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This website is not intended as a substitute for professional medical advice and does not address specific treatments or conditions specific to any patient. All health and treatment decisions must be made in consultation with your physician(s), utilizing your specific medical information. The information on this website is subject to change.
WHAT ARE THE KIDNEYS?
The kidneys are part of the urinary tract. They are a pair of organs found just above the waist on each side of the spine.
The kidneys remove waste products from the blood and produce urine. As blood flows through the kidneys, they filter waste products, chemicals, and unneeded water from the blood. Urine collects in the middle of each kidney, an area called the renal pelvis. Urine then drains from the kidney through a long tube, the ureter, to the bladder, where it is stored.
The kidneys also make substances that help control blood pressure and regulate the formation of red blood cells.
WHAT IS CANCER?
Cancer is a group of diseases. More than 100 different types of cancer are known and there are several types of kidney cancer. They all have one thing in common: cells become abnormal. These abnormal cells grow and destroy body tissue and can spread to other parts of the body.
Healthy cells that make up the body's tissues grow, divide, and replace themselves in an orderly way. This process keeps the body in good repair. If cells lose the ability to control their growth, they grow too rapidly and without any order. They form too much tissue. The mass of extra tissue is called a tumor. Tumors can be benign or malignant.
Benign tumors are not cancer. They do not spread to other parts of the body and are seldom a threat to life. Benign tumors can usually be removed, and they are not likely to return.
Malignant tumors are cancer. They can invade and destroy nearby healthy tissues and organs. Cancerous cells can also break away from the tumor and enter the bloodstream and lymphatic system. That is how cancer can spread to other parts of the body. This spread is called metastasis. Cancer that spreads is the same disease, and the new tumors have the same name as the original, or primary, cancer. Each year, more than 28,000 Americans find out they have cancer of the kidney.
In adults, most kidney cancers develop in the tissues that filter blood and produce urine. This type of cancer is called renal cell cancer. Cancer of the renal pelvis is called transitional cell carcinoma. This disease is very much like the type of cancer that occurs in the bladder, and it is often treated like bladder cancer.
Childhood kidney cancer is different from kidney cancer in adults. The most common type of kidney cancer in children is Wilms' tumor.
WHAT CAUSES KIDNEY CANCER?
Kidney cancer affects men about twice as often as women. Most people who contract this disease are over the age of 50.
At this time, the causes of kidney cancer are not well understood. It can seldom be explained why one person gets this disease and another doesn't. Kidney cancer is not contagious; no one can "catch" any type of cancer from another person.
Although scientists do not know exactly why kidney cancer develops, they have learned that some things (risk factors) increase a person's chance of getting this disease. For example, we know that smoking is a major risk factor for kidney cancer. Smokers are twice as likely to get this disease as nonsmokers. Scientists think cigarette smoking causes more than one-fourth of all kidney cancers in the United States. People who smoke are also more likely to get cancers of the lung, mouth, throat, larynx (voice box), esophagus, bladder, and pancreas.
Some people have developed kidney cancer after heavy, long-term use of a pain-killing drug called phenacetin. This drug is no longer sold in the United States.
Several studies suggest that the risk of developing kidney cancer may be higher than average among people with certain jobs. Groups with increased risk include coke oven workers and those who work with asbestos. Scientists are trying to learn more about these workers, and they are studying other occupations as well.
Although scientists cannot yet explain why, research shows that being overweight can increase the chance of getting some types of cancer. Kidney cancer may be one of them. Maintaining ideal weight may reduce the risk of cancer and other diseases, including heart disease, diabetes, and high blood pressure.
WHAT ARE THE SYMPTOMS OF KIDNEY CANCER?
The most common symptom of kidney cancer is blood in the urine. In some cases, a person can actually see the blood. It may be present one day and not the next. Traces of blood may also be found in urinalysis , a urine test done as part of a regular medical checkup.
Another symptom of kidney cancer is a lump or mass that can be felt in the kidney area. The tumor may cause a dull ache or pain in the back or side. Less often, signs of a kidney tumor include high blood pressure or an abnormal number of red blood cells.
Symptoms may develop suddenly. However, as with other types of cancer, kidney cancer can cause a general feeling of poor health. People with this disease may feel tired, lose their appetite, and lose weight. Some have a fever that comes and goes.
These symptoms may be caused by cancer or by other, less serious problems such as an infection or a fluid-filled cyst. A doctor is consulted for a definite diagnosis.
HOW IS KIDNEY CANCER DIAGNOSED?
To diagnose kidney cancer, the patient's personal and family medical history and is taken and a thorough physical examination is conducted. In addition to checking temperature, pulse, blood pressure, and other general signs of health, the doctor usually orders blood and urine tests and may do one or more of the exams described below (if transitional cell carcinoma is suspected, other tests may be used).
An IVP (intravenous pyelogram) is a test that lets the doctor see the kidneys, ureters, and bladder on x-rays. The x-rays are taken after an injection of dye that shows up on the x-ray film.
A CT or CAT scan is another x-ray procedure that gives detailed pictures of cross-sections of the body. The pictures are created by a computer.
Ultrasound is a test that sends high-frequency sound waves, which cannot be heard by humans, into the kidney. The pattern of echoes produced by these waves creates a picture called a sonogram. Healthy tissues, cysts, and tumors produce different echoes.
An arteriogram is a series of x-rays of blood vessels. Dye is injected into a large blood vessel through a narrow tube called a catheter. X-rays show the dye as it moves through the network of smaller blood vessels around and in the kidney.
MRI (magnetic resonance imaging) uses a very strong magnet linked to a computer to create pictures of cross-sections of the kidney.
A nephrotomogram is a series of x-rays of cross-sections of the kidney. The x-rays are taken from several angles before and after injection of a dye that outlines the kidney.
If these tests suggest that a tumor is present, the doctor may confirm the diagnosis with a biopsy. A thin needle is inserted into the tumor to withdraw a sample of tissue. The tissue is examined under a microscope by a pathologist to check for cancer cells.
When a diagnosis of kidney cancer is made, it is important to know the extent, or stage, of the disease. Because kidney cancer can spread to the bones, lungs, liver, or brain, staging procedures may include special x-rays and tests to check these organs.
HOW IS KIDNEY CANCER TREATED?
Treatment for kidney cancer depends on the location and size of the tumor and whether the cancer has spread to other organs. The person's age and general health are also considered in developing a treatment plan to fit the patient's needs.
Treatment Methods
Kidney cancer is treated with surgery, embolization, radiation therapy , hormone therapy, biological therapy , or chemotherapy . One treatment method or a combination can be used, depending on the patient's needs. In many cases, the patient is referred to doctors who specialize in different kinds of cancer treatment. Sometimes, several specialists work together as a team.
Most kidney cancer patients have surgery, an operation called a nephrectomy. In some cases, the surgeon removes the whole kidney or just the part of the kidney that contains the tumor. More often, the surgeon removes the whole kidney along with the adrenal gland and the fat around the kidney. Also, nearby lymph nodes may be removed because they are one of the first places where kidney cancer spreads. Finding cancer cells in the lymph nodes means there may be cancer elsewhere in the body.
In embolization, a substance is injected to clog the renal blood vessels. The tumor shrinks because it does not get the blood supply it needs to grow. In some cases, embolization makes surgery easier. When surgery is not possible, this treatment may help reduce pain and bleeding.
Radiation therapy (also called radiotherapy) uses high-powered rays to damage cancer cells and stop them from growing. Radiation therapy can be used to shrink a tumor before surgery or to kill cancer cells that may remain in the body after surgery. For patients who cannot have surgery, radiation therapy may be used instead. Radiation can also be used to treat kidney cancer that has spread to the bones or other parts of the body.
The radiation comes from a large machine. The patient receives radiation therapy 5 days a week for 5 to 6 weeks. This schedule helps protect normal tissue by spreading out the total dose of radiation. The patient does not need to stay in the hospital for radiation therapy.
Surgery, embolization, and radiation therapy are forms of local therapy. They affect only the cells in the treated area. Hormone therapy, biological therapy, and chemotherapy are types of systemic therapy. The substances travel through the bloodstream and affect cells all over the body.
Some kidney cancers may be treated with hormones to control the growth of cancer cells. Some hormones are taken by mouth; others are given by injection. Patients do not need to be in the hospital for their treatment. This kind of treatment helps a small number of patients with advanced kidney cancer, especially when the disease has spread to the lungs.
Biological therapy is a new way of treating kidney cancer. This treatment attempts to improve the way the body's immune system fights disease. Interleukin-2 and interferon are two forms of biological therapy being studied to treat advanced kidney cancer. Doctors are also exploring the benefits of using biological therapy after surgery for early stage kidney cancer. This additional treatment is called adjuvant therapy. Doctors are trying to find out whether adjuvant biological therapy can prevent the cancer from recurring by killing undetected cancer cells that may remain in the body. Most patients having biological therapy must stay in the hospital so that the effects of their treatment can be monitored.
Chemotherapy uses drugs to kill cancer cells. Chemotherapy has not been very effective against kidney cancer, but researchers are studying new drugs and new drug combinations that may prove to be useful.
WHAT ARE THE SIDE EFFECTS OF TREATMENT FOR KIDNEY CANCER?
The methods used to treat kidney cancer are very powerful. It is hard to limit the effects of treatment so that only cancer cells are destroyed; healthy cells may also be damaged. That is why treatment often causes unpleasant side effects. Side effects depend on the type of treatment and the part of the body being treated.
Nephrectomy is major surgery. For a few days after the operation, most patients need medicine to relieve pain. Discomfort may make it difficult to breathe deeply, and patients have to do special coughing and breathing exercises to keep their lungs clear. Patients may need IV (intravenous) feedings and fluids for several days before and after the operation. Nurses will keep track of the amount of fluid the patient takes in and the amount of urine produced. The remaining kidney takes over the work of the one that was removed.
Embolization can cause pain, fever, nausea, or vomiting. These problems are treated with medicine. Often, patients also require intravenous fluids.
During radiation therapy, the patient may become very tired as the treatment continues. Resting as much as possible is important. Skin reactions (redness or dryness) in the treated area are also common, and the skin should be protected from the sun. Good skin care is important at this time, but the patient should not use any lotion or cream on the skin without consulting the doctor. Radiation therapy can cause nausea, vomiting, and diarrhea . Usually, certain foods and medicines can ease these problems.
The side effects of hormone therapy are usually mild. Progesterone is the hormone most often used to treat kidney cancer. Drugs containing progesterone generally cause few side effects, though some patients may retain fluid and gain weight.
The side effects caused by biological therapies vary with the type of treatment. Often, these treatments cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Sometimes, patients develop a rash with dry, itching skin. Patients often feel very tired after treatment. In addition, interleukin-2 can cause the patient to retain fluid. These problems can be severe, and most patients need to stay in the hospital during treatment.
Loss of appetite can be a serious problem for patients during their treatment for cancer. Patients who eat well may be better able to withstand the side effects of their treatment, so good nutrition is an important part of the treatment plan. Eating well means getting enough calories to prevent weight loss and having enough protein to regain strength and rebuild normal tissues. Many patients find that eating several small meals and snacks during the day works better than trying to have three large meals.
The side effects that patients have during cancer treatment vary for each person. They may be different from one treatment to the next. Attempts are made to plan therapy to minimize problems. Fortunately, most side effects are temporary. Doctors, nurses, and dietitians can explain the side effects of cancer treatment and can suggest ways to deal with them.
WHAT HAPPENS AFTER TREATMENT FOR KIDNEY CANCER?
Regular follow-up examinations are very important after treatment for kidney cancer. These exams help doctors detect and treat problems if they should arise. Checkups can include exams, chest x-rays, and lab tests. The doctor sometimes orders scans (special x-rays) and other tests, too.
The diagnosis of kidney cancer can change the lives of cancer patients and the people who care about them. These changes can be difficult to handle. It is natural for patients and their families and friends to have many different and sometimes confusing emotions.
At times, patients and their loved ones may feel frightened, angry, or depressed. These are normal reactions when people face a serious health problem. Others in the same situation have found that they cope with their emotions better if they can talk openly about the illness and their feelings with those close to them. Sharing feelings can help everyone feel more at ease, opening the way for others to show their concern and offer their support.
Concerns about what the future holds, as well as worries about tests, treatments, a hospital stay, and medical bills, are common. Talking with doctors, nurses, or other members of the health care team may help to calm fears and ease confusion. Patients can take an active part in decisions about their medical care by asking questions about kidney cancer and their treatment choices. Patients often find it helpful to write down questions to ask the doctor as they think of them. Taking notes during visits to the doctor helps them remember what was said. It also helps to take a family member or friend along to the physician. Patients should ask the doctor to explain anything that is not clear.
Patients have many important questions, and the doctor is the best person to answer them. Most people ask about the extent of their cancer, how it can be treated, and how successful the treatment is likely to be.
Doctors often talk about "surviving" cancer, or they may use the term "remission" rather than "cure." They use these terms because cancer can recur. It is natural for patients to be concerned about their future. Sometimes they use statistics to try to figure out their chance of being cured. It is important to remember, however, that statistics are averages. They are based on the experiences of large numbers of patients, and no two cancer patients are alike. Only the doctor who takes care of the patient knows enough about his or her care to discuss the chance of recovery (prognosis).
The doctor is the best person to give advice about treatment, working, or limiting daily activities. Patients may also want to discuss concerns about the future, family relationships, and finances. If it is hard to talk with the doctor about feelings or other personal matters, it may be helpful to speak with a nurse, social worker, counselor, or a member of the clergy.
Sometimes patients who have been treated for cancer are concerned that the changes in their lives and the changes to their bodies will affect the way other people feel about them. They may worry about holding a job, caring for their family, or starting new relationships.
Learning to live with the changes brought about by kidney cancer is easier for patients and those who care about them when they have helpful information and support services. Many patients feel that it also helps to talk with others who are facing problems like theirs. They can meet other cancer patients through self-help and support groups. Often, a social worker at the hospital or clinic can suggest local and national groups that will help with rehabilitation, emotional support, financial aid, transportation, or home care.
WHAT DOES THE FUTURE HOLD IN THE FIELD OF KIDNEY CANCER?
Scientists are trying to find better ways to detect kidney cancer in an early stage, before it has begun to spread. For example, they are studying tumor markers, substances that may be present in abnormal amounts in the blood or urine of a person with kidney cancer. Several of these markers have been studied, but no reliable marker has yet been found.
KIDNEY CANCER AT A GLANCE
- The cause of kidney cancer is not known, however, risk factors have been identified
- Childhood kidney cancer is different from the adult kidney cancer
- The most common symptom of kidney cancer is blood in the urine
- The diagnosis of kidney cancer is supported by findings of the medical history and examination, blood, urine and x-ray tests and confirmed with a biopsy
- Treatment of kidney cancer depends on the location and size of the tumor, as well as the age and health of the patient
- Kidney cancer is treated with surgery, embolization, radiation therapy, hormone therapy, biological therapy or chemotherapy
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