Narayana Health Care

Kidneys are two bean-shaped organs, each about the size of your fist. They’re situated behind your intestines, with one kidney on each side of your spine. Their main job is to clean your blood by removing waste products and making urine. Kidney cancer starts in the kidneys. It happens when healthy cells in one or both kidneys go wild and form a lump (called a tumor). The most common type of kidney cancer is called Renal Cell Carcinoma. Fortunately, a large number of kidney cancers are found before they spread (metastasize) to far off organs. Furthermore, kidney cancers when caught early are easier to treat.

Symptoms:

There are rarely any signs or symptoms of kidney cancer in the initial stage. What’s more, at present, there are no standard tests used to screen for kidney cancer in the absence of symptoms. In the later stages, kidney cancer signs and symptoms may include:

• Blood in urine, which may appear pink, red or cola-colored
• Pain in the back or side that doesn’t leave
• Loss of appetite
• Unexplained weight loss
• Tiredness
• Fever, which generally appears and goes (irregular)

Risk Factors:

Risk factors for kidney cancer include –

• Smoking – Smokers have more danger of kidney cancer than nonsmokers do. The dangers diminish after you quit.
• Obesity – People who are obese are at a higher risk of kidney cancer.
• Dialysis – Patients on long term dialysis.
• Specific inherited syndromes – People born with certain inherited syndromes are at an increased risk of kidney cancer. These include Von-Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma, or familial renal cancer.
• Family history – People with a strong family history of renal cell cancer are also at a risk.

Diagnosis:

These days most of the kidney tumours are detected on a ultrasound scan which may have been done for some other reason, as most of the small kidney masses do not produce any symptoms in the initial period, in the past when ultrasound examinations were not readily available it was more difficult to pick up early kidney tumours. Once a mass has been detected, a contrast-enhanced CT scan of the chest and abdomen is performed to establish a diagnosis and to see, if the disease has spread beyond the kidney, very rarely an MRI scan may be used as an adjunct to help with the diagnosis. PET CT scans are of little or no value in establishing a diagnosis of kidney cancer and only add up the cost of treatment without providing any major benefits.

When we are unsure about the character of the renal mass a biopsy may be recommended, this is carried out under local anaesthesia under CT or Ultrasound guidance. Once a sample of tissue has been obtained, this is sent to the tested in the lab by a cancer pathologist for signs of cancer.

Treatment:

Post diagnosis, you can review an appropriate treatment option along with your doctors. Your best approach may depend on various factors like general health, stage of kidney cancer, and your treatment preference.

1. Surgery

Surgery is the mainstay of treatment for kidney cancer. More so these days with the advent of better technology kidney preserving surgery is the standard of care for curing kidney cancers. Following surgical procedures are used to treat kidney cancer –

• Nephrectomy (removing the affected kidney) – A total nephrectomy includes taking out the whole kidney, an edge of the healthy tissue and close by tissues like the lymph nodes, adrenal gland, or different structures. The doctors may conduct a nephrectomy through a cut in the abdomen or side (open nephrectomy) or small cuts in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy).
• Partial nephrectomy (Removing the tumor from the kidney) – Also called kidney-saving or nephron-sparing surgery, the doctor removes the tumor and a small margin of healthy tissue that encompasses it rather than the entire kidney. It very well may be done as an open procedure or laparoscopically or with robotic assistance. Robotic-assisted partial nephrectomy offers a more precise operation with a lesser likelihood of complications during or after surgery with early return to normal daily activities. Kidney-saving surgical procedure is the treatment of choice for small kidney cancers and it might be an option if you have just a single kidney. Certainly, having the entire kidney removed for small kidney cancers should become a thing of the past, and losing a vital organ is rather unnecessary. Whenever possible, the kidney-saving procedure is favoured over a total nephrectomy to safeguard kidney functions and reduce the danger of later complications, for example, kidney illness and the need for dialysis.

The kind of medical procedure your doctor suggests will be based on your cancer and its stage, as well as your wellbeing. At the point when the cancer is limited to the kidney, surgery is the only treatment option — no medications or radiation are required. Routine follow-up is all that’s required.

2. Nonsurgical treatments

Some alternative methods to treat kidney cancer apart from surgery are –

• Cryoablation (treatment to freeze cancer cells) – During cryoablation, a special empty needle is interposed through your skin and into the tumor using ultrasound or other image guidance. Cold gas in the needle is utilized to cool or freeze the cancer cells.
• Radiofrequency ablation (treatment to heat cancer cells) – Radiofrequency ablation is somewhat like cryoablation, just that here, instead of cold gas, an electrical current is run through the needle into the cancer cells, causing them to heat or burn.

These procedures may have advantages for certain patients and are a potential option for people who can’t have surgical procedures, although the long-term cancer cure rates with these procedures are inferior to having surgery.

Some kidney cancer that recurs and spread to other parts of the body may not be curable. It can be controlled with treatment. These treatments may include:

• Surgery to remove the majority of kidney tumor – At times surgery may or may not remove cancer, but it can be useful in removing as much cancer as possible. Likewise, surgery may also be utilized to remove cancer that has spread to another area of the body.
• Biological therapy (Drugs that use your immune system to fight cancer) – To fight cancer, biological therapy uses the body’s immune system. Drugs like interferon and aldesleukin (Proleukin) – a synthetic version of chemicals in your body, are used in this therapy. Nivolumab (Opdivo) immunotherapy is sometimes used to treat advanced renal cell carcinoma.
• Targeted therapy – Targeted treatments block precise abnormal signs present in kidney cancer cells that permit them to multiply. These medications assure the treatment of kidney cancer that has spread to different parts of the body. The targeted drugs cabozantinib (CaboMetyx), axitinib (Inlyta), bevacizumab (Avastin), pazopanib (Votrient), sorafenib (Nexavar), and sunitinib (Sutent) block signals that aid in the development of blood vessels that supports cancer cells and permit them to spread. Temsirolimus (Torisel) and everolimus (Afinitor) are the drugs that block the cancer cells from developing and enduring. Scientists keep on examining how patients with specific genes may react to certain targeted therapies.
• Radiation therapy – High-powered energy beams like X-rays are used to kill cancer cells in radiation therapy. This therapy is used to contain and reduce symptoms of kidney cancer that has spread to different parts of the body.

Be sure to discuss with your doctor the benefits, risks, and possible side effects of any treatment that you’re considering.

Dr. Saurabh Bhargava, Senior Consultant – Urology | Mazumdar Shaw Medical Center, Bommasandra