Kidney Cancers: Symptoms, Diagnosis and Treatment

Kidney cancers are predominantly a disease of old age with most patients diagnosed beyond 60 years of age. Kidneys are a pair of excretory organs located in the abdomen. Apart from their role in removal of toxic metabolic by products from the body they are also critical in maintaining the body electrolyte levels and blood pressure.

Who may get it?

The disease is seen to be related with carcinogenic exposure like smoking and is frequent in people employed in the dry cleaning industry having exposure with gasoline, solvents and heavy metals. The risk is also high among obese and hypertensive patients with long history of exposure to diuretic therapy and NSAIDs (pain killers). Apart from this patients with other benign kidney diseases and those having prolonged history of dialysis are also at increased risk of developing kidney cancers. As per some experts, the risk of Kidney Cancer is gradually growing due to a change in lifestyle and unhealthy food habits in urban cities.

Symptoms of Kidney Cancer

Kidney cancers are most commonly localised to the kidney at diagnosis however they have a potential for spread via blood and lymph to various organs with lungs, bone, brain and liver being the most common sites of spread.

Classically patients with localised kidney cancers present with symptoms of flank mass, pain and bleeding with urination. In a person presenting with cancer being spread to other organs (metastatic disease), the symptoms may vary from persistent pain in back to headache, vomiting, blurring of vision, seizures and difficulty in breathing.

Diagnosis of Kidney Cancer

Usually, a physical examination along with medical history can provide a lot of information to your doctor. He or she will enquire about signs of kidney cancer and other health problems. Many times, an abnormal lump is felt when the doctor examines the belly.

Most patients are diagnosed with the help of radiological imaging tests which require use of pre and post contrast CT and MRI images. Kidney biopsy and non-contrast Diffusion weighted MRI are useful in certain clinical scenarios. While most patients with radiological enhancement are correctly diagnosed as kidney cancers, as many as 20% of them are wrongly diagnosed making radiological diagnosis unreliable.

Doctors usually recommend a complete blood count for preliminary investigations. People with kidney cancer can have anemia (having too few red blood cells) very commonly, some may have too many red blood cells (called polycythemia) as well. Other lab tests include kidney function and urine analysis. These results become important for further imaging tests or if surgery is planned.

The most common benign kidney lesions confused with malignant disease radiologically are fat containing lesions of the kidney. While increasing tumor size on radiological imaging increases the likelihood of kidney cancer, a certain diagnosis requires kidney biopsy. It is majorly done for a certain group of people, those having advanced kidney cancer where the tumor has already spread.

Treatment of Kidney Cancer

Fortunately, most kidney cancers are diagnosed as localised disease as small renal masses. Historically these localised kidney cancers were treated with radical nephrectomy which required complete removal of kidneys but recently the treatment guidelines have evolved with acceptance for partial nephrectomy as well as active surveillance in selected patients. Partial nephrectomy requires complete removal of the tumor with maximum preservation of normal functioning kidney tissue on the affected side.

For larger localised kidney cancers where complete removal of tumor anyway results in unacceptable residual functioning of kidneys on the affected side, the radical nephrectomy is preferred over partial nephrectomy. Generally localised tumors beyond 7 cms are considered unsuitable for kidney preservation via partial nephrectomy.

For advanced metastatic disease, maximum removal of tumor tissues via nephrectomy and even removal of tumor from metastatic sites followed by systemic therapy is an accepted approach. Kidney cancer is a very vascular tumor and hence most systemic therapy in kidney cancers are targeted to block the generation of new blood vessels which are required for facilitating spread of kidney cancer.

Overall localised kidney cancers have good prognosis post treatment however for metastatic disease prognosis depends on factors like general well being of the patient, anaemia, high blood calcium and high blood WBC & platelet cell counts at the time of diagnosis. After treatment, it is advised to visit and consult your doctor for follow-up check ups or routine examinations.