kidney cancer

Kidney cancer

Kidney cancer is a malignant tumor that originates from the epithelial cells in the kidney. In Finland, approximately 900-1000 new kidney cancer is diagnosed each year.

Kidney cancer is mainly in older people's disease. It is diagnosed at an average age of 65 to 75 years. Kidney cancer in males is somewhat more common than females.

Humans have two kidneys and are responsible for removing toxins from the body and regulating the liquid and salt balance of the body. The kidneys are located on both sides of the spine at the back of the abdominal cavity under the shelter of the lowest ribs.

The kidney is about 12 cm in length and 7 cm in width. Inside it is a small pipe network, i.e. a pool-goblet system that filters and purifies the blood and produces urine. Urine travels from the kidneys to the urinary tract along the bladder, where it is stored until it exits the urethra along the body.

Renal cell carcinoma is not the same disease as kidney cancer. The renal cell carcinoma belongs to the urinary tract cancers and is treated like these.

Usually kidney cancer grows only with another kidney. In a few cases, one hundred kidney cancers are found simultaneously in both kidneys.

Causes of kidney cancer

The mechanism for the birth of kidney cancer is quite well known, but the causes are not very accurate. Smoking increases the risk of renal cancer to at least double.

Overweight and obesity are also risk factors for kidney cancer. Obesity has a greater impact on the risk of women than men. A higher blood pressure risk of developing kidney cancer is also slightly larger than usual.

In the past, kidney cancer has been linked to work-related exposure, but according to current knowledge only asbestos causes kidney cancer.

Cancer prevention (without cancer)

What causes cancer?

Heredity of kidney cancer

A few percent of kidney cancers are associated with hereditary susceptibility, which significantly increases the risk of kidney cancer. A hereditary predisposition to kidney cancer is associated with four known syndromes, namely von Hippel-Lindaun syndrome, inherited papillary kidney cancer, Birt – Hogg – Dubeen syndrome, and hereditary leiomyomatosis. In these syndromes, the gene causing the susceptibility to illness is known. The carriers of these gene defects will be monitored in order to detect potential kidney cancer in time.

Cancer NGO Inheritance Counseling

Cancer heredity

Kidney Cancer Symptoms

At present, a large proportion of renal cancers are found by chance in an ultrasound or CT scan, due to another cause. The cancers thus found are usually still localized and have not caused any symptoms.

The classic symptoms of kidney cancer are flank pain, presence of blood in the urine and a non-profable tumor under the rib arch. Classical kidney cancer symptoms indicate that the cancer has already spread to the kidney environment. Haematurity is caused by the fact that the tumor is penetrated into the kidney by the pool-goblet system. The pain is caused, in turn, when the tumor is grown in the surrounding tissues or the kidney surrounding the capsule is stretched.

In practice, only a small proportion of the kidney cancers are found on the basis of classical symptoms. It is more common for kidney cancer to be found in patients who come to a doctor due to vague symptoms such as fatigue, anorexia, fever and weight loss.

Detection and studies of renal cell carcinoma

If the patient is suspected of having kidney cancer, studies will begin with imaging. An imaging study is usually used to describe ultrasound, ECHO, or computed tomography.

Cancer detection and studies

Most kidney tumors can be categorized based on imaging to be benign or malignant, and treatment is selected based on it. If the kidney tumor is clearly of good quality, the change can be followed and the sampling or surgery may be considered only if changes occur in the tumour.

If there is a strong reason to suspect that the kidney tumor is malignant, a separate biopsy, i.e., a test return does not usually need to be taken if surgical treatment is considered possible. In this case, the tumour type and degree of differentiation can be found in the kidney removed from the surgery. If the change affects kidney cancer, but no surgery can be done for whatever reason, an aim of the tumor type tends to ensure a biopsy.

A tumour in the kidneys may also be, for example, a change in inflammation, lymphoma or other cancer metastasis. If this kind of suspicion, no surgical treatment is always the best option, but the tumor type is ensured by a biopsy.

The biopsy is taken through the abdominal or dorsal dermal imaging control using ultrasound or computed tomography. The final diagnosis of a kidney tumor is very likely to be evident from the test fire.

Classification of kidney cancer

70% of renal cancers have clear-cell renal carcinoma and approximately 10 – 15% are papillary renal carcinomas. Other subtypes of kidney cancer are rare.

The type of kidney cancer may not affect very much the choice of treatment or the prognosis of the disease. It is more essential to know how much cancer has been spread. Today, the longer one in four kidney cancer has had time to spread to other parts of the body, i.e. sent metastases when it is discovered. Most commonly, kidney cancer sends metastases to the skeletal system, abdominal cavity, lungs and brain.

The prevalence of renal cancer is described by TNM classification. In it T (tumor) represents the tumour intrusion into its environment, N (node) spread to nearby lymph nodes and M (metastasis) potential metastases. Lymph nodes are small pavulike filters through which the lymph flows.

Classification of kidney cancer

Parent tumor

The T1 tumor is internal to the kidney capsule and has a diameter not exceeding 7 cm.

T1A a tumour diameter not exceeding 4 cm.

T1B the tumor diameter is more than 4 cm, but not more than 7 cm.

T2 tumor is the internal of the kidney capsule and its diameter is more than 7 cm.

T2A tumor diameter greater than 7 cm, but not more than 10 cm.

T2B the tumour diameter is more than 10 cm.

The T3 tumor extends to the vein or the kidneys to adjacent fat or sinus fat.

T3A the tumor grows in a kidney vein, the kidney is adjacent to the fat or sinusfat.

T3B the tumor grows in the lower vena cava below the diaphragm.

T3C the tumor grows in the lower vena cava above the diaphragm.

T4 the tumor pierters the Gerotan Faskian and grows in the adrenal glands.

Regional lymph nodes

N0 lymph nodes have no metastases.

N1 metastasis in one of the regional lymph nodes.

N2 metastasis in more than one regional lymph node.

Distant metastases

M0 no metastases farther.

M1 one or more metastases farther away.

In addition to prevalence, the degree of differentiation of cancer cells affects the outcome and follow-up of therapies. Renal cancer is divided into three degrees of differentiation (Grade 1 – 3) according to microscopic findings. The better the cell is differentiated – that is, the closer it is to the normal cell structure – the slower the cancer usually grows or the metastases are transmitted. Poorly differentiated (grade 3) tumors spread more easily, and their prognosis is somewhat worse than others.

Cancer classification

Kidney cancer Treatment

Surgery is the primary treatment for kidney cancer. The surgery tends to eliminate the entire kidney and the tumor inside it. Its alternative is to make a partial removal surgery or to reduce the cancerous mass as part of other therapies. Surgery is the only curative treatment for kidney cancer.

After renal surgery, the patient remains under surveillance if the cancer was completely eliminated. After surgery, drug treatment is not given as a precaution, but only if the cancer is left in the kidney or elsewhere in the body.

Always surgery is not possible, and then treatment can be initiated with medicinal products in general condition of the patient. The incidence of the disease is ensured by imaging studies prior to initiation of the drug treatment. If the cancer is low and the patient is asymptomatic, treatment initiation can be delayed until the disease progresses or begins to cause symptoms.

Cancer treatment

Surgery

Surgery is the most important treatment for kidney cancer. The surgery aims to remove the tumor completely. The whole kidney, the surrounding fat, the adrenal glands and the regional lymph nodes are eliminated in the extensive surgery. If the tumor has penetrated into a renal vein or sub-vein, remove it from the injected vein. Sometimes you have to remove some of the bog.

However, the entire kidney removal surgery is not possible if the cancer has already spread beyond the kidney or the patient's second kidney is not working adequately.

Saving surgery: Kidney tissue saving surgery has become commonplace in recent years. A sparing surgical treatment result is as good as a broader surgery in selected patients. Often-sparing surgery is possible if the patient has a small local tumor. It is also sought if the patient has a bilateral tumor, thus requiring the remaining functional kidney tissue.

Metastatic cancer surgery: the parent tumor is aimed at eliminating quite often even when the disease has spread, although metastases cannot be removed. In this case, surgery may improve the patient's ability to benefit from cancer treatment. However, this type of surgery is not useful if there is a lot of metastatic disease or the overall condition of the patient is poor.

If surgery cannot be performed and a kidney tumor causes difficulties with local symptoms such as haematuriasis, the reduction of renal artery in connection with angiogram (angiography) may benefit the patient.

When localized kidney cancer has once been cut, but the cancer subsequently regenerates, attempts at individual metastases to intersect if the patient's overall condition is good and is estimated to benefit from surgery. In many different regions or as a broad colony, cancer surgery is not a benefit to the patient.

Cancer surgery Treatment

Drug treatments

No effective medical treatments were available for advanced kidney cancer in the last millennium. In the 2000 century these have fortunately become numerous. The medication is individually selected according to the nature of the disease, patient and underlying diseases. Each medicine has its own side effects and risks that are taken into account in the selection of medication. Some of the kidney cancers are progressing very slowly, and then it is wiser to follow the situation without medication and start treatment only when the disease clearly progresses.

Targeted medicines, that is, drug-specific medicines: kidney cancer is a high blood-cell tumor and therefore the medicinal products that inhibit the formation of blood vessels have proven to be effective in the treatment of metastatic kidney cancer. These medicines, called ' drug-prescribing ', have clearly improved the prognosis for patients with advanced kidney cancer. The majority of kidney cancer cells react to treatments fairly well. Unfortunately, some of the tumors continue to spread despite the treatments.

Several targeted medicines are used to treat kidney cancer. The major pharmaceutical group is tyrosine kinase inhibitors (e.g. sunitinib), oral contraceptives or capsules sorafenib, pazsopanib and axitinib, as well as the 2017-approved kabbotzantinib and lenvatinib, which are not yet 2017 Covered by the reimbursement of medicines. The Anti-VEGF antibody is administered intravenously and is used in combination with interferon. Protein kinase inhibitors called mTOR inhibitors are two medicines for renal cancer, everolilimus and intravenous temsirolimus to be used as tablets.

sunitinib, pazsopanib, bevacizumab and Temsirolimus are suitable as the first medicine for advanced kidney cancer. The other can only be used when the first drug treatment has not stopped the disease progression.

Immunological treatments: Immunological treatments have proven effective in the treatment of many cancers in recent years. Immunological therapies are intended to enhance the body's own defense system against cancer cells. Interferon has long been used as the only remedy for kidney cancer, but has been replaced by newer treatments in the 2000.

As a new immunologic medicinal product, the use of T-cell defence-affected medicinal products has already been approved for treatment with nivolumab and others are under development. These immunological therapies may be administered intravenously in good condition in patients whose cancer has progressed during previous drug treatment, but such therapies are not suitable for autoimmuunitauteja patients.

cell blockers: cell blockers used to treat many other cancers do not work with kidney cancer and are therefore not much used. However, chemotherapy treatments can be used in selected patients, such as some rarer kidney cancer sub-types.

Symptomatic treatments: A patient with kidney cancer is used to treat symptoms such as medicines such as Pain killers and nausea medicines as usual. Effective alleviation and treatment of both the cancer and the symptoms and the harm caused by cancer treatments is important for both the quality of life and the endurance of cancer treatments.

Metastatic kidney cancer medications are long-term care. At its best, medications reduce disease-induced symptoms and may decrease tumor colonies. Above all, it keeps the disease under control and prevents it from progressing.

The treatment of cancer therapy continues for as long as it is sensible for the general health of the disease, the quality of life remains good and the use of medication is more beneficial than harm. At some point, it is more meaningful to discontinue active medical treatments and concentrate on the symptoms and pain caused by kidney cancer.

Radiotherapy

Radiation therapy uses high-energy, ionising radiation to kill cancer cells and reduce tumors. Kidney cancer radiation therapy is mainly used to treat symptoms because it does not prolong the life of patients or improve treatment outcomes. Radiotherapy is commonly used to relieve pain associated with bone metastasis in addition to analgesic medicines. In some situations, individual metastases may be used to treat a high radiotherapy dose to destroy the colony.

Radiotherapy

Monitoring, regeneration and prognosis of renal cell carcinoma

After surgery for the local kidney cancer, the patient is usually monitored for a period of five years. The vast majority of recurreence comes during this period. The follow-up studies often use lung imaging and abdominal echo or computed tomography.

The frequency and duration of monitoring kidney cancer depends on the extent to which the risk of metastases is assessed. The risk of metastasis is low if the tumour has been small and localised, there has been no metastasis in the lymph nodes and the tumor has been very differentiated.

The prognosis is influenced by the prevalence of renal cell carcinoma, the degree of differentiation and the patient's age and other health status. If the cancerous tumor is small and within the kidney, and has not sent metastases, the patient's prognosis is good. In this case, the tumor can be cut out and the patients almost all are alive after five years.

If the cancer has spread or the disease recurs, the patient's prognosis is worse. However, in the last ten years, the survival of the new target medicinal products has been significantly improved in patients with advanced renal cancer.