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Kidney Cancer

Kidney cancer

Definition

Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma , sometimes referred to as hypernephroma, occurs in the cells lining the kidneys (epithelial cells). It is the most common type of kidney cancer. Eighty-five percent of all kidney tumors are renal cell carcinomas. Wilms' tumor is a rapidly developing cancer of the kidney most often found in children under four years of age.

Description

The kidneys are a pair of organs shaped like kidney beans that lie on either side of the spine just above the waist. Inside each kidney are tiny tubes (tubules) that filter and clean the blood, taking out the waste products and making urine. The urine that is made by the kidney passes through a tube called the ureter into the bladder. Urine is held in the bladder until it is discharged from the body. Renal cell carcinoma (RCC) generally develops in the lining of the tubules that filter and clean the blood. Cancer that develops in the central portion of the kidney (where the urine is collected and drained into the ureters) is known as transitional cell carcinoma of the renal pelvis. Transitional cell cancer is similar to bladder cancer . Wilms' tumor is the most common type of childhood kidney cancer and is distinct from kidney cancer in adults.

Demographics

Kidney cancer accounts for approximately 3% of all cancers. In the United States, kidney cancer is the tenth most common cancer and the incidence has increased by 43% since 1973; the death rate has increased by 16%. There are approximately 20, 000 new cases of kidney cancer found each year. There are approximately 95, 000 deaths per year worldwide due to kidney cancer. RCC accounts for 90-95% of malignant neoplasms that originate from the kidney.

Kidney cancer occurs most often in men over the age of 40. The median age of diagnosis is 65. Men are twice as likely as women are to have cancer of the kidney.

Causes and symptoms

The causes of kidney cancer are unknown, but there are many risk factors associated with kidney cancer. The risk factors listed from greatest to smallest include:

  • von Hippel-Lindau disease (> 100)
  • Chronic dialysis (32)
  • Obesity (3.6)
  • Tobacco use (cigarettes ) (2.3)
  • First-degree relative with kidney cancer (1.6)
  • Hypertension (1.4)
  • Dry-cleaning worker (1.4)
  • Diuretics (non-hypertension use) (1.3)
  • Trichloroethylene exposure (1.0)
  • Heavy phenacetin use (1.1-6.0)
  • Polycystic kidney disease (0.8-2.0)
  • Cadmium exposure (1.0-3.9)
  • Arsenic exposure (1.6)
  • Asbestos (1.1-1.8)

The most common symptom of kidney cancer is blood in the urine (hematuria). Other symptoms include painful urination, pain in the lower back or on the sides, abdominal pain, a lump or hard mass that can be felt in the kidney area, unexplained weight loss , fever , weakness, fatigue , and high blood pressure.

Diagnosis

A diagnostic examination for kidney cancer includes taking a thorough medical history and making a complete physical examination in which the doctor will probe (pal-pate) the abdomen for lumps. Blood tests will be ordered to check for changes in blood chemistry caused by substances released by the tumor. Laboratory tests may show abnormal levels of iron in the blood. Either a low red blood cell count (anemia ) or a high red blood cell count (erythrocytosis) may accompany kidney cancer. Occasionally, patients will have high calcium levels.

If the doctor suspects kidney cancer, an intravenous urography (also called pyelogram or IVP) may be ordered. An IVP is an x-ray test in which a dye is injected into a vein in the arm. The dye travels through the body, and when it is concentrated in the urine to be discharged, it outlines the kidneys, ureters, and the urinary bladder. On an x-ray image, the dye will reveal any abnormalities of the urinary tract. The IVP may miss small kidney cancers.

Renal ultrasound is a diagnostic test in which sound waves are used to form an image of the kidneys. Ultrasound is a painless and non-invasive procedure that can be used to detect even very small kidney tumors. Imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) can be used to evaluate the kidneys and the surrounding organs. These tests are used to check whether the tumor has spread outside the kidney to other organs in the abdomen. If the patient complains of bone pain , a special x ray called a bone scan may be ordered to rule out spread to the bones. A chest x ray may be taken to rule out spread to the lungs.

A kidney biopsy is used to positively confirm the diagnosis of kidney cancer. During this procedure, a small piece of tissue is removed from the tumor and examined under a microscope. The biopsy will give information about the type of tumor, the cells that are involved, and the aggressiveness of the tumor (tumor stage).

Staging, treatment, and prognosis

Staging

Staging guidelines for kidney cancer are as follows (2.5 cm equals approximately 1 in):

  • Stage I: Primary tumor is 5 cm or less in greatest dimension and is limited to the kidney, with no lymph node involvement.
  • Stage II: Primary tumor is larger than 5 cm in greatest dimension and is limited to the kidney, with no lymph node involvement.
  • Stage III: Primary tumor may extend into major veins or invade adrenal glands or perinephric tissues, but not beyond Gerota's fascia. There may be metastasis in a single lymph node.
  • Stage IV: Primary tumor invades beyond Gerota's fascia. Metastasis in more than one lymph node. Possible metastasis to distant structures in the body.

Treatment

Each person's treatment is different and depends on several factors. The location, size, and extent of the tumor have to be considered in addition to the patient's age, general health, and medical history.

The primary treatment for kidney cancer that has not spread to other parts of the body, which is a Stage I, II, or III tumor, is surgical removal of the diseased kidney (nephrectomy). Because most cancers affect only one kidney, the patient can function well on the one remaining. Two types of surgical procedure are used. Radical nephrectomy removes the entire kidney and the surrounding tissue. Sometimes, the lymph nodes surrounding the kidney are also removed. Partial nephrectomy removes only part of the kidney along with the tumor. This procedure is used either when the tumor is very small or when it is not practical to remove the entire kidney. It is not practical to remove a kidney when the patient has only one kidney or when both kidneys have tumors. There is a small (5%) chance of missing some of the cancer. Nephrectomy can also be useful for Stage IV cancers, but alternative surgical procedures such as transarterial angioinfarction may be used.

Radiation therapy , which consists of exposing the cancer cells to high-energy gamma rays from an external source, generally destroys cancer cells with minimal damage to the normal tissue. Side effects are nausea, fatigue, and stomach upsets. These symptoms disappear when the treatment is over. In kidney cancer, radiation therapy has been shown to alleviate pain and bleeding, especially when the cancer is inoperable. However, it has not proven to be of much use in destroying the kidney cancer cells. Therefore radiation therapy is not used very often as a treatment for cancer or as a routine adjuvant to nephrectomy. Radiotherapy, however, is used to manage metastatic kidney cancer.

Treatment of kidney cancer with anti-cancer drugs (chemotherapy ) has not produced good results. However, new drugs and new combinations of drugs continue to be tested in clinical trials .

Immunotherapy or immunologic therapy , a form of treatment in which the body's immune system is harnessed to help fight the cancer, is a new mode of therapy that is being tested for kidney cancer. Clinical trials with substances produced by the immune cells (aldesleukin and interferon) have shown some promise in destroying kidney cancer cells. These substances have been approved for use but they can be very toxic and produce severe side effects. The benefits derived from the treatment have to be weighed very carefully against the side effects in each case. Immunotherapy is the most promising systemic therapy for metastatic kidney cancer.

Prognosis

Because kidney cancer is often caught early and sometimes progresses slowly, the chances of a surgical cure are good. It is also one of the few cancers for which there are well-documented cases of spontaneous remission without therapy.

Alternative and complementary therapies

There are several healing philosophies, approaches, and therapies that may be used as supplemental or instead of traditional treatments. All of the items listed may have varying effectiveness in boosting the immune system and/or treating a tumor. The efficacy of each treatment also varies from person to person. None of the treatments, however, have demonstrated safety or effectiveness on a consistent basis. Patients should research such treatments for any potential dangers (laetrile, for example, has caused death due to cyanide poisoning) and notify their physician before taking them.

  • 714-X
  • antineoplastons
  • Cancell
  • cartilage (bovine and shark)
  • Coenzyme Q10
  • Gerson Therapy
  • Gonzalez Protocol
  • Hydrazine sulfate
  • immuno-augementative therapy
  • Laetrile
  • mistletoe

Coping with cancer treatment

Side effects of treatment, as well as nutrition, emotional well-being, and other complications, are all parts of coping with cancer. There are many possible side effects for a cancer treatment that include:

  • constipation
  • delirium
  • fatigue
  • fever, chills, sweats
  • nausea and vomiting
  • mouth sores, dry mouth, bleeding gums
  • pruritus (itching )
  • sexuality
  • sleep disorders

Anxiety, depression , loss, post-traumatic stress disorder, sexuality, and substance abuse are all possible emotional side-effects. Nutrition and eating before, during, and after a treatment can also be of concern. Other complications of coping with cancer include fever and pain.

Clinical trials

There are many clinical trials in place studying new types of radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, ways of combining various types of treatment for kidney cancer, side effect reduction, and improving quality of life. Immunostimulatory agents and gene-therapy techniques that modify tumor cells, antiangiogenesis compounds, cyclin-dependent kinase inhibitors, and differentiating agents are all being investigated as possible therapies. Consult <http://ClinicalTrials.gov> and your doctor for a list of kidney cancer clinical trials.

Prevention

The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. However, because a strong association between kidney cancer and tobacco has been shown, avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet may also help prevent kidney cancer.

See Also Renal pelvis tumors; Von Hippel-Lindau Syndrome

Resources

BOOKS

Berkow, Robert, ed. The Merck Manual of Diagnosis and Therapy, 16th ed. Rahway, NJ: Merck Research Laboratories, 1997.

Dollinger, Malin, Ernest H. Rosenbaum, and Greg Cable. Everyone's Guide to Cancer Therapy. How Cancer Is Diagnosed, Treated, and Managed Day to Day. Kansas City: Andrews McMeel, 1998.

Murphy, Gerald P., Lois B. Morris, and Dianne Lange. Informed Decisions: The Complete Book of Cancer Diagnosis, Treatment and Recovery. New York: Viking, 1997.

Scher, H.I., and R.J. Motzer. "Renal Cell Carcinoma." In Harrison's Principles of Internal Medicine. Fauci, Anthony, et al, eds. New York: McGraw-Hill, 1998.

PERIODICALS

Dutcher, J.P. "Immunotherapy: Are We Making a Difference?"Current Opinion in Urology (September 2000): 435-9.

Godley, P.A., and K.I. Ataga. "Renal Cell Carcinoma." Current Opinion in Oncology (May 2000): 260-4.

Halperin, E.C. "Kidney Cancer." Lancet (February 1999): 594.

Vogelzang, N.J., and W.M. Stadler. "Kidney Cancer." Lancet (November 1998): 1691-6.

ORGANIZATIONS

American Cancer Society (National Headquarters). 1599Clifton Rd. NE, Atlanta, GA 30329. (800) 227-2345. <http://www.cancer.org.>

American Foundation for Urologic Disease. E-mail: admin@afud.org. Cancer Research Institute (National Headquarters). 681 Fifth Ave., New York, NY 10022. (800) 992-2623. <http://www.cancerresearch.org>.

Kidney Cancer Association. 1234 Sherman Ave., Suite 203, Evanston, IL 60202-1375. (800) 850-9132. <http://www.kidneycancerassociation.org>.

National Cancer Institute. 9000 Rockville Pike, Building 31, Room 10A16, Bethesda, MD 20892. (800) 422-6237. <http://www.nci.nih.gov>.

National Kidney Cancer Association. 1234 Sherman Ave., Suite 203, Evanston, IL 60202-1375. (800) 850-9132.

National Kidney Foundation. 30 East 33rd St., New York, NY10016. (800) 622-9010. <http://www.kidney.org>.

American Urological Association. 1120 N. Charles St., Baltimore, MD 21201. (410) 727-1100. <http://www.auanet.org/patient_info/find_urologist/index.cfm>.

Lata Cherath, Ph.D.

Laura Ruth, Ph.D.

KEY TERMS

Biopsy

The surgical removal and microscopic examination of living tissue for diagnostic purposes.

Bone scan

An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.

Chemotherapy

Treatment with anticancer drugs.

Computed tomography (CT) scan

A medical procedure in which a series of x-ray images are made and put together by a computer to form detailed pictures of areas inside the body.

Hematuria

Blood in the urine.

Immunotherapy

Treatment of cancer by stimulating the body's immune defense system.

Intravenous pyelogram (IVP)

A procedure in which a dye is injected into a vein in the arm. The dye travels through the body and concentrates in the urine to be discharged. It outlines the kidneys, ureters, and the urinary bladder. An x-ray image is then made and any abnormalities of the urinary tract are revealed.

Magnetic resonance imaging (MRI)

A medical procedure used for diagnostic purposes in which pictures of areas inside the body can be created using a magnet linked to a computer.

Nephrectomy

A medical procedure in which the kidney is surgically removed.

Primary tumor

A cancer's origin or initial growth.

Radiation therapy

Treatment with high-energy radiation from x-ray machines, cobalt, radium, or other sources.

Renal ultrasound

A painless and non-invasive procedure in which sound waves are bounced off the kidneys. These sound waves produce a pattern of echoes that are then used by the computer to create pictures of areas inside the kidney (sonograms).

QUESTIONS TO ASK THE DOCTOR

  • What should I expect from a biopsy test?
  • What type of kidney cancer do I have?
  • What is the stage of the disease?
  • What are the treatment choices? Which do you recommend? Why?
  • What are the risks and possible side effects of each treatment?
  • What are the chances that the treatment will be successful?
  • What new treatments are being studied in clinical trials?
  • How long will treatment last?
  • Will I have to stay in the hospital?
  • Will treatment affect my normal activities? If so, for how long?
  • What is the treatment likely to cost?

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Cherath, Lata; Ruth, Laura. "Kidney Cancer." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. 25 Jul. 2016 <http://www.encyclopedia.com>.

Cherath, Lata; Ruth, Laura. "Kidney Cancer." Gale Encyclopedia of Cancer. 2002. Encyclopedia.com. (July 25, 2016). http://www.encyclopedia.com/doc/1G2-3405200247.html

Cherath, Lata; Ruth, Laura. "Kidney Cancer." Gale Encyclopedia of Cancer. 2002. Retrieved July 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3405200247.html

Kidney Cancer

Kidney Cancer

Definition

Kidney cancer is a disease in which the cells in certain tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma, which occurs in the cells lining the kidneys (epithelial cells), is the most common type of kidney cancer. Eighty-five percent of all kidney tumors are renal cell carcinomas. Wilms' tumor is a rapidly developing cancer of the kidney most often found in children under four years of age.

Description

The kidneys are a pair of organs shaped like kidney beans that lie on either side of the spine just above the waist. Inside each kidney are tiny tubes (tubules) that filter and clean the blood, taking out the waste products and making urine. The urine that is made by the kidney passes through a tube called the ureter into the bladder. Urine is held in the bladder until it is discharged from the body. Renal cell carcinoma generally develops in the lining of the tubules that filter and clean the blood. Cancer that develops in the central portion of the kidney (where the urine is collected and drained into the ureters) is known as transitional cell cancer of the renal pelvis. Transitional cell cancer is similar to bladder cancer.

Kidney cancer accounts for approximately 2-3% of all cancers. In the United States, kidney cancer is the tenth most common cancer and the incidence has increased by 43% since 1973; the death rate has increased by 16%. According to the American Cancer Society, 35,710 Americans were diagnosed with kidney cancer in 2004, and 12,480 died from the disease. RCC accounts for 90-95% of malignant neoplasms that originate from the kidney.

Causes and symptoms

The causes of kidney cancer are unknown, but men seem to have a greater risk than women of contracting the disease; the male:female ratio in the United States and Canada is 3:2 as of the early 2000s. There is a strong association between cigarette smoking and kidney cancer. Cigarette smokers are twice as likely as non-smokers are to develop kidney cancer. Working around coke ovens has been shown to increase people's risk of developing this cancer. Certain types of painkillers that contain the chemical phenacetin are associated with kidney cancer. The United States government discontinued use of analgesics containing phenacetin about 20 years ago. Obesity may be yet another risk factor for kidney cancer. Some studies show a loose association between kidney cancer and occupational exposure to cadmium, petroleum products, lead, dry-cleaning solvents, trichloroethylene (TCE), and asbestos. Other risk factors for the development of kidney cancer include Hispanic heritage and preexisting von Hippel-Lindau disease.

The most common symptom of kidney cancer is blood in the urine (hematuria). Other symptoms include painful urination, pain in the lower back or on the sides, abdominal pain, a lump or hard mass that can be felt in the kidney area, unexplained weight loss, fever, weakness, fatigue, and high blood pressure.

Other symptoms may occur if the cancer has spread beyond its original location. Spread of kidney cancer most commonly occurs to the lung (55%), liver (33%), bone (33%), adrenal (20%), and opposite kidney (10%). Lymph node spread is also common, occurring in about 25% of patients).

Diagnosis

A diagnostic examination for kidney cancer includes taking a thorough medical history and making a complete physical examination in which the doctor will probe (palpate) the abdomen for lumps. Blood tests will be ordered to check for changes in blood chemistry caused by substances released by the tumor. Laboratory tests may show abnormal levels of iron in the blood. Either a low red blood cell count (anemia) or a high red blood cell count (erythrocytosis) may accompany kidney cancer. Occasionally, patients will have high calcium levels.

If the doctor suspects kidney cancer, an intravenous pyelogram (IVP) may be ordered. An IVP is an x-ray test in which a dye in injected into a vein in the arm. The dye travels through the body, and when it is concentrated in the urine to be discharged, it outlines the kidneys, ureters, and the urinary bladder. On an x-ray image, the dye will reveal any abnormalities of the urinary tract. The IVP may miss small kidney cancers.

Renal ultrasound is a diagnostic test in which sound waves are used to form an image of the kidneys. Ultrasound is a painless and non-invasive procedure that can be used to detect even very small kidney tumors. Imaging tests such as computed tomography scans (CT scans) and magnetic resonance imaging (MRI) can be used to evaluate the kidneys and the surrounding organs. These tests are used to check whether the tumor has spread outside the kidney to other organs in the abdomen. If the patient complains of bone pain, a special x ray called a bone scan may be ordered to rule out spread to the bones. A chest x ray may be taken to rule out spread to the lungs.

A kidney biopsy is used to positively confirm the diagnosis of kidney cancer. During this procedure, a small piece of tissue is removed from the tumor and examined under a microscope. The biopsy will give information about the type of tumor, the cells that are involved, and the aggressiveness of the tumor (tumor stage).

Treatment

Each person's treatment is different and depends on several factors. The location, size, and extent of the tumor have to be considered in addition to the patient's age, general health, and medical history. In addition, much has changed in the treatment and management of kidney cancer since the 1980s, including new surgical techniques, new anticancer drugs, and the development of effective treatments for advanced disease.

The primary treatment for kidney cancer that has not spread to other parts of the body, which is a Stage I, II, or III tumor, is surgical removal of the diseased kidney (nephrectomy ). Because most cancers affect only one kidney, the patient can function well with the remaining one. Two types of surgical procedure are used. Radical nephrectomy removes the entire kidney and the surrounding tissue. Sometimes, the lymph nodes surrounding the kidney are also removed. Partial nephrectomy removes only part of the kidney along with the tumor. This procedure is used either when the tumor is very small or when it is not practical to remove the entire kidney. It is not practical to remove a kidney when the patient has only one kidney or when both kidneys have tumors. There is a small (5%) chance of missing some of the cancer. Nephrectomy can also be useful for Stage IV cancers, but alternative surgical procedures such as transarterial angioinfarction may be used.

The rapid development and widespread use of laparoscopic techniques has made it possible for surgeons to remove small tumors while sparing the rest of the kidney. Most tumors removed by laparoscopy are 4 cm (1.6 in) in size or smaller. Laparoscopy also allows the surgeon to remove small tumors with cryoablation (destroying the tumor by freezing it) rather than cutting.

Radiation therapy, which consists of exposing the cancer cells to high-energy gamma rays from an external source, generally destroys cancer cells with minimal damage to the normal tissue. Side effects are nausea, fatigue, and stomach upsets. These symptoms disappear when the treatment is over. In kidney cancer, radiation therapy has been shown to alleviate pain and bleeding, especially when the cancer is inoperable. However, it has not proven to be of much use in destroying the kidney cancer cells. Therefore radiation therapy is not used very often as a treatment for cancer or as a routine adjuvant to nephrectomy. Radiotherapy, however, is used to manage metastatic kidney cancer.

Treatment of kidney cancer with anticancer drugs (chemotherapy ) has not produced good results. However, new drugs and new combinations of drugs continue to be tested in clinical trials. One new drug, semaxanib (SU5416), is reported to have good results in treating patients with kidney cancer. As of 2004, however, semaxanib is still undergoing clinical trials in the United States.

KEY TERMS

Biopsy The surgical removal and microscopic examination of living tissue for diagnostic purposes.

Bone scan An x-ray study in which patients are given an intravenous injection of a small amount of a radioactive material that travels in the blood. When it reaches the bones, it can be detected by x ray to make a picture of their internal structure.

Chemotherapy Treatment with anticancer drugs.

Computed tomography (CT) scan A medical procedure in which a series of x-ray images are made and put together by a computer to form detailed pictures of areas inside the body.

Cryoablation A technique for removing tissue by destroying it with extreme cold.

Hematuria Blood in the urine.

Immunotherapy Treatment of cancer by stimulating the body's immune defense system.

Intravenous pyelogram (IVP) A procedure in which a dye is injected into a vein in the arm. The dye travels through the body and concentrates in the urine to be discharged. It outlines the kidneys, ureters, and the urinary bladder. An x-ray image is then made and any abnormalities of the urinary tract are revealed.

Magnetic resonance imaging (MRI) A medical procedure used for diagnostic purposes in which pictures of areas inside the body can be created using a magnet linked to a computer.

Nephrectomy A medical procedure in which the kidney is surgically removed.

Radiation therapy Treatment with high-energy radiation from x-ray machines, cobalt, radium, or other sources.

Renal ultrasound A painless and non-invasive procedure in which sound waves are bounced off the kidneys. These sound waves produce a pattern of echoes that are then used by the computer to create pictures of areas inside the kidney (sonograms).

Immunologic therapy (or immunotherapy), a form of treatment in which the body's immune system is harnessed to help fight the cancer, is a new mode of therapy that is being tested for kidney cancer. Clinical trials with substances produced by the immune cells (aldesleukin and interferon) have shown some promise in destroying kidney cancer cells. These substances have been approved for use but they can be very toxic and produce severe side effects. The benefits derived from the treatment have to be weighed very carefully against the side effects in each case. Immunotherapy is the most promising systemic therapy for metastatic kidney cancer.

Prognosis

Because kidney cancer is often caught early and sometimes progresses slowly, the chances of a surgical cure are good. Length of survival depends on the size of the original tumor, the aggressiveness of the specific cells making up the tumor, and whether the cancer cells spread from the kidney to surrounding or distant tissues.

Kidney cancer is also one of the few cancers for which there are well-documented cases of spontaneous remission without therapy. Unfortunately, recurrences can occur even as long as ten years after the original diagnosis and treatment, and cancer can also crop up in the other, previously unaffected kidney.

Prevention

The exact cause of kidney cancer is not known, so it is not possible to prevent all cases. However, because a strong association between kidney cancer and tobacco has been shown, avoiding tobacco is the best way to lower one's risk of developing this cancer. Using care when working with cancer-causing agents such as asbestos and cadmium and eating a well-balanced diet may also help prevent kidney cancer.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD., editors. "Renal Cell Carcinoma (Hypernephroma; Adenocarcinoma of the Kidney)." Section 17, Chapter 233 In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2004.

Quek, Marcus L., and John P. Stein. "Malignant Tumors of the Urogenital Tract." In Conn's Current Therapy 2001. 53th ed. Philadlphia: W.B. Saunders Company, 2001.

PERIODICALS

Brauch, H., G. Weirich, B. Klein, et al. "VHL Mutations in Renal Cell Cancer: Does Occupational Exposure to Trichloroethylene Make a Difference?" Toxicology Letters 151 (June 15, 2004): 301-310.

Dutcher, J.P. "Immunotherapy: Are We Making a Difference?" Current Opinion in Urology September 2000: 435-9.

Godley, P.A., and K.I. Ataga. "Renal Cell Carcinoma." Current Opinion in Oncology May 2000: 260-4.

Griffiths, T. R., and J. K. Mellon. "Evolving Immunotherapeutic Strategies in Bladder and Renal Cancer." Postgraduate Medical Journal 80 (June 2004): 320-327.

Jennens, R. R., M. A. Rosenthal, G. J. Lindeman, and M. Michael. "Complete Radiological and Metabolic Response of Metastatic Renal Cell Carcinoma to SU5416 (Semaxanib) in a Patient with Probable von Hippel-Lindau Syndrome." Urologic Oncology 22 (May-June 2004): 193-196.

Lam, J. S., O. Svarts, and A. J. Pantuck. "Changing Concepts in the Surgical Management of Renal Cell Carcinoma." European Urology 45 (June 2004): 692-705.

Lotan, Y., D. A. Duchene, J. A. Cadeddu, et al. "Changing Management of Organ-Confined Renal Masses." Journal of Endourology 18 (April 2004): 263-268.

Moon, T. D., F. T. Lee, Jr., S. P. Hedican, et al. "Laparoscopic Cryoablation under Sonographic Guidance for the Treatment of Small Renal Tumors." Journal of Endourology 18 (June 2004): 436-440.

ORGANIZATIONS

American Cancer Society. 1599 Clifton Road, N.E., Atlanta, GA 30329. (800) 227-2345. http://www.cancer.org.

Cancer Research Institute (National Headquarters). 681 Fifth Avenue, New York, NY 10022. (800) 992-2623. http://www.cancerresearch.org.

National Cancer Institute (NCI). 9000 Rockville Pike, Building 31, Room 10A16, Bethesda, MD 20892. (800) 422-6237. http://www.nci.nih.gov.

National Kidney Cancer Association. 1234 Sherman Avenue, Suite 203, Evanston, IL 60202-1375. (800) 850-9132.

National Kidney Foundation. 30 East 33rd Street, New York, NY 10016. (800) 622-9010. http://www.kidney.org.

Cite this article
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Carson-DeWitt, Rosalyn; Frey, Rebecca. "Kidney Cancer." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. 25 Jul. 2016 <http://www.encyclopedia.com>.

Carson-DeWitt, Rosalyn; Frey, Rebecca. "Kidney Cancer." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Encyclopedia.com. (July 25, 2016). http://www.encyclopedia.com/doc/1G2-3451600925.html

Carson-DeWitt, Rosalyn; Frey, Rebecca. "Kidney Cancer." Gale Encyclopedia of Medicine, 3rd ed.. 2006. Retrieved July 25, 2016 from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3451600925.html

Kidney Cancer

Kidney Cancer

Wilms Tumor

Adult Kidney Cancer

How Do Doctors Diagnose and Treat Kidney Cancer?

Resources

Kidney cancer occurs when cells in the kidney divide without control or order, forming a growth called a tumor and sometimes spreading to other parts of the body.

KEYWORDS

for searching the internet and other reference sources

Oncology

Nephrology

Renal cell carcinoma

Urology

Wilms tumor

The kidneys are two bean-shaped organs located near the spine whose main function is to filter salts, excess water, and impurities from the blood, producing the liquid waste called urine. Urine drains from the kidneys to the bladder through a tube called the ureter. It is stored in the bladder until it leaves the body through another tube called the urethra. The kidneys also help produce red blood cells and help maintain healthy blood pressure.

If cancer develops in the kidneys, it may affect not only the kidneys but nearby organs as well, including the liver, pancreas, and large intestine. Or kidney cancer cells may spread through the bloodstream or lymphatic system to other parts of the body. The most common form of kidney cancer in children is Wilms tumor, and the most common form of kidney cancer in adults is renal cell cancer.

Wilms Tumor

Wilms tumor, the most common cause of kidney cancer in children, begins to develop even before a child is born. As the fetus grows in the womb, the kidney cells develop into the netlike structures of blood vessels and tissues that are needed to filter the blood. When these cells do not mature as they should, the baby is born with some underdeveloped cells. Usually these cells mature by the time a child is three or four. But sometimes they start to grow out of control, forming the jumbled mixture of small cells called a Wilms tumor, after the German doctor Max Wilms (1867-1918), who first wrote about it in 1899.

Doctors find the tumor when a mass is felt while examining a babys belly. There are usually few, if any, symptoms. If the tumor has not spread out of the kidney, the outlook for the childs recovery is excellent. Most children with Wilms tumor are treated with surgery or chemotherapy* If the cancer has spread beyond the kidney, doctors might also prescribe radiation therapy, which uses focused, high-energy rays to destroy cancer cells.

* chemotherapy
(kee-mo-THER-a-pee) is the treatment of cancer with powerful drugs that kill cancer cells.

Adult Kidney Cancer

Kidney cancer in adults is much more common than in children, affecting about 30,000 people each year. In four out of five cases, the tumor forms in the tissue responsible for filtering the blood, but it also can affect the renal pelvis, the structure that collects the urine after filtration. Unlike Wilms tumor, kidney cancer in adults often spreads to nearby organs and to other parts of the body.

Kidney cancer is more common in people who smoke cigarettes. Exposure to certain harsh chemicals and to medications containing the pain-reliever phenacetin appears to increase risk for the disease. Heredity can play a role too. However, many cases of kidney cancer develop without apparent cause. The most common early symptoms include:

  • Blood in the urine.
  • Pain in the lower back.
  • Unexplained weight loss.
  • Recurring fevers.
  • High blood pressure.

How Do Doctors Diagnose and Treat Kidney Cancer?

Diagnosis Doctors start with a medical history, physical examinastion, and laboratory tests of blood and urine samples. Based on their findings, they may order tests that produce pictures of the kidneys and nearby organs. Additional tests may be ordered, including:

  • Intravenous pyelogram (IVP) (in-tra-VEN-us PY-e-lo-gram), which is a series of x-rays of the kidneys, ureters, and bladder after dye is injected.
  • Arteriogram (ar-TER-ee-o-gram), which is a similar test that creates images of the network of blood vessels in and around the kidney.
  • Imaging tests, such as CT scans*, MRIs*, and ultrasound*.
* CT scans
or CAT scans are the shortened names for computerized axial tomography (to-MOG-ra-fee), which uses computers to view structures inside the body.
* MRI,
which is short for magnetic resonance imaging, produces computerized images of internal body tissues based on the magnetic properties of atoms within the body.
* ultrasound
is a painless procedure in which sound waves passing through the body create images on a computer screen.

If kidney cancer is suspected, a surgeon will perform a biopsy by inserting a thin needle into the tumor and removing a sample of tissue to be examined under the microscope. If these cells turn out to be cancerous, doctors need to find out whether or not the cancer has spread beyond the kidney. Kidney cancer cells often spread through the bloodstream or the lymph nodes, which filter the infection-fighting fluid called lymph. Doctors may order more imaging tests to examine nearby organs and to check for swollen lymph nodes in the chest and abdomen. They also may order chest x-rays and bone scans, because the cancer most often spreads to the lungs or the bones. If the cancer is found to have spread to the lungs or other organs, it still will be kidney cancer because those are the cancer cells that have spread.

Treatment

How the disease is treated depends on whether it has spread beyond the kidney. If it has not, the most common treatments are surgery and radiation therapy. Surgery involves removing part or all of the kidney, a procedure called nephrectomy (nef-REK-tom-ee). The remaining kidney generally is able to perform the work of both kidneys.

Kidney cancer that has spread to other parts of the body is very difficult to treat. Doctors can use biological therapy, chemotherapy, and hormone therapy. Biological therapy, also called immunotherapy, attempts to boost the bodys own natural defenses against the cancer. Interleukin-2 and interferon are two examples of substances that are used as immune boosters. Chemotherapy delivers anti-cancer drugs into the persons bloodstream through a needle or in pill form. Hormone therapy involves blocking or increasing the bodys own chemical messengers (hormones) to try to control the growth of cancer cells.

These treatments have helped only a small percentage of people with advanced kidney cancer. That is why researchers are conducting clinical trials, which are research studies with volunteer patients, to test new treatment approaches. People with advanced kidney cancer and their caregivers also find support groups a valuable resource.

See also

Anemia

Bladder Cancer

Cancer

Hypertension

Tumor

Resources

U.S. National Cancer Institute, National Institutes of Health,

Bethesda, MD. NCI posts a fact sheet called What You Need to Know

about Kidney Cancer at its website. Its CancerTrials website

posts information about clinical trials.

Telephone 800-4-CANCER

http://cancernet.nci.nih.gov/wyntk_pubs/kidney.htm

http://cancertrials.nci.nih.gov

U.S. National Kidney and Urologic Diseases Information Clearinghouse,

3 Information Way, Bethesda, MD 20892-3580. This division of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) posts many different fact sheets about the kidney at its website. Telephone 301-654-4415

http://www.niddk.nih.gov/health/kidney

American Cancer Society Cancer Resource Center. The ACS posts information about Wilms tumor and adult kidney cancer at its website. Telephone 800-ACS-2345 http://www3.cancer.org/cancerinfo/specific.asp

Kidney Cancer Association, 1234 Sherman Avenue, Suite 203, Evanston, IL 60202-1378. Telephone 800-850-9132 http://www.nkca.org

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