Renal cell carcinoma (patient information)

For the WikiDoc page for this topic, click here


 * Associate Editor-In-Chief: Jinhui Wu, M.D. Ujjwal Rastogi, MBBS [mailto:urastogi@perfuse.org]

Overview
Renal cell carcinoma is also called hypernephroma or renal cancer. Kidneys are fist-sized peritoneum organs on either side of the backbone. The function of kidneys is to filter and clean your blood, take out waste products and make urine. Usually, renal cell carcinoma originates in the lining of tiny tubes. renal cell carcinoma doesn't have any early symptoms. With the development of the cancer, frequent symptoms include blood in your urine, pain in your side, a lump in your abdomen and unexplained weight loss. Treatments include surgery, radiation therapy, chemotherapy or biologic therapy.

What are the symptoms of Renal cell carcinoma?
Early renal cell carcinoma does not have any symptoms. As the tumor grows larger, people may notice one or more of the following symptoms:
 * Hematuria (blood in the urine)
 * Lower back pain on one side
 * A mass or lump on one side of the lower back
 * Fatigue and unexplained weight loss
 * Edema (swelling of ankles and legs)

Other health problems may also cause these symptoms. Only a doctor can tell for sure. A person with any of these symptoms should tell his/her doctor so that the problems can be diagnosed and treated as early as possible.Diseases with similar symptoms are listed in the following:
 * Urinary calculi
 * Urinary tract infection
 * Bladder cancer and ureter cancer
 * Urinary tract tuberculosis

What causes Renal cell carcinoma?
It is the most common type of kidney cancer in adults. It occurs most often in men ages 50 - 70.

The exact cause is unknown.

Who is at highest risk?
Clinical data has suggested that the development of renal cell carcinoma is related to several factors.

Genetic and hereditary risk factors


 * Von Hippel-Lindau disease


 * Hereditary papillary renal cell carcinoma


 * Hereditary leiomyomatosis


 * Birt-Hogg-Dube syndrome


 * Hereditary renal oncocytoma

Lifestyle-related and job-related risk factors


 * Smoking: Tobacco use increases the risk of developing renal cell carcinoma.


 * Obesity: Clinical surveys demonstrate that renal cell carcinoma has a close relationship with people who are very overweight.


 * Workplace exposures: Clinical studies have suggested that workplace exposure to certain substances such as asbestos, cadmium, some herbicides, benzene, and organic solvents, particularly trichloroethylene, may increase the risk for renal cell carcinoma.

Drugs: Some studies have suggested that phenacetin (non-prescription pain reliever) and diuretics (medicines uesd to treat hypertension or heart failure by causing the kidneys to remove salt and fluid from the body) may be linked to renal cell carcinoma.

Advanced kidney disease: People with advanced kidney disease, especially those needing dialysis, have a higher risk of renal cell carcinoma. The reasons may be the accumulation of the metabolic toxin. A family history of renal cell carcinoma

Hypertension

Gender: Men have about twice the risk of developing renal cell carcinoma than women.

Race: Epidemical data shows that African Americans have a slightly higher rate of renal cell carcinoma than other races.

When to seek urgent medical care?
Call your health care provider if symptoms of renal cell carcinoma develop. If you experience either of the following symptoms, seeking urgent medical care as soon as possible:


 * Severe low back pain or abdominal pain
 * A large amount of hematuria

Diagnosis
Lab Tests


 * Urinalysis: This is the most common test for urinary system diseases. Red blood cells and white blood cells may be detected by the test.


 * Blood chemistry tests: The levels of certain chemicals in the blood may be affected in patients with renal cell carcinoma.


 * Complete blood count: Anemia is very common in renal cell carcinoma patients. Sometimes erythropoietin which is a kind of hormone, is made by the cancerous cells and can produce too many red blood cells.

Ultrasonography: This is an painless test which uses sound waves to create a picture of the internal organs. Because tumors generate different echoes of sound waves than normal tissue, the doctor can locate a mass inside the body.

Computed tomography (CT) scan and biopsy: CT scans are often used to diagnose renal cell carcinoma. It can confirm the location of the cancer and show the organs near the kidneys, as well as lymph nodes and distant organs where the cancer might have spread. These are helpful for determining the stage of the cancer and in determining whether surgery is a good treatment option. CT scans can also be used to guide biopsy and a biopsy sample is usually removed and looked at under a microscope.

Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture.

Positron emission tomography (PET) scan: When doing this test, a small amount of a radioactive medium is injected into your body and absorbed by the organs or tissues. This radioactive substance gives off energy which in turn is used to produce the images. PET can provide more helpful information than either CT or MRI scans. It is useful to see if the cancer has spread to the lymph nodes and it is also useful for your doctor to locate where the cancer has spread.

Chest X-ray: This plain x-ray of your chest may be done to see if the cancer has spread to your lungs.

Whole Bone Scan: The goal of a whole body bone scan is to show if a cancer has metastasized to your bones.

Treatment options
Patients with renal cell carcinoma have many treatment options. The selection depends on the stage of the tumor. The options are surgery, radiation therapy, chemotherapy, biologic drugs treatment, or a combination of these methods. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effect may not be the same for each person, and they may change from one treatment session to the next.


 * Surgery: Surgery is the main treatment for most renal cell carcinoma. Surgical removal of all or part of the kidney (nephrectomy) is recommended. The types of surgery for renal cell carcinoma include radical nephrectomy, laparoscopic nephrectomy, regional lymphadenectomy (lymph node dissection), partial nephrectomy (nephron-sparing surgery) and so on.


 * Radiation therapy: This therapy does not usually work well for renal cell carcinoma. In some cases, hormone treatments may reduce the growth of the tumor.


 * Chemotherapy: This is also generally not effective for treating renal cell carcinoma. The drug such as interleukin-2 (IL-2) is not recommended for use because of its toxicity.


 * Biologic drug treatment (Immunotherapy): This is a newer therapy. Until recently, this was the most common first-line therapy for advanced renal cell carcinoma. The goal of this therapy is to boost the body's immune system to fight off or destroy cancer cells more effectively. Usual drugs include sorafenib (Nexavar), sunitinib (Sutent), bevacizumab (Avastin) and temsirolimus (Torisel).

Where to find medical care for Renal cell carcinoma?
Directions to Hospitals Treating renal cell carcinoma

What to expect (Outlook/Prognosis)?
The outcome depends on:
 * The stage of the cancer: the size of the tumor, whether the cancer has spread outside the kidneys.
 * The individual's response to treatment

Possible complications

 * High blood pressure (hypertension)
 * Too much calcium in the blood
 * High red blood cell count
 * Liver problems
 * Spread of the cancer