Urology Health Specialists, LLC - Urologists, Philadelphia, Pennsylvania

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Kidney Cancer

Overview

The kidneys are paired organs which filter the blood, control blood pressure, and secrete certain hormones responsible for red blood cell formation. A malignant tumor of the kidney is called "renal cell carcinoma" or "hypernephroma". These types of tumors account for 85% of kidney tumors. If detected early, kidney tumors can be curable by surgical removal of either the tumor or the entire kidney. In 2006, there were about 39,000 new cases of kidney cancer and about 13,000 people died of the disease. Kidney cancer is the 8th most common cancer in men and the 10th most common cancer in women.

Diagnosis

Most renal cancers have no symptoms early in their course and are often found incidentally on imaging (CT, MRI, Ultrasound). If signs or symptoms are present, the most common presenting sign of a renal tumor is blood in the urine (hematuria). Microscopic blood in the urine may be detected by a simple office test which is usually performed at the time of a yearly physical examination. Blood that is detectable by the naked eye should always be evaluated promptly since it may be a sign of significant disease. When a renal tumor is more advanced, there may be other signs such as weight loss, back or flank pain, fever, or loss of energy. A mass or lump in the abdomen may also be noted by a physician when the tumor is large.

Once a kidney tumor is suspected by any of the above signs, diagnostic studies need to be performed to confirm that a tumor exists. The initial study ordered by a physician will depend upon the individual patient's signs/symptoms. These tests may include:

CT scan of the abdomen and pelvis
MRI
Ultrasound
IVP

In most cases, a CT scan will eventually be performed since this test will confirm that a renal tumor exists and to ensure that it has not spread to other organs. The CT scan will determine the extent (size and location) of the tumor and whether or not other studies are needed. If there is suspicion that the tumor involves adjacent blood vessels or the lungs, additional testing may include a MRI, CT scan of the chest, or arteriogram. Other studies often performed include a chest x-ray, bone scan, and blood tests.

Biopsies of kidney tumors are not routinely performed. Since a biopsy of the kidney mass may "miss" the tumor, a negative biopsy does not exclude the presence of a malignancy. Therefore, if a tumor has the characteristics of a malignancy on appropriate x-ray studies (which may be more reliable than a biopsy), then treatment is warranted.

Treatment

Most patients have 2 equally functioning kidneys. Removal of 1 kidney typically does not affect a person's overall kidney function and most patients can live with only 1 kidney for the remainder of their life. Usually, surgical removal of a renal mass is considered the best option for treatment. Several treatment options are available though:

Active surveillance, also known as observation
Ablation (destruction) of the tumor with cryotherapy (freezing) or radiofrequency ablation (heating) by either percutaneous (through a small hole into the kidney), laparoscopic (surgery through several small skin incisions) or open (surgery through a larger incision) methods
Partial nephrectomy (removing just the tumor and a small amount of normal adjacent kidney tissue)
Radical nephrectomy (removing the entire kidney)
- Partial and radical nephrectomy can be performed by either open, laparoscopic or robotic methods.

For patients who have advanced disease and had the cancer surgically removed, newer therapies are currently being used in appropriate situations to control or even try to prevent the spread of disease. Results for these medications, often called Tyrosine Kinase Inhibitors (TKI's) have been encouraging in recent studies.