Kidney Cancer (Renal Cell Carcinoma)

The kidneys are paired organs in the back of the upper portion of the abdomen. These organs filter our blood of waste products and toxins. These waste products are concentrated in our urine, passed into the collecting system and drained through the ureters into the bladder. Renal cell carcinoma (or adenocarcinoma of the kidney) is the most common form of kidney cancer. Renal cell carcinoma is a rapid growth of abnormal cells from within the kidney.

Historically most patients with renal cell carcinoma presented with blood in the urine (hematuria), and sometimes with flank pain, weight loss, anemia, or a mass in their abdomen. Recently, most renal tumors are detected incidentally on a CT scan that was performed for some other reason, like lung problems, or bowel problems. If a solid mass is found in the kidney, and the patient does not have a history of another kind of cancer elsewhere in the body, we have found that 70 to 90% of the time the mass turns out to be renal cell carcinoma. People with a family history of kidney cancer, a history of smoking, or overuse of over the counter pain medications have been found to be at an increased risk for renal cell carcinoma.

Once a renal mass has been detected, the following tests may be used to determine the size, location, and extent of the mass:

  1. Blood chemistries – to check the salts in the blood and to check the overall kidney function
  2. Blood counts – to make sure the patient is not anemic.
  3. Urine tests – urinalysis and possibly urine cytology
  4. Liver function tests – to rule out involvement of the liver
  5. Chest x-ray – to rule out spread to the lungs
  6. CT scan – to determine the size of the tumor, what other organs may be involved, and to determine if there are any lymph nodes.
  7. Renal Ultrasound – this may be used to further evaluate the mass, if it looks cystic or possibly contains fat.
  8. MRI – this type of scan is utilized as an alternative to CT scan, or to rule out invasion into the blood vessels of the kidney

The stage of the cancer is determined from the findings of the tests noted above. There are 3 parts to the staging, and the staging system is referred to as the TNM cancer staging system.

  1. T = Tumor size and extent
  2. N = Nodal involvement
  3. M= Metastasis outside the nodal system, involving other parts of the body.

Treatment of the tumor depends on the stage and size of the tumor.

  1. If it is an early stage tumor, and less than 4 cm, the tumor can be treated several different ways:
    1. Partial Nephrectomy – removing the tumor and a small amount of normal kidney tumor around the tumor. This can be performed open or laparoscopically (through tiny ports in the skin)
    2. Radical Nephrectomy – removal of the whole kidney. This can also be done open or laparoscopically.
    3. Cryosurgery – freezing the tumor mass. This can be performed percutaneously or laparoscopically.
    4. Radiofrequency ablation (RF) – destroy the tumor using radio waves.
    5. Active observation – especially if the patient is not well, and unable to undergo surgery.
  2. If it is an early stage tumor, but 4 to 7 cm in size, the tumor can be treated with:
    1. Partial Nephrectomy (open or laparoscopic) – although the size or depth of invasion may preclude this option.
    2. Radical Nephrectomy (open or laparoscopic) – removal of the whole kidney.

  3. If it is larger (> 7 cm), but not invading other organs, the best treatment is usually radical Nephrectomy (open or laparoscopic). On a rare occasion a tumor this size can be treated with a partial Nephrectomy, but this would be unusual.
  4. If it is invading the vessels - this is usually treated with open surgery.
  5. If the tumor is involving other organs, or is metastatic (spread to other parts of the body):
    1. Radical Nephrectomy – for palliation or tumor debulking prior to systemic therapy (biologic therapy, chemotherapy or Antiangiogenic therapy)
    2. Arterial embolization
      1. For palliation – relief of symptoms
      2. For potential cure – embolization is followed by surgery
    3. External beam therapy for palliation
    4. Experimental therapies
      1. Biologic therapies alone or in combination with surgery
        1. Interferon
        2. Interleukin – 2
      2. Antiangiogenic therapy alone of in combination with surgery or biologic therapy
        1. Sorafenib
        2. Sunitinib
        3. Bevacizumab

Once the kidney cancer has been successfully treated, the patient will require period blood tests to monitor the renal function, a Chest x-ray, and a CT scan or renal US of the renal bed as well as the kidney on the other side.

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