Your kidneys are two bean-shaped organs, each about the size of your fist. They're located behind your abdomen, one on each side of your spine. Like other major organs in the body, the kidneys can sometimes develop cancer. In adults, the most common type of kidney cancer is renal cell carcinoma (renal adenocarcinoma), which begins in the cells that line the small tubes within your kidneys. Children are more likely to develop a kind of kidney cancer called Wilms' tumor.
Kidney cancer seldom causes problems in its early stages. But as a tumor grows, you may notice blood in your urine or experience unintentional weight loss or back pain that doesn't go away. Kidney cancer cells may also spread (metastasize) outside your kidneys to nearby organs as well as to more distant sites in the body. Yet if kidney cancer is detected and treated early, the chances for a full recovery are good.
Kidney cancer rarely causes signs or symptoms in its early stages. In the later stages, the most common sign of both renal cell and transitional cell cancers is blood in the urine (hematuria). You may notice the blood when you urinate, or your doctor may detect it by urinalysis, a test that specifically checks the contents of your urine. Other possible signs and symptoms may include:
Wilms' tumor usually has no symptoms, and doctors are likely to discover this condition when examining a child's abdomen.
Your kidneys are part of the urinary system, which removes waste and excess fluid and electrolytes from your blood, controls the production of red blood cells, and regulates your blood pressure. Inside each kidney are more than a million small filtering units called nephrons. As blood circulates through your kidneys, the nephrons filter out waste products as well as unneeded minerals and water. This liquid waste — urine — flows through two narrow tubes (ureters) into your bladder, where it's stored until it's eliminated from your body through another tube, the urethra.
Renal cell carcinoma, which accounts for most kidney cancers, usually begins in the cells that line the small tubes (tubules) that make up a part of each nephron. In most cases, renal cell tumors grow as a single mass, but you may have more than one tumor in a kidney or develop tumors in both kidneys.
A far less common type of kidney cancer, transitional cell carcinoma, develops in the tissue that forms the tubes connecting the kidneys to the bladder. Transitional cell carcinomas can also begin in the ureters themselves or in the bladder. A rare form of kidney cancer, renal sarcoma, begins in the connective tissue of the kidney.
Just what causes kidney cells to become cancerous isn't clear. But researchers have identified certain factors that appear to increase the risk of developing both renal and transitional cell kidney cancers.
The risk of renal cell carcinoma increases with age; most kidney cancers occur in people 60 and older. Men are more than twice as likely as are women to develop renal cell carcinoma, and black men have a slightly higher risk than white men do. Other risk factors for renal cell carcinoma include:
Risk factors for transitional cell carcinoma include:
See your doctor right away if you notice blood in your urine. In most cases, this doesn't mean you have kidney cancer. Blood in the urine may be a sign of many conditions, including a renal cyst — a noncancerous lesion of the kidney that's common in people older than 50 — bladder or kidney stones, prostate problems, urinary tract infections or glomerulonephritis, a kidney disease that affects the kidneys' filtering function. In rare cases, you may even notice blood in your urine after strenuous exercise such as a marathon run.
If you think you may be at risk of developing kidney cancer, discuss your concerns with your doctor. He or she may suggest ways to reduce your risk and can schedule regular checkups. When kidney cancer is diagnosed early, it's easier to treat and your chances of survival are good. Once cancer has spread, however, treatment is more difficult and the prognosis is less positive.
In addition to taking a complete medical history and performing a physical exam, your doctor will likely recommend blood and urine tests. If your doctor suspects a problem or if you are at high risk of kidney cancer, you may also have one or more of the following tests to check for growths or tumors:
Tests for transitional cell cancer
If the results of an IVP suggest transitional cell cancer, your doctor will likely recommend a test that examines your bladder for signs of cancer (cystoscopy). In this procedure, a long, narrow tube called a cystoscope is inserted through your urethra into your bladder. The tube carries a light source and special lens, which allow your doctor to inspect both your urethra and bladder. The cystoscope can also be used to remove a small tissue sample from a tumor. In some cases, a microscopic examination of the sediment in your urine may also help identify cancer cells.
Tests to determine whether cancer has spread
If your doctor finds signs of kidney cancer, the next step is to determine whether the cancer has spread. This usually means more tests, including additional blood tests, an ultrasound of your liver, a CT scan, a chest X-ray or a bone scan. A bone scan is a test in which you're given a small amount of a radioactive material that's then taken up by your bones. Tumors absorb even more of this material and show up as a black area when a special camera scans your body.
Second opinions
If you've received a diagnosis of kidney cancer, you may want to seek a second opinion. Sometimes your insurance company may even require you to do so. In that case, your current doctor may be able to recommend other specialists. In addition, the Cancer Information Service at (800) 4-CANCER, or (800) 422-6237, can provide information on treatment centers. You can also get a list of doctors from your local hospital or a nearby medical school.
Together, you and your treatment team — which may include a surgeon, a doctor who specializes in disorders of the urinary organs (urologist), a cancer specialist (oncologist) and an oncologist who specializes in treating cancer with radiation (radiation oncologist) — will discuss all of your options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have and whether the cancer has spread.
Renal cell carcinoma
Treatments for renal cell carcinoma include:
Surgical removal. Until recently, the standard treatment for cancer that was confined to the kidney was surgical removal of the entire kidney (radical or simple nephrectomy). In a radical nephrectomy, surgeons remove the kidney along with the adrenal gland that sits atop the kidney, a border of normal tissue and adjacent lymph nodes. A simple nephrectomy involves removing the entire kidney, although not the adrenal gland or lymph nodes. But studies show that removing just the tumor (nephron-sparing surgery), rather than the whole kidney, results in survival rates similar to those of more radical procedures. In addition, people who have nephron-sparing surgery appear less likely to develop chronic kidney failure and are more likely to enjoy a better quality of life than do those who have the whole kidney removed.
Sometimes surgeons may choose to remove the entire kidney because of the extent and the location of the tumor. In that case, laparoscopic nephrectomy may offer advantages over traditional open surgery because it typically results in less postoperative pain, faster recovery time and less scarring. In a laparoscopic procedure, a tiny camera is inserted into your body through a small incision. The camera transmits video images that allow your surgeon to see the kidney in great detail. The surgeon inserts surgical instruments through two or three additional small incisions and performs the operation. The recovery time and side effects of any type of kidney surgery will vary, but it's likely you'll feel tired and weak for a time, even with laparoscopic nephrectomy.
Transitional cell cancer
To treat transitional cell cancer in its early stages, surgeons remove an area surrounding the tumor while trying to save the kidney itself. If the tumor is too large or too centrally located, the kidney and ureter may need to be removed along with the portion of the bladder that's connected to the ureter. This helps decrease the risk of cancer cells spreading to the bladder. Chemotherapy is often used to treat transitional cell cancer that has spread.
Wilms' tumor
Treatment for children with Wilms' tumor depends on the child's age and overall health, the type of tumor and whether the cancer has spread. In many cases, treatment may include surgical removal of the tumor followed by chemotherapy or radiation.
Clinical trials
If kidney cancer has spread, standard treatments are seldom effective. For that reason, you may choose to participate in a clinical trial. These trials test the effectiveness and side effects of new treatments. Those who take part have a chance to receive a treatment that may be promising but not yet widely available. If you're interested in clinical trials, talk to your doctor. You can also contact the National Cancer Institute for detailed information, or visit the clinical trials page on its Web site.
Although the following steps may not prevent kidney cancer, they can help reduce your cancer risk and keep you healthier overall:
Eating well, managing stress and exercising are ways to promote your overall health and cope with any form of cancer.
Eating well
Good nutrition is especially important for people undergoing cancer treatment. But eating well can be difficult, especially if your treatment includes chemotherapy or radiation treatment. You may feel nauseated or lose your appetite, and foods may seem tasteless. You may find that the last thing you want to do is plan meals.
Even so, eating well during cancer treatment can help you maintain your stamina and your ability to cope with the side effects of treatments. Good nutrition may also help you prevent infections and remain more active.
Remember these strategies for eating well when you don't feel well:
Managing stress
Methods for reducing physical tension can help you manage stress. One simple and powerful technique is to simply close your eyes and notice your breathing. Pay attention to each inhalation and exhalation. Your breathing will become slower and deeper, promoting relaxation. Another technique is to lie down, close your eyes and mentally scan your entire body for any points of tension.
Exercise
In addition, activities that require repetitive movements, such as running and swimming, can produce a mental state similar to meditation. So can yoga and other stretching exercises.
Your doctor may have more specific suggestions about how to best care for yourself before, during and after treatment for kidney cancer.
February 10, 2006