate operation. As more advanced options, your urologist might prescribe a contrasted CT scan or angiography (if any relation to vessels is suspected).
The biopsy is carried out to confirm that suspected cells are malignant. Then, the doctor inserts a hollow needle with a punch through the abdominal wall into the tumour. The procedure is usually done with the help of imaging techniques (ultrasound or CT). A biopsy is unnecessary for most kidney neoplasms that are not confirmed.
Magnetic resonance imaging is usually only performed if computed tomography is not possible due to the patient's intolerance to contrast containing iodine. In contrast to CT, MRI uses magnetic fields, and there are no X-rays.
After having the whole picture of the disease, a urologist can perform staging. For example, stages of cancer in kidneys include:
- Stage Ι - the tumour is limited to the kidney, without spreading to the lymphatic system and neighbouring organs;
- Stage ΙΙ - the tumour grows into the adrenal gland without spreading to the lymphatic system and adjacent organs;
- Stage ΙΙΙ - a tumour of any size spread throughout the lymphatic system. There is no spread to surrounding organs or distant metastases;
- Stage ΙV - a kidney tumour that grows into neighbouring organs or has distant metastases.
Treatment options for kidney malignancy
The treatment plan is adopted at an oncology meeting, where specialists from various fields participate, including a urologist-oncologist. The primary treatment method for kidney cancer is surgical intervention, and the presence of isolated metastases is rarely a contraindication.
Surgery is the treatment of choice for renal cancer. If possible, a doctor performs an organ-preserving operation (partial nephrectomy). The procedure is usually conducted as an open operation or as part of a laparoscopy (through minor cuts and a probe). Also, urologists might perform a radical nephrectomy (removal of the whole kidney). Modern surgical procedures include minimally invasive operations:
- Robot-assisted DaVinci kidney surgery is a minimally invasive surgical technique. The robotic system of the device makes it possible to ensure minimal trauma and reduce bleeding during the procedure.
- Renal artery embolisation (RAE) is the procedure of blockage of the kidney artery. During an embolisation procedure, the interventional radiologist injects tiny particles through a catheter into the vessels, feeding a tumour. It causes blood shortage and subsequent renal tumour shrinking.
Chemotherapy is the systemic use of antitumour drugs to reduce the size of the neoplasm so that it can be easily removed as the next step. In addition, there are more targeted types of chemotherapy:
- Transarterial chemoembolisation - is the injection of drugs into the vessel feeding cancerous cells. The simultaneous blockage of this artery kills renal cancer and metastasis.
- Transarterial chemoperfusion - is a chemotherapy method for introducing antitumour drugs into the arteries feeding the malignant neoplasm.
Some drugs force the immune system against the tumour by releasing the brakes on the immune system. Such medications are called immunotherapy and can be a great option if kidney cancer cells have specific particles on their surface to respond correctly. Another drug therapy is target medications. It has a significant result in treating locally advanced or metastatic kidney cancer. This is because they affect tumour metabolism's signalling pathways and slow down or stop growth.
Radiation therapy works by destroying cancer cells. However, radiotherapy is only used in the last stages to treat metastases in renal cell carcinomas, which are less sensitive to radiation. It also relieves discomfort and pain. Proton beams use high-powered energy for kidney cancer treatment. It is safer than conventional radiotherapy because it has minimal effect on surrounding tissues. At the same time, the protons are much more powerful and precise.
There are multiple cases when surgery is no longer the option. Healthcare providers can recommend interventional radiologists to heat and destroy cancer without complications. Ablation therapy directly kills the renal tumour tissue without significant surgical intervention. This technique uses cold (cryoablation), heat (radiofrequency ablation, RFA), microwaves (microwave ablation, MWA), or alcohol (ethanol ablation).
Patients must undergo a preventive examination and ultrasound examination of the kidneys at least once a year. It will not negate the chances of recovery and improve the quality of life. Detecting kidney cancer at an early stage gives high treatment results.
Kidney cancer statistics and prognosis
The prognosis of renal cancer is comparatively good. The relative 5-year survival rate is 78% for men and 76% for women. Early diagnosis is key for successful treatment. For tiny tumours, the chance of recovery is even higher, and the rate is over 90%. In individual cases, however, the statistics depend on the stage of kidney cancer.
Is a cancer of the kidney curable?
A locally limited (non-metastatic) renal cell cancer is curable. If the malignant tumour can be excised entirely, renal cancer is curable. The oncologist can treat kidney tumours and individual metastases using surgery and radiotherapy. Medications are also available to treat kidney cancer affecting the whole body (systemic therapy).
Can a cyst on the kidney turn into cancer?
Cysts of the kidneys are fluid-filled cavities surrounded by an envelope and are very common overall. Benign tumours and cysts can also become cancerous under the influence of certain factors (age, smoking, chronic renal diseases, infections).
Is kidney surgery the best treatment for renal cancer?
Surgery is the treatment of choice and the best way to fight kidney cancer. In the case of a non-spreading tumour that has not metastasised or grown into nearby tissues, removing the neoplasm can cure cancer. As a result, the patient can live even without relapses. But since the disease is often detected in the last stages, this is not enough. Therefore, the most common treatment regimen includes chemo and radiotherapy.
Can kidney cancer spread?
Kidney tumours spread to surrounding tissues, lymph nodes or distant organs. This stage is called metastatic disease. The main ways of metastasis are hematogenous, lymphogenic, and lymphohematogenous. The malignant process may also penetrate the surrounding organs and grow into blood vessels.
Is cancer in kidneys aggressive?
Compared to other malignancies, kidney cancer is not such an aggressive disease. In most cases, doctors detect the early stages of cancer and provide appropriate treatment. It is also noticeable that complete tumour removal often leads to stable remission and shows a good prognosis.
Where can I get Kidney cancer treatment?
What are the best clinics for Kidney cancer treatment?
Who are the best doctors for Kidney cancer?
Prof. Dr. med. Jurgen Gschwend from University Hospital rechts der Isar Munich
Prof. Dr. med. Florian Bassermann from University Hospital rechts der Isar Munich
Prof. Dr. med. Christian Brandts from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Felix K. H. Chun, MA, FEBU from University Hospital Frankfurt am Main of Goethe-University
Prof. Dr. med. Hubert Serve from University Hospital Frankfurt am Main of Goethe-University