The kidneys are the filtration units of our body. Majority of us have one on the left and one of the right side, although some people may be born with only one functioning kidney. The purpose of the kidneys is to balance fluids and electrolytes and to detoxify our blood. They also produce certain hormones to regulate our blood pressures, make red blood cells, and keep our bone minerals stable.
It is estimated that over 63,000 new cases of kidney cancer will be diagnosed in 2018. Approximately 15,000 people will die from this disease. Although kidney cancers are uncommon in people younger than 45, a person in any age group can be diagnosed with a kidney tumor. Kidney cancer is among the top 10 cancers in the US and the lifetime risk for developing kidney cancer is about 1 in 50. Certain people are at increased risk of developing this disease such as those with a strong family history, exposure to chemicals, or heavy smokers. However, even the healthiest of people have been diagnosed with kidney cancer.
The rate of kidney cancer diagnoses have increased over the past two decades. This may be due to the increase in utilization of imaging studies such as CT scans. Therefore, incidental small renal masses are becoming more common. When a tumor is discovered early, many treatment options are available.
Renal Cell Carcinomas (RCC) are the most common malignant kidney tumors. About 15-20% of kidney tumors can also be benign but may grow large and cause symptoms such as bleeding or pain. There are also certain tumors that are almost exclusively found in kids.
What are symptoms of a Kidney Tumor?
Unfortunately most kidney masses have no symptoms. Some of the earliest signs may be blood in the urine (hematuria), pain in the flank or back on one side, unexplained weight loss and loss of appetite, low blood count (anemia), and fever that does not go away.
How are people diagnosed with Kidney Cancer?
As mentioned above, many people these days are diagnosed when they have a CT scan for unrelated reasons. However, if your physician discovers blood in your urine during routine physicals, this may prompt them to do additional testing, which will ultimately lead to a diagnosis of kidney cancer. Imaging studies that are most often used are ultrasound, CT scan, or MRI.
Once a tumor is identified, your physician may order additional testing to determine the tumor grade and stage. The tumor grade tells us how aggressive your cancer may be. The tumor stage tells us how much the cancer has spread. At this point you should be seen by a urologist or medical oncologist to guide further care.
What treatments are available for Kidney Cancer?
Depending on the size, location, and involvement of the tumor as well as your overall physical health, many different options are available. The following options are often discussed:
Active Surveillance
Partial Nephrectomy (partial removal of the kidney)
Radical Nephrectomy (removal of the whole kidney)
Local Ablation (Cryoablation, Radiofrequency ablation)
Radiation Therapy
Chemotherapy
Active Surveillance
For small tumors, active surveillance may be an option. Your physician may monitor the growth rate of your tumor by obtaining imaging studies every 3-6 months to determine how fast the tumor grows. This is often suitable for older patients and those who are not good candidates for definitive treatment.
Partial Nephrectomy
This is a treatment where the surgeon removes only the cancerous tissue with a small amount of surrounding tissue. This procedure is best performed with robotic technology. You should consult with a urologist who is well trained in Robotic Partial Nephrectomy as it is the least invasive surgical approach and may provide cure from this disease. Robotic technology allows robotic surgeons to use technologies such as ultrasound and Firefly to ensure removal of tumor without compromising normal kidney tissue. Read our article on this technology.
Radical Nephrectomy
sometimes the tumor may be too large or it may be located in an area where a partial nephrectomy is no longer feasible or safe. In such cases your surgeon may recommend removal of the entire kidney to give you the best chance for survival. If you have a normal kidney on the other side, this may not affect your life after surgery much. However, those with a single kidney or poorly functioning second kidney may require life long medical therapy or dialysis after surgery.
Local Ablation
Ablation therapies such as cryoablation or radiofrequency ablation aim to destroy small kidney tumors with either extreme heat or cold. This is often reserved for those who are not good surgical candidates and do not wish to undergo active surveillance.
Chemotherapy/Radiation
Depending on the grade and stage of your tumor and whether it has spread beyond the kidney, your physician may recommend a multi-specialty approach consisting of a urological surgeon and a medical and radiation oncologists.
What happens after treatment?
Depending on your treatment, you will need to be under surveillance for several years to make sure that the treatment has been successful. Always keep your follow up appointments and follow the advice of your physicians.
As always, the information above is meant to be informative and does not replace your physician's recommendations or judgement. Each individual case has to be evaluated carefully to determine the best course of action. Call or use our contact page to request an appointment to further discuss your unique case with Dr. Shakuri-Rad.