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What is kidney cancer? |
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Kidneys are two bean shaped organs, one on either side of the spine which is involved
in filtration of the blood and removal of waste products by way of urine.
Kidney cancer originated from the cells of the kidneys tubules (very small tubes
in the kidney that filter the blood) or from renal pelvis (the part of kidney where
urine collects). The most common type is renal cell cancer (also called renal
cell carcinoma), which represents 85 percent of all kidney tumors. Other less common
type of kidney cancer is Transitional cell carcinoma
(which arises from the renal
pelvis) and Wilm’s tumor (the type of kidney cancer that develops in children more
commonly under the age of 5). |
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What causes kidney cancer? |
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Renal cell carcinoma typically occurs in people over the age of 50 and is twice
more common in men than in women.
The exact cause of kidney cancer is not known. However, certain risk factors are
associated with it, including smoking, overuse of certain painkillers for long time,
including over-the-counter pain medications, long-term dialysis, exposure to asbestos
or cadmium, being overweight and eating a high fat diet. In addition, few genetic
conditions such as von Hippel-Lindau disease and tuberous sclerosis may increase
the risk.
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What are the symptoms of kidney cancer? How it
is diagnosed? |
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In the early stages, kidney cancer usually causes no obvious signs or symptoms.
It is sometime found by chance when a person is having tests for something else.
The following symptoms should raise concern.
- Chronic fatigue, anemia
- Unexplained, rapid weight loss
- Loss of appetite
- Presence of blood in urine (seen either by the eye, or microscopically)
- Fever
- Leg and ankle swelling
- Hypertension (high blood pressure)
- Pain in side or lower back that doesn’t go away
- Mass or lump in the abdomen
These symptoms can also be caused by noncancerous conditions, but only your doctor
can tell for sure.
As kidney cancer grows, it may invade organs near the kidney such as the liver,
colon or pancreas. Kidney cancer cells may also break away from the original tumor
and spread (or metastasize) to other parts of the body such as the lymph nodes,
bones or lungs. About one third of cases showing metastasis at the time of diagnosis.
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How is the kidney cancer diagnosed and investigated? |
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In case where history and examination leads to the suspicion of kidney cancer, various
tests which include urine examination, blood test and imaging test. Imaging tests
done for the evaluation include Ultrasound, CT scan and MRI.
- Ultrasound (Sonography):
It is usually the first imaging test done to evaluate for the cause of blood in
urine. An ultrasound of the abdomen with special attention to the kidneys, ureters,
and bladder is ordered. Ultrasonography uses high-energy sound waves to produce
images of the internal organs. It is generally not uncomfortable and usually no
preparation is needed for this test other than keeping your bladder full during
the examination.
- CT scan (CAT scan)
computed tomography: A CT scan is a specialized X-ray unit that is
used to visualize internal organs. It is one of the primary imaging tools for the
assessment of kidney cancers. To enhance the image of the abdominal organs, a dye
may be taken by mouth and by intravenous route before the scan. There is generally
no pain associated with the CT scan, although the IV dye may cause a hot flushing
sensation. Some people may also experience an allergic reaction to the IV dye. Inform
your doctor if you are allergic to Iodine or has any history of allergy to IV contrast.
- MRI (magnetic resonance
imaging): MRI is another highly specialized imaging method to create
an accurate cross section picture of internal organs of the body and allowing a
layer by layer examination. It uses a powerful magnet and radio waves to produce
the images, therefore people with metallic implants within their body- such as pacemakers,
prosthetic hip replacement and metal plates may not be the right candidate to undergo
this investigation. The test may also require the patient to lie still for a long
time in a narrow space.
- Bone Scan:
It is a sensitive investigation to check for the spread of the cancer to the bones.
It is done by injecting small amounts of a special radioactive material in the blood
stream. The radioactive material is then carried to the bone, where the there is
lot of bone activity. It may light up both cancerous and non cancerous areas. Therefore
interpretation by an expert and sometime additional test such as X ray or CT scan
of the bone may also be needed.
- Biopsy:
Biopsy is performed only if the diagnostic imaging test results are equivocal. During
biopsy, a small piece of kidney tissue is taken from suspected tumor site with a
thin needle and is viewed under a microscope by a pathologist.
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Other tests |
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In addition of the tests described above, one of more of the following tests may
be required to complete the evaluation
Blood tests
Complete blood counts, Kidney function
tests, Liver function test, Serum Calcium.
Urine examination
- Urinalysis is usually a part of complete physical examination.
Microscopic examination may show evidence of blood in urine.
- Urine cytology: Microscopic examination of the urine sample to
look for cancerous cell shed in the urine may be done in case of suspicion of cancer
in the collecting system of the kidney.
Chest x-ray
An x ray of the chest is done to see if
the cancer has spread to the lungs. If there is any suspicion on the x ray, the
doctor may order for CT scan of the chest to evaluate.
What is the treatment for
kidney cancer? |
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The treatment for kidney cancer depends upon the stage of the cancer and patient’s
age and general health status. The stage of cancer is determined by various imaging
tests like CT scan, MRI, Chest x ray and bone scan.
The treatment options offered to the patient (depending upon the tumor stage and
health status) include
Surgery
Radical Nephrectomy:
This procedure involves complete removal of the kidney along with surrounding fat,
adrenal and lymph nodes. Now a days minimally invasive surgeries like Laparoscopic
or Robotic Radical Nephrectomy are the modality of choice which gives results equivalent
to open surgery while minimizing the morbidity of procedure.
Partial Nephrectomy: This is undertaken in case of small tumors
where the cancer is removed along with some of the kidney tissue around it. A partial
nephrectomy may be done to prevent loss of kidney function when the other kidney
is damaged or has already been removed or in case of tumor involving both the kidneys.
When surgery to remove the cancer is not possible, a treatment called arterial embolization
may be used to shrink the tumor. Embolization is indicated in case of uncontrolled
hematuria or pain. |
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Radiation therapy
Radiation therapy uses high energy x-rays or other radiation to kill the cancer
cells. Various types of cancers have different response to the radiation therapy.
Occasionally, some patients may be given chemotherapy or radiation therapy after
surgery to kill any cancer cells that are left. Treatment after the surgery, to
increase the chances of cure is called as adjuvant therapy.
Chemotherapy
Chemotherapy is treatment of cancer that uses drugs to stop the growth of cancer
cells by stopping the cell from growing. Various forms of drugs care given either
by month or injected into a vein. The kind of medication (chemotherapy) to be given
depends upon the type and stage of the cancer being treated.
Targeted therapy
This newer form of therapy uses medications that attack specific cancer cells without
affecting normal cells. Antiangiogenic agents are a type of agents that may be used
to treat advanced kidney cancers. They prevent formation of newer blood vessels
in the tumor thus shrink the tumor or slow growth of the cancer. |
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