Kidney cancer: the hidden disease often diagnosed too late

25.09.2018

The kidneys' main job is to filter waste from your blood and make pee. But they also help control your blood pressure and make sure you have enough red blood cells. Kidney cancer, also called renal carcinoma, happens when cells in one or both of them start growing out of control and form a tumor that crowds out healthy cells. It's usually one tumor inside one kidney, but there can be more than one, and they can happen in both kidneys

Risk factors

Most people diagnosed with kidney cancer are between 50 and 70 years old. Men are 2 to 3 times more likely to get it than women, and African-American people have a higher chance of getting it than other groups. High blood pressure, kidney disease, and certain problems with your genes, like von Hippel-Lindau disease, also can raise your risk. It can run in families, too.

However, there are other risk factors related to your behaviour:

  • You smoke: This doubles your risk. It's believed to cause 30% of kidney cancers in men and 25% in women.
  • You have extra weight: People who are overweight or obese are nearly twice as likely to get RCC.
  • You take too many over-the-counter meds: Too much aspirin, acetaminophen, or ibuprofen over a long period of time can play a role.

Symptoms

If you have a small tumor, you might not notice any signs, but larger ones can cause these problems:

  • Blood in your pee
  • A lump on your side or lower back
  • Low back pain
  • Feeling tired
  • Weight loss for no reason
  • Fever

Diagnosis: Urine and Blood Tests

Your doctor will give you an exam. If he thinks you might have kidney cancer, he'll probably start with urinalysis, which tests your pee for blood or cancer cells. He also might do a blood test to see how well your kidneys are working and a complete blood count to make sure you have a healthy number of white blood cells, red blood cells, and platelets. People with kidney cancer often have anemia -- when you don't have enough red blood cells.

Diagnosis: Imaging Tests

Your doctor may do scans to get a closer look at your kidneys:

  • Ultrasound: Sound waves make black-and-white images on a computer screen.
  • Computerized tomography (CT) scan: X-rays from different angles are put together to make a more complete picture.
  • Magnetic imaging resonance (MRI) scan: Magnets and radio waves make detailed images.
  • Positron emission tomography (PET) scan: Radiation makes 3-D color images.

Biopsy

With kidney cancers, biopsies are rarely needed and are done only in very rare situations. If your doctor decides one is needed, he will recommend surgery to take a tiny sample from the tumor with a needle so it can be tested. In a case like that, the biopsy is used to tell for sure whether what you have is cancer.

Grades

If it turns out you do have cancer, your doctor will want to try to predict how fast it may grow. He'll do this based on how much the cancer cells look like healthy ones. Kidney cancer can be grade 1, 2, or 3 -- grade 3 cells look very different from normal ones and tend to grow fastest.

Staging

Your doctor will also try to tell how far the cancer has spread -- it can be stage I, II, III, or IV. A stage I cancer is only in your kidney, while a stage IV has spread to other parts of your body.

Treatment Plan

Your doctor will make recommendations based on the grade and stage of the cancer, your age, and any other health problems you might have.

Wait and See

Your doctor may suggest this approach if your tumor is small. He'll want to do tests often to see if it starts to grow quickly or gets bigger than an inch and a half.

Surgery

This is the most common treatment. Your doctor may take out only the part of the kidney where the tumor is and let the healthy part keep working. In other cases, it may need to be removed -- most people do fine with only one.

Tumor 'Destroyers'

If you're not able to have surgery to take out the tumor, your doctor may try to destroy it instead. He might use radio waves to heat the tumor or cold gases to freeze it. These can kill cancer cells without hurting your kidney. If your cancer is causing a lot of bleeding, he might block the artery that brings blood to the kidney. But that kills not only the tumor, but your kidney, too.

Targeted Therapy

Kidney tumors make their own network of blood vessels that let them grow. A new kind of drug targets these vessels but leaves normal ones alone. Without blood, the tumor stops growing or even shrinks. This therapy is used to treat more advanced renal cell cancer.

Immunotherapy

The idea with this is to boost your immune system so it can fight or kill cancer cells. But so far, it only seems to work for a small percentage of people with kidney cancer. Your doctor may suggest it if targeted therapy doesn't work for you, or he may recommend that the two be used together.

Chemotherapy

This is a combination of powerful drugs that's used to kill cells that are growing fast. It doesn't seem to work well against kidney cancer, but your doctor may try it if other treatments haven't worked.

Radiation

This treatment uses high-energy rays to kill cancer cells or shrink tumors. But kidney cancer isn't very sensitive to radiation, so it's not done often. You may get it if you can't have surgery or to help with symptoms like pain or bleeding. You also might have it if cancer has spread to other parts of your body, like your bones or brain.

Clinical Trials

Researchers are working to find new treatments. If you volunteer to be part of a clinical trial, you may get cutting-edge treatment years before other people can. Talk to your doctor, to find studies near you.