Kidney Cancer & Treatment

What is kidney cancer?
To understand more about kidney cancer, it helps to know about the normal structure and function of the kidneys.
The kidneys are a pair of organs on either side of the spine in the lower abdomen. Each kidney is about the size of a fist. Attached to the top of each kidney is an adrenal gland. A mass of fatty tissue and an outer layer of fibrous tissue (Gerota's fascia) enclose the kidneys and adrenal glands.

The kidneys are part of the urinary tract. They make urine by removing wastes and extra water from the blood. Urine collects in a hollow space (renal pelvis) in the middle of each kidney. It passes from the renal pelvis into the bladder through a tube called a ureter. Urine leaves the body through another tube (the urethra).

The kidneys also make substances that help control blood pressure and the production of red blood cells.

Symptoms of Kidney Cancer

Common symptoms of kidney cancer include:

• Blood in the urine (making the urine slightly rusty to deep red)
• Pain in the side that does not go away
• A lump or mass in the side or the abdomen
• Weight loss
• Fever
• Feeling very tired or having a general feeling of poor health

Causes of Kidney Cancer

Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Doctors can seldom explain why one person develops kidney cancer and another does not. However, it is clear that kidney cancer is not contagious. No one can "catch" the disease from another person.

Studies have found the following risk factors for kidney cancer:

Smoking 

Cigarette smoking is a major risk factor. Cigarette smokers are twice as likely as nonsmokers to develop kidney cancer. Cigar smoking also may increase the risk of this disease.

Obesity 

People who are obese have an increased risk of kidney cancer.

High blood pressure: High blood pressure increases the risk of kidney cancer.

Long-term dialysis

 Dialysis is a treatment for people whose kidneys do not work well. It removes wastes from the blood. Being on dialysis for many years is a risk factor for kidney cancer.

Von Hippel-Lindau (VHL) syndrome 

VHL is a rare disease that runs in some families. It is caused by changes in the VHL gene. An abnormal VHL gene increases the risk of kidney cancer. It also can cause cysts or tumors in the eyes, brain, and other parts of the body. Family members of those with this syndrome can have a test to check for the abnormal VHL gene. For people with the abnormal VHL gene, doctors may suggest ways to improve the detection of kidney cancer and other diseases before symptoms develop.

Occupation 

Some people have a higher risk of getting kidney cancer because they come in contact with certain chemicals or substances in their workplace. Coke oven workers in the iron and steel industry are at risk. Workers exposed to asbestos or cadmium also may be at risk.

Gender 

Males are more likely than females to be diagnosed with kidney cancer. Each year in the United States, about 20,000 men and 12,000 women learn they have kidney cancer.

Treatment for Kidney Cancer

At any stage of disease, people with kidney cancer may have treatment to control pain and other symptoms, to relieve the side effects of therapy, and to ease emotional and practical problems. This kind of treatment is called supportive care, symptom management, or palliative care.

People with kidney cancer may have: 

• surgery 
• arterial embolization 
• radiation therapy 
• biological therapy 
• chemotherapy 

Surgery

Surgery is the most common treatment for kidney cancer. It is a type of local therapy. It treats cancer in the kidney and the area close to the tumor.

An operation to remove the kidney is called a nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:

• Radical nephrectomy: Kidney cancer is usually treated with radical nephrectomy. The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.
• Simple nephrectomy: The surgeon removes only the kidney. Some people with Stage I kidney cancer may have a simple nephrectomy.
• Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery.

Arterial embolization

Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.

The doctor inserts a narrow tube (catheter) into a blood vessel in the leg. The tube is passed up to the main blood vessel (renal artery) that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.

Radiation therapy

Radiation therapy (also called radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.

A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.

Biological therapy

Biological therapy is a type of systemic therapy. It uses substances that travel through the bloodstream, reaching and affecting cells all over the body. Biological therapy uses the body's natural ability (immune system) to fight cancer.

For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 or aldesleukin). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.

Chemotherapy

Chemotherapy is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer. However, many doctors are studying new drugs and new combinations that may prove more helpful. The section on "The Promise of Cancer Research" has more information about these studies.

Prevention

The following measures may help reduce your risk of developing kidney cancer, as well as other cancers, diseases and conditions:

• Don't smoke
• Eat plenty of fruit and vegetables
• Exercise regularly
• Keep your body weight within normal limits for your height, sex and age
• Get at least 7 hours good quality continuous sleep every night (or 24-hour period)
• Maintain healthy blood pressure
• Avoid toxic chemicals

Lifestyle changes after Kidney Cancer

You can't change the fact that you have had cancer. What you can change is how you live the rest of your life -- making choices to help you stay healthy and feel as well as you can. This can be a time to look at your life in new ways. Maybe you are thinking about how to improve your health over the long term. Some people even start during cancer treatment.

Making healthier choices

For many people, a diagnosis of cancer helps them focus on their health in ways they may not have thought much about in the past. Are there things you could do that might make you healthier? Maybe you could try to eat better or get more exercise. Maybe you could cut down on the alcohol, or give up tobacco. Even things like keeping your stress level under control may help. Now is a good time to think about making changes that can have positive effects for the rest of your life. You will feel better and you will also be healthier.

Eating better

If treatment caused weight changes or eating or taste problems, do the best you can and keep in mind that these problems usually get better over time. You may find it helps to eat small portions every 2 to 3 hours until you feel better. You may also want to ask your cancer team about seeing a dietitian, an expert in nutrition who can give you ideas on how to deal with these treatment side effects.

One of the best things you can do after cancer treatment is put healthy eating habits into place. You may be surprised at the long-term benefits of some simple changes, like increasing the variety of healthy foods you eat. Getting to and staying at a healthy weight, eating a healthy diet, and limiting your alcohol intake may lower your risk for a number of types of cancer, as well as having many other health benefits.

Rest, fatigue, and exercise

If you were sick and not very active during treatment, it is normal for your fitness, endurance, and muscle strength to decline. Any plan for physical activity should fit your own situation. An older person who has never exercised will not be able to take on the same amount of exercise as a 20-year-old who plays tennis twice a week. If you haven't exercised in a few years, you will have to start slowly – maybe just by taking short walks.

If you are very tired, you will need to balance activity with rest. It is OK to rest when you need to. Sometimes it's really hard for people to allow themselves to rest when they are used to working all day or taking care of a household, but this is not the time to push yourself too hard. Listen to your body and rest when you need to. (For more information on dealing with fatigue, please see Fatigue in People With Cancer and Anemia in People With Cancer.)

Keep in mind exercise can improve your physical and emotional health.

• It improves your cardiovascular (heart and circulation) fitness.
• Along with a good diet, it will help you get to and stay at a healthy weight.
• It makes your muscles stronger.
• It reduces fatigue and helps you have more energy.
• It can help lower anxiety and depression.
• It can make you feel happier.
• It helps you feel better about yourself.