The kidneys
- Two bean-shaped organs, each about the size of a fist.
- Positioned near the middle of the back, on either side of the backbone.
- Part of the body’s urinary system.
- Main job is to filter the blood and remove any excess water, salt and waste products.
- Filtered materials are converted into urine.
- Produce certain hormones, which help control the production of red blood cells and regulate the body’s calcium levels.
Nephrons in the kidney regulate blood pressure and volume, blood pH and levels of electrolytes and metabolites. There are approximately one million nephrons in each kidney.
If one kidney is damaged or diseased, the other kidney is usually able to take up the extra work. Many people are able to live quite normally with one functioning kidney.
Types of kidney cancer
Renal cell carcinoma:
- about 90% of all kidney cancers
- develops in the nephrons of the kidney
- usually only one kidney is affected
- in rare cases it may develop in both kidneys.
Transitional cell carcinoma:
- a less common type of kidney cancer
- begins at the point where the kidney joins the tube that connects to the bladder (the ureter).
Rarer types of kidney cancer:
- renal sarcoma – type of cancer that affects the connective tissue of the kidney
- Wilms’ tumour – type of cancer more common in children than adults.
In the early stages, primary kidney cancer forms a tumour that is confined to the kidney. However, as the cancer grows, it may spread (metastasise) to other parts of the body.
Kidney cancer may be a secondary cancer which has spread from a primary cancer in another part of the body.
How common is it?
- About 900 people are diagnosed with kidney cancer each year.
- Between 2 and 3% of all cancers diagnosed.
- More common in people over 55.
- Men are almost two times as likely to be diagnosed with kidney cancer as women.
Diagnosis
Urine test
- Allows doctor to look for any blood, abnormal proteins or cancer cells in urine.
Cystoscopy
- Often done after a blood test.
- A urologist passes a tiny telescope called a cystoscope through the urethra and into the bladder.
- Examination of the inside of the bladder for any tumours or abnormalities.
Blood test
Checks for changes in the blood that can be caused by kidney cancer, such as:
- too few or too many red blood cells
- high calcium levels
- high levels of certain liver enzymes.
Biopsy
- Sometimes called fine needle aspiration.
- A thin needle is inserted through the skin to remove fluid or cells.
- Tissue is examined under a microscope.
CT (computerised tomography) scan
- Uses x-ray beams to compile many pictures of the body.
- You may have an injection of a special dye into your veins before the scan.
- You will be asked to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you.
- Painless.
- The scan and prep takes 10 to 30 minutes.
MRI (magnetic resonance imaging) scan
- Uses a combination of magnetism and radio waves to build up detailed cross-section pictures of the body.
- A special dye may be injected into your veins before the scan.
- You will lie on a couch in a metal cylinder – a large magnet – that is open at both ends.
- Painless.
- Takes about one hour.
Ultrasound
- A scan that uses soundwaves to build up pictures of the body.
- A gel is spread over the abdomen or back and a paddle-shaped device is moved over the area for a few minutes.
- You may have to drink fluid so you have a full bladder for the scan.
- Painless and non-invasive.
- Only takes a few minutes.
- Checks the lymph nodes in the neck for signs of cancer.
Intravenous pyelography
- Sometimes called an intravenous urography.
- A type of x-ray used to locate abnormalities in the urinary system.
- Dye is injected into a vein, usually in your arm.
- Doctors watch the dye move through the bloodstream and the urinary system on an x-ray screen.
- A compression band (belt) may be placed around your body to help the doctors obtain a clearer picture.
- You may feel temporary discomfort.
- Takes about one hour.
Chest x-ray
- Used to check for abnormalities in the organs and bones of the chest.
- Only takes a few minutes.
- Painless and safe.
Radioisotope bone scan
- A small amount of radioactive liquid is injected into a vein in the arm.
- After about 20 minutes, a machine called a gamma camera detects radioactive liquid absorbed by cells.
- May be used as a follow-up test.
- Painless.
- * It is safe to interact with others soon after the scan.
Staging
Staging tells the doctor how far the cancer has spread. This helps your health care team decide what treatment is best.
Most cancers follow a general, international staging system called TNM.
Some types of thyroid cancer are staged according to a numeric system. The system ranges from stage 1 (small, localised cancer) to stage 4 (cancer that has spread to remote parts of the body).
Prognosis
Prognosis means the expected outcome of a disease. Iit is not possible for any doctor to give you a prognosis that is 100% accurate.
In most cases, the earlier that kidney cancer is diagnosed, the better your prognosis will be. However, your prognosis also depends on factors such as your age and general well-being. You will need to talk with your doctor about your prognosis, what treatment options are best for you and what you might expect the outcome to be.
Treatment
Surgery
Surgery is the main treatment for people with kidney cancer, although it is not possible for all patients.There are two main types of surgery for renal cell carcinoma.
A radical nephrectomy
- removal of the affected kidney
- the adrenal gland above the kidney, surrounding fatty tissue and nearby lymph nodes may also be removed
- it is not always possible to remove all the cancerous tissue.
A partial nephrectomy
- removal of part of the kidney
- may be the best choice for people who have a small tumour in one kidney (less than 4 cm).
- used for people with cancer in both kidneys or only one working kidney.
Kidney surgery is usually carried out under a general anaesthetic. The surgeon will remove as much of the cancer as possible through a cut in the side of your abdomen.
You may be able to have keyhole surgery (laparoscopy) through several small incisions.
Immunotherapy (biologic therapy)
Immunotherapy involves boosting the body’s own immune system to help it fight off disease. Drugs called cytokines, which are proteins that activate the immune system, may cause the cancer to shrink in size.
Your surgeon may first remove all or part of your affected kidney.
Tyrosine kinase inhibitors
Tyrosine kinase inhibitors (TKIs) are a type of drugs that block chemical messengers, or enzymes, that are produced by the body’s cells. These enzymes tell cells when to divide and grow.
Ask your doctor if you are suitable for this treatment, which is only available at some treatment centres.
Chemotherapy
Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs.
The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells. Chemotherapy is only very occasionally used to treat kidney cancer.
Chemotherapy may be given for advanced cancer that has spread (metastasised) to other parts of the body.
Chemotherapy is usually given by injection into a vein (intravenously). You will probably have several sessions of chemotherapy over a few weeks, however your medical team will determine your treatment schedule.
Radiofrequency ablation
Radiofrequency ablation (RFA) is a type of treatment that uses radio waves to heat and destroy cancer cells. This treatment, which is still being evaluated, is sometimes used for patients who can’t have surgery.
In RFA treatment, a needle is inserted into the tumour under anaesthesia. An electrical current passes into the tumour, destroying the cells and creating scar tissue.
In most cases, patients only require a single RFA treatment. The treatment takes approximately 15 minutes. Side effects, which include pain or fever, can be managed with medication.
Cryotherapy (cryosurgery)
Cryotherapy treatment is considered an alternative treatment for kidney cancer, as it is still being evaluated. In this treatment, a probe is inserted into the tumour (usually through a cut in the abdomen or back) and liquid nitrogen is injected. This freezes the area and destroys cancer cells.
Cryotherapy typically takes about 30 to 60 minutes. You may have to stay in hospital overnight, and your doctors will help you manage any pain with medications.
Radiotherapy
Radiotherapy is the use of high-energy x-rays or electron beams to kill or damage cancer cells. It is not a common treatment for kidney cancer, but may be used for people who can’t have surgery, or for pain management.
If you receive radiotherapy, the total number of treatments and duration of your treatment will depend on your situation. Sometimes only a couple of treatments are necessary, or you may require several treatment sessions over a number of weeks.
Palliative treatment
Palliative treatment helps improve people’s quality of life by alleviating symptoms of cancer, without trying to cure the disease.
Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.
Health professionals
Your GP will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist who will arrange further tests and advise you about treatment options.
Health professionals who may care for you include:
- urologist – specialises in diseases and surgery of the urinary system
- nephrologist – specialises in diseases of the kidneys
- medical oncologist – responsible for chemotherapy
- radiation oncologist – responsible for radiotherapy
- nurses – support you through all stages of your cancer experience
- cancer care coordinator – coordinates the care you receive and supports you and your family through treatment
- dietician – supports and educates patients about optimal nutrition and diet during treatment and recovery
- social workers, physiotherapists and occupational therapists – advise you on support services and help you to get back to your normal activities.