kidney cancer

The masses detected in the kidney are divided into 2 groups as benign tumors and malignant tumors. There are many classifications of kidney tumors. The most common mass in the kidney is simple kidney cysts. Simple cysts are usually asymptomatic, they constitute 70% of all kidney masses, may be single or multiple. These cysts can be easily distinguished by radiological imaging. Most of the time, kidney cysts that occur coincidentally never threaten human life. Kidney cysts often do not even require treatment, annual follow-up of cyst sizes is sufficient. If it reaches large sizes, causes pain and causes a disorder in the kidney structure, intervention is required. Kidney cysts are divided into 4 categories radiologically. In this classification, there is no need for further investigations in the 1st and 2nd categories.3. In this category, further examination should be performed, and they should be surgically removed. Cysts in the 4th category are called cancer and must be surgically removed.

Other benign tumors of the kidney;

Angiomyolipoma:

They are benign renal tumors consisting of smooth muscle, fat and thick-walled vessels in varying proportions. These tumors are mostly seen in patients with tuberous sclerosis. It is very rare for these tumors to transform into malignant form. It may present as flank pain, palpable mass and bleeding in the urine, shock may develop due to bleeding in 10% of patients. Pregnancy may increase bleeding. The diagnosis can be made easily. Masses less than 4 cm should be followed up with 6-month and annual controls. Masses over 4 cm should be surgically removed.

Oncocytoma:

It constitutes 3-7% of benign kidney tumors. It is common after the age of 50. It is more common in men than in women. It is usually unilateral, but may be bilateral and multiple. It is difficult to diagnose radiologically, but the diagnosis is made pathologically. Most of the time, kidney cancer is diagnosed and nephrectomy or partial nephrectomy is performed, and it is understood that oncocytoma is present after pathology.

Renal Adenoma:

They are usually 1-3 mm in diameter, rarely exceeding 1 cm. They are more common in men and do not give any symptoms. It is difficult to distinguish it from cancer in the examinations, usually partial nephrectomy is performed.

Kidney Cancer
Kidney cancer originates from the cells (epithelium) in the kidney that line the small urinary canals that collect urine. Histologically, it can be classified as clear cell carcinoma, papillary cell carcinoma, collecting duct carcinoma, and chromophobe cell cancer. In addition, urothelial cancer can be seen originating from the renal pelvis and similar to cancers seen in the bladder in many respects. Nephroblastoma (Wilm’s tumor) seen in childhood can be seen in 80% of kidney tumors. It is most commonly seen at the age of 2-4 years. Renal cell cancer (renal cell ca) constitutes 85% of all malignant kidney tumors and approximately 3% of adult cancers. Today, approximately 30% of patients with kidney cancer still have spread at the time of initial diagnosis. In addition, metastatic disease develops in the advanced period in 20-30% of patients who undergo nephrectomy for localized cancer. It should not be forgotten that kidney cancer will be completely cured if early diagnosis and appropriate treatment is given. If diagnosed at an early stage, the survival rate of patients with kidney cancer can be between 70% and 100%.

The most important feature of renal cell cancers is that they are resistant to radiotherapy or chemotherapy. They also respond poorly to hormonal therapy. Renal cell cancers can be surgically removed if they are caught early, that is, when they are confined to the kidney. This is the most effective treatment for renal cell carcinoma confined to the kidney.

What are the Risk Factors for the Development of Kidney Cancer?
Kidney cancer usually occurs between the ages of 50 and 60. It is 2 times more common in men than women. The exact cause of kidney cancer is not yet known. However, researchers have identified some risk factors for developing kidney cancer. However, not everyone with these risk factors will get kidney cancer, and not every kidney cancer patient has these risk factors. Hereditary features also play an important role in the origin of kidney cancers. If kidney tumors are seen at an early age, bilateral and more than one in the kidney, hereditary kidney cancers should be considered. Von hippel-lindau syndrome, Hereditary papillary cancer, Hereditary clear cell cancer, Hereditary renal oncocytoma can be given as examples of these cancers.

Other non-hereditary risk factors are listed below.
1-End stage renal failure and dialysis

2-Acquired polycystic kidney disease with end-stage renal disease

3-Smoking and tobacco use

4-Obesity

5-Metal workers

6-Asbestosis

7-In exposure to cadmium

8- In arsenic exposure

9- those who work in dry cleaning

10-Hypertension

11-Polycystic kidney disease

12-Long-term use of phenacetin

13-Long-term use of diuretics (diuretics)

What are the symptoms and how is it diagnosed?

The most frequently encountered clinical symptom in kidney cancer is bleeding in the urine, a hard mass that can be felt in the abdomen, and it is in the form of three entities, which we define as pain. Early-stage kidney cancers usually do not give any symptoms and are detected incidentally during ultrasonography or radiological examinations performed for other reasons. Diagnosis is most commonly made in stage 2 disease. Complaints in kidney tumors arise due to several reasons. In other words, when diagnosed early, treatment is easier and the probability of getting rid of cancer completely increases. However, as the tumor grows and spreads, the possibility of a complete cure decreases. Routine controls increase the possibility of early diagnosis and provide complete recovery from the disease. According to the frequency of occurrence, one or more of the symptoms listed below may be a sign of kidney cancer:

Pain is the most common complaint, 41% of the patients apply to the doctor with the complaint of pain, the second important complaint is bleeding, bleeding occurs in the form of a change in urine color, dark urine, 38% of the patients have hematuria, another important complaint is the kidney on that side. palpable swelling and mass, this is a complaint seen in 24% of patients. Other complaints are generally seen in cancer patients, weight loss, weakness, fatigue, as well as complaints such as fever and hypertension caused by substances released from kidney cancer.

These complaints may be a symptom of kidney cancer or may be caused by other diseases such as infection. People with these complaints should definitely see a urologist. Cancer diagnosed early is curable.

Imaging in Kidney Cancer:

In general, ultrasound and medicated kidney film are taken as the first examination for patients with bleeding in the urine. Ultrasound is the first choice in imaging the urinary system today, it should be done as the first step because it is cheap, easy, and performed under emergency conditions. Intravenous Pyelography IVP (Medicated kidney film); Accumulations called calcifications can be observed as white spots in these films. The accuracy of intravenous pyelography alone is 75%.

Computed tomography: It is more sensitive than ultrasound and medicated kidney film in the diagnosis of kidney cancers. The accuracy rate of CT Nil diagnosis is 95%. It gives information about the localization size of the mass, its local involvement and spread to the surrounding tissues.

MR Imaging; The most important advantages are that it has few side effects, shows the structure of the masses with high accuracy, can be applied in patients with renal failure and contrast material allergy, and shows the renal vein and vena cava thrombi without the need for contrast material.

Scintigraphy: It is useful in cases where bone metastasis is thought and in cases of bone pain and high alkaline phosphatase.

PET (positron emission tomography) guides the treatment and course of patients with metastasis.

Biopsy; In some cases, if there is much doubt about the diagnosis, it can be raised and can usually be done under the guidance of computed tomography. However, there are problems in the evaluation of biopsy.

Sites of Metastasis and Spread in Renal Cell Carcinoma:

Region

Ratio(%)

Lung

50-60

Bone

30-40

Regional lymph nodes

15-30

main renal vein

15-20

Perirenal adipose tissue

10-20

Adrenal (same side)

10-15

vena cava

8-15

Brain

10-13

opposite kidney

1-2

What are the treatment options?

Treatment in Kidney Cancer

The treatment of kidney tumor is determined according to the general condition of the patient, the size of the tumor, the extent of the disease, and the age of the patient. Since kidney tumors are generally cancers that are resistant to radiotherapy and chemotherapy, surgical treatment remains as a treatment option. Surgery is the standard method in the treatment of kidney cancers. Surgically, either the entire kidney is removed or the tumor is removed with a part of the kidney.

Radical nephrectomy is called complete removal of the kidney, adrenal gland and surrounding membranes and fat layers together with the operation. Removal of the tumor with a part of the kidney is called partial nephrectomy. Surgical technique can be either open operation or laparoscopic or robotic operation. After the operation, the patient may experience pain and discomfort.

Additional Treatments in Kidney Cancer

Radiation therapy: Radiation therapy is based on the use of high-energy rays from a radioactive source outside the body to kill cancer cells. The effectiveness of radiotherapy is different in different types of cancer. However, kidney cancer is one of the cancers that radiation therapy is less affected by. Therefore, it is accepted that it has no place in the definitive treatment of kidney cancer.

Biological therapy (immunotherapy): Interleukin-2 and interferon are substances used in biological therapy and can be described as weapons of the defense system, which are actually produced naturally in the body. It is aimed to better use and strengthen the immune system of the patient by giving it to the body from the outside. About 20% of patients with cancer that has spread respond to this treatment. The administration of these substances is within a program determined by the doctor. Due to its side effects, it is appropriate to be applied in very careful and experienced centers. During biologic therapy, the patient often stays in the hospital to monitor for side effects. These treatments can cause muscle pain, weakness, loss of attention, fever, vomiting and diarrhea as side effects. Patients often feel very tired. Some have skin flaking.
These problems can be very serious, but these effects disappear when the treatment is finished.

Chemotherapy: Chemotherapy is the use of drugs to kill cancer cells. Although it is effective in many other cancers, it has a very limited effect in kidney cancer.

Despite this, researchers are experimenting with new drugs and drug combinations. The side effects of chemotherapy vary according to the drugs given. In general, cancer drugs affect rapidly growing blood cells and cause hair loss. As a result, they suffer from loss of resistance to diseases and loss of energy.

Hormone therapy: It is tried to control the growth of the cell with hormones.
Hormone therapy is used in advanced kidney cancers. Progesterone is the most commonly used hormone in kidney cancer. It is often used as “palliative therapy” to temporarily reduce symptoms. It is no longer considered therapeutic today. Side effects are generally moderate. Medicines containing progesterone may cause changes. It causes sweating and water loss. Side effects disappear when treatment is stopped.

How is patient follow-up done?

It is very important to monitor patients with kidney cancer after treatment. It is monitored with physical examination, chest X-ray and laboratory tests at intervals determined by the doctor. The doctor may also order ultrasonography, computed tomography or other tests when necessary. When patients encounter a problem other than what they have been told, they should immediately consult a doctor. After radical nephrectomy, patients should be followed up regularly every 3-6 months. Any progression of the disease should be evaluated. There are factors that affect the prognosis (the course of the disease) and what kind of treatment should be applied.

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