Kidney Cancer

Kidney Cancer or Renal cell cancer (RCC)

Renal cell cancer (RCC), which is distinct from kidney cancer that involves the renal pelvis or renal medulla. About 10 percent are hereditary.

  • About 63,340 new cases of kidney cancer
  • About 14,970 people will die from this disease.
  • Clear cell renal cell carcinoma is the most common type of kidney cancer.
  • Smoking, Being overweight, and High blood pressure are risk factor

Detection of kidney cancer is difficult because there are often no obvious signs or symptoms until a tumor may be quite large. Many of the symptoms that might occur – palpable mass, flank pain, or blood in the urine – may become manifest only when cancer has grown to a large size. These considerations may lead to important delays in diagnosing kidney cancer, which may, in turn, lead to more advanced disease stage at diagnosis and may undermine treatment efficacy. Most cases of kidney cancer are diagnosed incidentally. This form of kidney cancer is discovered when the individual is being tested for something completely different, by ultrasound, CT scan, or another type of test.

How frequent is Kidney Cancer?

The American Cancer Society’s most recent estimates for kidney cancer in the United States are for 2018:

About 63,340 new cases of kidney cancer (42,680 in men and 22,660 in women) will occur.

About 14,970 people (10,010 men and 4,960 women) will die from this disease.

These numbers include all types of kidney and renal pelvis cancers.

Most people with kidney cancer are older. The average age of people when they are diagnosed is 64. Kidney cancer is very uncommon in people younger than age 45.

Kidney cancer is among the 10 most common cancers in both men and women. Overall, the lifetime risk for developing kidney cancer in men is about 1 in 48. The lifetime risk for women is 1 in 83.

What are the types of Kidney Cancer?

The terms ‘kidney cancer’ and ‘renal cell carcinoma’ are often used interchangeably, but in fact renal cell carcinoma is the most common type of kidney cancer. The three most common are the clear cell, chromophobe and papillary types. Renal cell carcinoma is also classified according to its extent or stage.

Clear cell renal cell carcinoma: A type of cell that looks clear inside when viewed under a microscope. Clear cell renal cell carcinoma is the most common type of kidney cancer. Approximately 75–80% of kidney cancers are this subtype.

Papillary renal cell carcinoma: The second most common type of kidney cancer. Approximately 10–15% of kidney cancers are this subtype.

Chromophobe renal cell carcinoma: This type accounts for only 5% of all kidney cancers. Chromophobe kidney cancer rarely spreads outside of the kidneys.

Collecting duct carcinoma: A rare type of kidney cancer that arises in the collecting ducts of the kidneys.

Transitional cell carcinoma: of every 100 cancers in the kidney, about 5 to 10 are transitional cell carcinomas (TCCs), also known as urothelial carcinomas.

Transitional cell carcinomas don’t start in the kidney itself but in the lining of the renal pelvis (where the ureters meet the kidneys). This lining is made up of cells called transitional cells that look like the cells that line the ureters and bladder.

Wilms tumor (nephroblastoma): Wilms tumors almost always occur in children. This type of cancer is very rare among adults.

Renal sarcoma: renal sarcomas are a rare type of kidney cancer that begin in the blood vessels or connective tissue of the kidney. They make up less than 1% of all kidney cancers.

What are risk of kidney cancer?

Kidney cancer is the 10th most commonly occurring cancer in US.  It is more common in men than in women.  Kidney cancer occurs most often in people 45 years of age and older. Like many cancers, the exact causes of kidney cancer are not really known.  However, there is scientific evidence that the following factors increase your risk of developing kidney cancer

  • Smoking
  • Being overweight or obese
  • High blood pressure (hypertension)
  • Inherited (hereditary) genetic disorders
  • Family history of kidney cancer
  • Advanced kidney disease
  • Occupational exposure to certain chemicals like the chemical trichloroethylene (TCE) at work are at an increased risk of developing kidney cancer and the risk seems to increase with exposure to higher levels of TCE. TCE is a solvent that is mainly used in industries to remove grease from metal and may also be used in dry cleaning.

Some people develop kidney cancer without having any of these risk factors.  Also, having some of these risk factors does not mean you will develop kidney cancer.  Other risk factors may be linked to kidney cancer, but there is not enough evidence to show that they cause kidney cancer

 

 What is the inheritance of kidney cancer?

It is likely that other undiscovered genes and background genetic factors contribute to the development of familial RCC in conjunction with nongenetic risk factors.

Four major autosomal dominantly inherited RCC syndromes have been identified: von Hippel-Lindau disease (VHL, caused by pathogenic variants in VHL); hereditary leiomyomatosis and renal cell cancer (HLRCC, caused by pathogenic variants in FH); Birt-Hogg-Dubé syndrome (BHD, caused by pathogenic variants in FLCN); and hereditary papillary renal carcinoma (HPRC, caused by pathogenic variants in MET). Each of these syndromes, with the exception of HPRC, is associated with other benign or malignant tumors in other organs.

Regular surveillance is a mainstay in individuals found to have or be at risk of carrying a pathogenic variant in VHL, FH, FLCN, or MET. Surveillance recommendations include regular screening for both renal and nonrenal manifestations of the disease.

What are the Stages and treatments for Kidney Cancer?

A treatment plan for kidney cancer Depend on Stage, type, and hereditary type. Treatment may include one or more of the following:

Active Surveillance

This means watching your kidney tumour closely by doing imaging tests such as CT scans, MRIs or ultrasounds and waiting to start treatment until the tumor grows or starts to cause problems.  This may be an option for some people with small, slow-growing renal masses (tumor is smaller than 4 cm), or if you are elderly and have other serious health problems.  Some patients may not be healthy enough for surgery, or their kidney tumour may not pose a large risk to their health at the time, so treatment and the risks associated with it are delayed until it is really needed.  Kidney tumors smaller than 4 cm rarely spread (metastasize).  They can usually be removed by doing a partial nephrectomy or treated with ablative therapies if they start to show aggressive features during surveillance.

Surgical interventions

The management of Renal tumors has changed significantly as clinicians have learned how to balance the risk of cancer dissemination while minimizing renal morbidity. Some of the initial surgical series focused on performing radical nephrectomy. Nephron-sparing surgery (NSS) for in the 1980s. NSS is now considered the surgical standard of care when technically feasible.

Ablative techniques-Radiofrequency ablation (RFA) and cryoablation (CA)

Thermal ablative techniques utilize either extreme heating or cooling of a mass in an effort to destroy the tumor. For sporadic renal masses, both thermal ablative techniques have a nearly 90% recurrence-free survival rate, leading the American Urologic Association to consider this as a recommendation in high-risk patients with a small renal mass (≤4 cm).

Chemotherapy/immunotherapy

Targeted therapy has been utilized during the past 6 years for the treatment of renal cell carcinoma especially those that are the inherited forms.

 aldesleukin, a vascular endothelial growth factor (VEGF) receptor tyrosine kinase inhibitors, mTOR inhibitors, and checkpoint inhibitors are based on data from the treatment of sporadic clear cell kidney cancer. Despite limited studies investigating these agents in the VHL population with metastatic kidney cancer, they are believed to be efficacious and are available as treatment options.

A 2011 study prospectively evaluated the safety and efficacy of sunitinib in patients) and the significant response was observed in RCC.

Radiation therapy: can be used to slow down or even stop the progression of renal cancer that has spread to other parts of the body; for example, to bone.

Tumour embolization: If a tumor is contained within the kidney, only surgical management is required. If cancer has spread (metastasized) from the kidney to other parts of the body, medical management (medication) becomes necessary. Whenever possible, surgery is used in conjunction with targeted therapy.

When life throws questions and decisions about you or family, what you need – quite simply – is information, answers, and direction. This online guide has been developed to provide you with clear and practical information about cancer.

The information in this document does not replace a medical consultation. It is for personal guidance use only. We recommend that patients ask their doctors about what tests or types of treatments are needed for their type and stage of the disease.

Sources:

American Cancer Society

The National Cancer Institute

National Comprehensive Cancer Network

American Academy of Gastroenterology

National Institute of Health

MD Anderson Cancer Center

Memorial Sloan Kettering Cancer Center

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