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RENAL CANCER

Renal cancer; also commonly known as kidney cancer, is a condition in which the cells found in the lining of the tubules of kidneys become malignant (cancerous).

Your kidneys are two bean-shaped organs, which are an integral part of the urinary system situated lower the abdomen on either side of the spine, each about the size of a fist. The key function of the kidneys is to cleanse your blood, remove toxic waste products and aid in removing them through urine.

Incidence of renal cancer is on the rise!

One of the most common types of kidney cancer seen amongst adults is renal cancer, accounting for nearly 90% of malignancy.

Usually, kidney cancer is diagnosed in adults at around 64 years of age, while it is rarely seen in people younger than 45 years.

If the patient is diagnosed early (stage I or II cancer), 75-80% will survive.

Epidemiology of Renal Cancer according to ACS (American Cancer Society) in 2019

According to ACS, kidney cancer is one of the 10 most common cancers.

Over a lifetime, it is known that kidney cancer affects about 1 in every 48 men and 1 in every 83 women.

The ACS expected that more than 73,000 new cases of kidney cancer will be diagnosed in 2019 in the U.S, with a predication that nearly 14,770 people would die due to the condition.

The risk of being diagnosed with renal cancer is higher in men than in women.

In time diagnosis and treatment can help cure kidney cancer.

If you have any of these, you are at a higher risk of developing kidney cancer

As you age, you are at a higher risk of renal cancer.

If you smoke, you are at a higher risk of renal cancer, as compared to non-smokers. However, the risk may drop if you quit smoking.

People who are overweight may have a higher risk of kidney cancer, as some research says that obesity causes changes in certain hormones leading to renal cancer.

If you have high blood pressure (hypertension) you are at an increased risk of kidney cancer.

People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer.

Certain genetic and hereditary syndromes have been linked to the risk of developing kidney cancer, such as those who have von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex or familial renal cancer.

Individuals who have a strong family history of renal cell cancer have a greater chance of developing kidney cancer.

Exposure to certain heavy metals such as cadmium or specific herbicides or organic solvents may lead to developing this cancer.

If you are aware of these risk factors and following a healthy lifestyle such as controlling your blood pressure, maintaining your weight and not smoking — it can help reduce the risk of kidney disease.

Signs and Symptoms

In the early stages of the cancer, there may be no signs or symptoms. Signs and symptoms usually appear as the tumor grows larger. If you see any of these signs, check with your doctor for renal cancer:

• Blood in the urine.
• A lump in the abdomen.
• A pain in the side that doesn’t go away.
• Loss of appetite.
• Weight loss for no known reason.
• Anemia
• Fever which lasts for a few weeks
• Edema of the ankle and legs

Getting an early diagnosis: Nip the problem in the bud

The chances of survival and better treatment increases if the tumor is detected early. Overall the outlook depends on two things:

• How aggressive are the cancer cells
• How far the tumor has spread

The following tests and procedures may be used to detect if you have renal cancer:

A physical check-up of the abdomen is done in order to check for signs of disease, such as lumps or any other unusual observations. A complete medical history of your health habits, family history and past illnesses and treatments is taken. Your doctor may ask you questions like:

• When did you first notice a problem?
• Is there blood in your urine?
• Have you been having any pain? Where?
• Does anything make your symptoms better or worse?
• Has anyone in your family had von Hippel-Lindau disease? What about kidney cancer?

A sonogram maybe taken with the help of imaging tests such as ultrasound to visualize the tumor. Other tests such a CT scan and MRI may be conducted to get detailed visuals of the affected areas.

Blood tests may be conducted to determine any abnormality in the blood profile. An unusual amount of a substance can be a sign of disease.

Analysis of the urine and its contents, such as presence of sugar, protein, red blood cells, and white blood cells.

In rare cases, your doctor may suggest removal of cells or tissues from the tumor to observe under a microscope by a pathologist to check for signs of cancer.

Getting an early diagnosis generally improves a person’s outlook towards the condition. Medical experts use past statistics to calculate how likely individuals with cancer are to live at least 5 years after diagnosis as compared to those in the overall population.

Treatment of renal cancer: A multifactorial approach

Your doctor will choose a treatment plan depending on various factors as mentioned below:

• Tumor grade and stage
• Your age
• Your overall health and health history
• Your anatomy

TREATMENT OPTIONS

Surgery (removal of the tumor)

The doctor may suggest to remove as much of the kidney tumor as possible. Partial or radical nephrectomy may be recommended, depending on tumor and patient characteristics. Surgery may also be advised to remove cancer that has spread to another area of the body.

In this procedure, the surgeon removes just the tumor or part of the kidney that has the tumor. The kidney is preserved.

In this treatment option, the doctor may remove the complete kidney. If required, the surrounding tissues and lymph nodes may also be removed and it is seen that most people can live a healthy, normal life with one kidney.

Thermal Ablation

This is a treatment that destroys the tumor by burning or freezing it. The most common types of thermal ablation are radiofrequency ablation (burning) or cryoablation (freezing). It is used mostly in people with small tumors who are not good candidates for surgery.

Active Surveillance

In some cases, a small tumor (less than 4 centimeters) can be closely watched to see if it grows. Many small tumors grow slowly and not all kidney tumors require surgery. Some actually behave like non-cancerous tumors.

Targeted Therapy (to kill cancer cells)

The mechanism of action of these targeted treatments is that they block specific abnormal signals present in kidney cancer cells that allow them to multiply. Thus, these drugs show promise in treating kidney cancer that has spread to other parts of the body.

DrugsDescription
Bevacizumab or Tyrosine kinase inhibitors: – Axitinib, cabozantinib, pazopanib, sorafenib, sunitinib.Inhibit VEGF and slow down tumor growth for people with metastatic renal cell carcinoma.
DrugsDescription
Everolimus and temsirolimusIt targets certain protein that helps kidney cancer cells grow, called mTOR.
DrugsDescription
FDA approved combinations- axitinib and pembrolizumab; axitinib and avelumabIn 2019, FDA approved these combination treatments for the first treatment in advanced renal cell carcinoma.

Immunotherapy/biologic therapy (to kill cancer cells)

Immunotherapy/biologic therapy, as the name suggests, it uses the body’s immune system to fight cancer. Some drugs in this category, interferon and aldesleukin (Proleukin), are synthetic versions of chemicals made in your body. Nivolumab is an immunotherapy used to treat advanced renal cell carcinoma.

Cellular hormone called a cytokine produced by WBCs.

• Treat kidney cancer that has spread and lengthen the lives.
• Change proteins on the surface of cancer cells and slow their growth.

FDA approved combinations:-nivolumab and ipilimumab; pembrolizumab andaxitinib.

Chemotherapy (using anticancer drugs)

Following chemotherapeutic agents all have been used in advanced renal cell cancer:

Fluorouracil is an antineoplastic antimetabolite, which inhibits the formation of thymidylate from uracil, which leads to inhibition of DNA and RNA synthesis and causes cell death.

Vinblastine is an alkaloid antineoplastic agent. Vinblastine binds to the microtubular proteins of the mitotic spindle, leading to crystallization of the microtubule and mitotic arrest or cell death.

Paclitexal works by disrupting the normal function of microtubules, thus inhibiting cancer cells division.

Carboplatin undergoes activation inside cells forming a complex that cause the intra and inter strand cross-linkage of DNA molecules within the cell and inhibits DNA synthesis

Gemcitabine’s most important mechanism of action is inhibition of DNA synthesis and cell death.

Doxorubicin is an antineoplastic in the anthracycline class.  It slows or stops the growth of cancer cells by blocking the enzyme topo isomerase.

Radiation Therapy

Radiation therapy uses high-powered energy beams, such as X-rays, to destroy cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain.

Useful links:
• https://www.mayoclinic.org/diseases-conditions/kidney-cacer/symptoms-causes/ syc-20352664
• https://www.cancer.org/cancer/kidney-cancer/causes-risks-prevention/risk-factors.html
• https://emedicine.medscape.com/article/281340-treatment#d13
• https://www.kidney.org/atoz/content/kc-treatment
• https://www.cancer.gov/about-cancer/treatment/drugs/kidney

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