The kidney cancer is a relatively common type of cancer, which typically occurs between 50 and 70 years, preferably in men. There are different types, the most common being clear cell cancer (80%) and papillary carcinoma.
What are the causes of kidney cancer?
Kidney cancer has been linked to tobacco use and obesity and is common in patients with a disease from birth called tuberous sclerosis. Families with a greater predisposition to this type of cancer have also been described, so there must be an unidentified hereditary component.
What symptoms does this type of cancer produce?
Patients with kidney cancer:
Sometimes they are asymptomatic. In these cases, the diagnosis is made by chance when performing an ultrasound of the abdomen or a CT scan for any other reason.
- When they have symptoms, the most common are:
- The presence of blood in the urine (hematuria).
- Abdominal pain or pain around
- Appearance of a mass (lump) in the abdomen.
- General symptoms such as weight loss, fever, anemia, high blood pressure or others.
- Often these tumors secrete certain substances that cause an exaggerated increase in the number of red blood cells (polycythemia) or platelets (thrombocytosis), increased calcium, alterations in the liver, etc.
- Sometimes the first manifestation of the tumor is the appearance of distant metastases.
How is the disease diagnosed?
The diagnosis of suspected kidney cancer is established by an ultrasound of the kidney or a CT scan of the abdomen. In patients in which a solid mass is detected (no cyst) in the kidney with any of the above tests, you must always think that may be malignant and must perform other tests, such as X – ray or CT of the chest to rule out the possibility of metastasis and a urine cytology to see if there are malignant cells.
If no metastases are seen, surgery to remove the kidney mass should be recommended for any solid mass, although there is always the possibility that it is a benign tumor or an inflammatory mass. In people who are not candidates for surgery, CT-directed tumor puncture may be considered.
Can it be prevented?
Kidney cancer cannot be prevented. Nor is it indicated to carry out routine studies to rule out its presence in the general population. These periodic studies could however be carried out in:
- People with a significant number of family members with kidney cancer.
- People who have received kidney radiation.
- People with diseases that are associated with an increased risk of developing kidney cancer, such as tuberous sclerosis.
What is the prognosis of affected patients?
Kidney cancer is divided into 4 stages:
- Stage I. Cancer only affects the kidney.
- Stage II. Cancer invades the capsule that surrounds the kidney.
- Stage IIIa. Cancer invades the vena cava or renal vein.
- Stage IIIb. Cancer affects neighboring nodes.
- Stage IV. Cancer invades neighboring organs or metastasizes at a distance.
The prognosis varies depending on the stage, with 5-year survivals ranging between 70% and 10%.
What is the treatment for kidney cancer?
Treatment of kidney cancer depends on the extent of the tumor:
- The recommended treatment in stages I, II, and some III is radical nephrectomy, that is, completely removing the affected kidney, its capsule, the adrenal gland above it, and the local nodes. In some cases, if the tumor is small or if there is kidney failure, a partial nephrectomy can be performed, that is, removing only part of the kidney. In these stages, no additional treatments are recommended.
- In people in whom surgery poses a significant risk, for example in the elderly or in patients with other serious diseases, attempts can be made to destroy the tumor by other techniques such as cryoablation (cold destruction) or radiofrequency ablation.
- In patients with advanced disease (stage IV) the evolution of the tumor is unpredictable. For some doctors, the kidney is not operated on unless there are serious local complications such as continuous bleeding or a lot of pain. For others, if the clinical situation is good, the kidney must be removed to reduce the tumor burden. Subsequently, there are various treatment options depending on whether there is a good or bad prognosis and as the first or second line of treatment:
- Immunotherapy associated or not with VEGF (vascular endothelial growth factor) inhibitors.
- Medications against tyrosine kinase.
- Medications against mTOR.
- Interleukin 2 and alpha interferon.
In general, traditional chemotherapy is not effective in these patients and radiation therapy has limited efficacy.