Kidney Cancer: What are the Symptoms and Treatment?

Kidney cancer is characterized by the presence of cancerous cells in the kidney. Renal cell carcinoma is the most common type of kidney cancer, It is mostly seen in older age (>70). The chances of kidney cancer are highly prevalent in men than women. ¹

Stages of kidney cancer –

Stage I and II – Cancers include tumor of any size that are confined to the kidney.
Stage III – Cancers are either locally invasive or involve lymph nodes.
Stage IV- Cancers have spread beyond the kidney into organs nearby or distant metastases.

What Causes Kidney cancer?

Studies have found that prostate cancer can be caused by different DNA mutations like a mutation in:

FH genes
FLCN gene
SDHB and SDHD genes (familial renal cancer).

What are the Risk factors?

Smoking
Older age
Obesity
Hypertension
Family history
Being on kidney dialysis
Workplace exposure to chlorinated chemicals
Inherited syndromes (4-6%)

Signs and Symptoms

Blood in urine
Persistent pain in the back abdomen
Low back pain on one side
Loss of appetite
Unexplained weight loss
Tiredness
Fever
Anemia

What are the Complications?

Secondary cancers, High blood pressure, Liver and spleen problems, Recurrence of cancer.

Diagnosis: How to diagnose Kidney cancer?

Medical history – Check for symptoms and other risk factors.
Physical examination – Palpation, Auscultation, Blood pressure
Diagnostic tests – The tests performed are:
- Urinalysis
- Blood tests like Complete blood count, blood chemistry tests.
- Imaging tests –
  - Chest x-ray
  - Computerized tomography(CT) scan : Series of x-ray images taken at different angles
  - Positron emission tomography (PET) scan : A procedure that uses radioactive glucose to find malignant tumor cells in the body.
  - Magnetic resonance imaging (MRI) : A procedure that uses a magnet, radio waves, and a computer to make detailed images of areas inside the body.
  - Ultrasound- A procedure in which high-energy sound waves (ultrasound) are used to form a picture of a kidney called a sonogram
- Kidney biopsy – Removal of a small amount of tissue for examination under a microscope to look for precancerous cells or cancer cells.
- Bone scan
- Angiography – x-ray to look for blood vessels.

Treatment: How is Kidney cancer treated?

Surgery is the main treatment for most kidney cancers.

Surgery :
Radical nephrectomy – Surgery that involves removal of the entire kidney, attached adrenal gland, nearby lymph nodes, and the fatty tissue around the kidney.
Partial nephrectomy (nephron-sparing surgery) – Only the part of kidney is removed.
Radiotherapy
- 1. External radiation therapy uses a machine outside the body to send radiation toward cancer.
- 2. Internal radiation therapy uses a radioactive substance that is placed directly into or near cancer.
Cryotherapy
- Use of very cold temperatures to kill cancer cells
Radiofrequency Ablation (RFA) – Use radio waves to heat the tumor and kill cancer cells.
Targeted therapy
- 1. Angiogenesis inhibitor – Bevacizumab – binds to vascular endothelial growth factor (VEGF) – signals growth of new blood vessels ( slows the spread of cancer)
- 2. Kinase inhibitor – Lenvatinib
- 3. mTOR inhibitor therapy: mTOR inhibitors block a protein called mTOR, which helps control cell division. Everolimus, Temsirolimus (Torisel)
Immunotherapy
- Immune checkpoint inhibitor–
  - The immunotherapy drug pembrolizumab (Keytruda) ( PD-1 protein inhibitor) is approved to treat tumors that have either high microsatellite instability (MSI-high) or dMMR, regardless of the tumor’s location in the body.
  - Nivolumab
- PD-L1 inhibitor – Atezolizumab, Durvalumab.
- CTLA-4 inhibitor – Ipilimumab
- Other drugs used in specific cases – Interleukin-2, Interferon-alfa.
Kidney cancer cells are not much responsive to Chemotherapy.

Prevention: Can we prevent it?

Prevention of Kidney cancer –

Kidney cancer is not preventable but some factors may reduce the risk of cancer.

Quit smoking
Healthy weight
Physical activities

Living with Kidney cancer –

Follow-up care ( doctor visits and tests)
Survivorship care plan
Avoid smoking
Staying at a healthy weight
Regular physical activities

When to see a doctor? :

It is wise to consult with a nephrologist immediately if observed any symptoms. The typical consultation fee for a nephrologist ranges from Rs. 1000 to Rs. 2000 in India.