Treatment of kidney cancer (renal cancer) abroad
Kidney cancer is included in the top-ten most common cancer types and accounts for 2-4% of all the malignant tumors in different countries. The highest incidence among European countries is observed in Russia and Great Britain.
This number tends to grow, but their life expectancy is also increasing due to the improved treatment techniques.
Causes of kidney cancer
It is well-known that risk of the kidney cancer depends on the person’s lifestyle and environmental factors. The key risk factors are:
- Alcohol addiction
- Certain medicines (ibuprofen, naproxen, x-ray contrast substances)
- Occupational hazards like impact of cadmium or asbestos
Uncontrolled or poorly controlled risk factors are:
- Genetic predisposition
- Kidney pathology when a person requires dialysis
- Hepatitis C
- Renal stone disease
- Hypertension disease
Symptoms of kidney cancer
Cancer may exist without any symptoms with in along period of time. Illness is manifested by a conventional triad of symptoms:
- Hematuria which is blood in the urine. It is not stable. Hematuria can appear 1-2 times, after which it is often absent for a long time. Hematuria appears suddenly, often when a person is completely healthy.
- Kidney is palpable and enlarged. Tumor formation may also be palpable. The presence of this symptom is determined by the size of malformation and its location, as well as the condition of the anterior abdominal wall.
- Pain in the lower back appears when tumor sprouts into the capsule. Pain syndrome strengthens when a tumor grows into the nerve stems of the lumbar roots.
All three symptoms should not necessarily be present. They occur in different times. Accordingly, at the time of patient’s reference, only one or two of the listed clinical signs can be noticed.
Other possible symptoms are:
- Increased blood pressure
- Intoxication symptoms: weakness, subfebrile body temperature, headache
- Weight loss
Sustained blood loss due to hematuria, anemic syndrome develops. But kidney cancer is sometimes accompanied by an increase in the hematopoietic function of the bone marrow due to increased secretion of erythropoietin. Therefore, the number of red blood cells and other formed elements (cells) of blood can increase, but not decrease, even in presence of hematuria.
Diagnostics of the kidney cancer
Next diagnostic measures are done to confirm the diagnosis:
Cytological examination of urine sediment as cancer cells can be found in it.
Methods of visualization like ultrasound, MRI, computed tomography are used. They can detect a tumor-like formation in the kidney. Also, visualization methods are used to:
- Estimate the prevalence of the pathological process
- Evaluate treatment effectiveness
- Detect signs of tumor recurrence after treatment
During fine-needle biopsy doctor takes tissue sample for cytological and histological analysis. It is not necessary to do biopsy to confirm kidney cancer. But, it is obligatory in the certain cases when it’s impossible to confirm the diagnosis other way.
Positron-emission tomography (PET) is a high-tech research method available in German hospitals. It is very rarely used in the developing countries, since most hospitals do not have the appropriate equipment. PET can detect small foci of the tumor, including metastases in the lymph nodes. Fluorodeoxyglucose is introduced into the patient’s body, which is accumulated much faster in cancer cells than in the healthy tissues.
Excretory urography is an additional diagnostic technique used if there is a need to access kidneys function. A contrasting agent is administered intravenously and then excreted by the kidneys at different speed, depending on the kidneys’ function. The location and amount of contrast medium is determined by X-ray images, which are performed at regular intervals.
Angiography is an X-ray examination with the introduction of contrast dye into the renal artery that is used in the planning of kidney cancer surgical treatment.
Treatment of kidney cancer abroad
Surgery is basic for kidney cancer treatment. Volume and type of surgery is determined by the certain clinical case. A doctor performs partial or complete nephrectomy. This means, that a kidney or its damaged fragment are removed.
Also, some other parts can be removed by surgeon’s decision:
- Lymph nodes
- Ureter or its fragment
- Adrenal gland
- Fat tissues surrounding the kidney
They more often completely remove a kidney as this surgery is simpler. Nevertheless, specialists in developed states give preference to the partial nephrectomy. The surgery is more complex but it gives a chance to preserve an organ.
There are contraindications to partial nephrectomy:
- Tumor of a size more than 7 cm
- Its central location
- Presence of several tumors
- Presence of metastases
Kidney cancer doesn’t respond to chemotherapy. It responds to the radiation therapy, but still poorly. Thus, these techniques are rarely used. Radiation therapy may be used as a palliative treatment to ease cancer symptoms.
Innovative treatments of kidney cancer
New treatment techniques are developed constantly while the existing ones are undergoing improvement to reach better therapeutic results.
Target therapy has been used in the recent years at the advanced stages of kidney cancer to slow down the growth of the malformation and increase patient’s life expectancy:
- Drugs that block blood vesselsfeeding the tumor - Sorafenib, Sunitinib
- MPM inhibitors (protein that controls the division of tumor cells) – Temsirolimus
Robotic laparoscopic nephrectomy is the operation performed by a robot, which the surgeon controls remotely. A tube with a camera and surgical instruments are inserted into the patient's body through the small incisions. Robotic laparoscopic nephrectomy makes it possible to achieve:
- Reduction of complications risk
- Reduction of blood loss during surgery
- Reduction of the rehabilitation period
- Reduction of postoperative pain
- Reduction of inpatient stay and inability to work
Surgeons in German hospitals have great experience of robotic laparoscopic surgeries for kidney cancer treatment. But such surgical interventions are possible only if a tumor diameter does not exceed 10 cm. When deciding on the method of surgical treatment, it is also considered whether the tumor germinates into the renal vein or lymph nodes.
- PD-1 and PD-L1 inhibitors are a whole group of new medicines that block proteins hiding a tumor from the immune system. Recent studies have proved that Nivolumab medicine increases patients’ life expectancy at the advanced stages of kidney cancer.
- Dendritic cells are the cells of the immune system taken from the patient's blood. They are treated with cytokines in the presence of inactivated cancer cells. As a result, immune cells “remember” tumor antigens. Afterwards, they are injected back into the body. Dendritic cells “show” what they managed to “remember” to other cells of immunity - those that are responsible for the destruction of foreign agents. Now, the immune system “knows” what a tumor looks like, and begins to attack it. The method is still at the stage of clinical research, but already demonstrates encouraging results.
- Radiofrequency ablation and cryotherapy are minimally invasive methods of treatment at the initial stage of cancer. In the first case, the tumor is heated to a high temperature, in the second - it is frozen. As a result, tissue death occurs. The effectiveness and expediency of using these techniques for kidney cancer treatment has not been proven so far and the research still continues.
Prognosis for kidney cancer
Five-year-survival of patients suffering from kidney cancer in the developed states is:
- Median for all the patients – 73%
- If cancer is present in only one kidney – 92%
- If cancer has spread to the lymph nodes – 65%
- If distant metastases are present – 12%
Median five-year-survival depending on the kidney cancer stage is:
- Stage 1 – 81%
- Stage 2 – 74%
- Stage 3 – 53%
- Stage 4 – 8%
Best prognosis is peculiar for those in the low risk group when cancer didn’t go beyond one kidney borders at the time of diagnosis. Five-year-survival of such patients in Germany reaches 97%.