According to the World Cancer Research Fund, kidney cancer was ranked 9th among the most common oncological pathologies in the world in 2018. Most tumors develop from the renal tubules, which actively filter up to 2000 liters of blood per day. As a result, kidney cancer is mostly diagnosed at an early stage, before metastasizing. Kidney cancer treatment includes surgical tumor removal, biological therapy and maintenance of the remaining kidney function.
Symptoms of different kidney cancer stages
Most patients do not have any manifestations at the initial stages of cancer. As the neoplasm grows, renal (related to the kidneys directly) and extrarenal (not related to the kidneys directly) symptoms develop.
Renal symptoms include:
- Acute pain with localization in the hypochondrium or lumbar region
- Pain that is resistant to painkillers
- Appearance of blood in the urine that is visible to the naked eye
- Detection of a palpable neoplasm in the hypochondrium
Extrarenal manifestations of the disease include:
- Swelling of the lower extremities and deep vein thrombosis
- Dilation of the saphenous veins of the anterior abdominal wall
- Severe anemia (hemoglobin levels are less than 70-80 g/L)
- Weight loss, up to cachexia
- Fever, persistent low grade fever
- Persistent and resistant to antihypertensive drugs arterial hypertension
At the advanced stages, the tumor can cause bone pain, coughing up blood or a spinal cord disorders. However, these symptoms, as well as extrarenal manifestations of the disease, are not strictly specific for oncology.
Diagnostics, ranging from simple lab tests to biopsy
An objective examination consists of laboratory tests, imaging studies and biopsy with histological and immunohistochemical examination of a removed tissue sample.
Laboratory diagnostics of kidney cancer includes:
- Complete blood count with assessment of the hemoglobin levels (patients often have anemia), white blood cells, ESR
- Urinalysis serves to identify single red blood cells or macrohematuria
- Biochemical blood test with assessment of the kidney and liver function, protein and blood glucose levels
- Coagulogram involves the assessment of the blood coagulation system, which is especially important at the planning stage of the operation (patients may be prone to spontaneous bleeding)
Instrumental diagnostic methods allow oncologists to evaluate the size and location of the tumor, as well as the degree of its invasion into the surrounding tissue:
- Ultrasound is helpful in distinguishing between cystic formations and solid tumors, determining the approximate volume of the neoplasm and the type of its growth, including spreading to healthy tissues
- CT scan of the abdominal cavity and retroperitoneal space is considered the most informative imaging technique that gives the doctor information about the condition of the kidneys, adrenal glands, liver and portal vein, as well as lymph nodes
- MRI of the abdominal cavity and retroperitoneal space is used as an additional technique, which is informative in assessing spreading of the malignant process
- Renal arteriography is a contrast radiography that allows doctors to selectively assess the condition of the renal blood vessels, including the arteries that feed the tumor
- Skeletal scintigraphy can be prescribed in case of suspected development of bone metastases
Biopsy is considered a "gold standard" of diagnostics. Biopsy is a sampling of kidney tissue in an operating room. Formally, with the available convincing data from imaging studies, the doctors can make a diagnosis without the histological confirmation. Nevertheless, the leading cancer clinics always prefer performing a needle or open biopsy, because its results allow for the accurate determination of the tumor type and planning the optimal kidney cancer treatment.
Treatment methods and individual rehabilitation
A multidisciplinary medical team consisting of an urologist, an oncologist and a surgeon deals with the treatment of kidney cancer. In most cases, the first stage of a comprehensive therapeutic regimen involves a surgical procedure:
- Partial laparoscopic nephrectomy can be performed in patients with tumors less than 4 cm in size, especially in presence of concomitant impaired kidney function, when total removal of the affected organ will lead to severe kidney failure. Tumor resection is performed within healthy tissues. This means that there should be no cancer cells it the edges of the surgical wound, which can be confirmed by an intraoperative examination of the tumor bed under a microscope.
- Simple nephrectomy involves total removal of the affected organ.
- Simple or laparoscopic nephrectomy with ureterectomy is an extensive operation, which serves to remove the organ itself, adrenal gland, part of the ureter, pararenal adipose tissue and regional lymph nodes.
Alternatives to classical surgery are cryotherapy, radiofrequency ablation and tumor embolization. Chemotherapy and radiation therapy are not considered as first-line methods for nephrological oncopathologies.
The next most effective method is biological therapy, which includes targeted action on the tumor cells and restoration of the patient's antitumor immunity. In particular, in case of metastatic renal cell carcinoma, interferon alpha and interleukin-2 preparations can be used. Both substances are involved in the implementation of non-specific antitumor immune responses. Angiogenesis blockers, tyrosine kinase and mTOR inhibitors are prescribed as targeted agents.
Due to the inevitable damage to the kidneys during the active treatment, patients can often develop kidney failure. Before discharge from the hospital, doctors give detailed recommendations on nutrition (a diet helps normalize kidney function and reduces the need for hemodialysis), physical activity and medications intake. In the most complex situations, a donor kidney transplant can be performed.
Selection of the clinic without any geographical restrictions with Booking Health
The specialized European clinics and clinics in Turkey consistently demonstrate the highest success rates in the treatment of kidney malignancies. Thanks to the Booking Health, when choosing a medical facility, the patients can give priority to the quality of medical services without any geographical limitations.
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Choose treatment abroad and you will for sure get the best results!
Author: Dr. Nadezhda Ivanisova