KIDNEY CANCER

By: Myra R. Abria & Karen Hingada

KIDNEY CANCER
Kidney cancer is an uncontrolled growth of
abnormal kidney cells that invade and destroy
the normal kidney tissue and can spread
(metastasize) to other organs.
Renal is from the Latin word renalis for
kidneys.
The 2 most common types of kidney CA are
renal cell carcinoma (RCC) and urothelial cell
carcinoma (UCC) of the renal pelvis.

The different types of kidney cancer (such as
RCC and UCC) develop in different ways,
meaning that the diseases have different
outlooks (or prognosis), and need to
be staged and treated in different ways.





RCC or RENAL CELL CARCINOMA or HYPERNEPHROMA UCC or UROTHELIAL CELL CARCINOMA or TRANSITIONAL
CELL CARCINOMA
RCC is responsible for approximately 80% of primary renal
cancers. It is also known to be the most lethal of all the
genitourinary tumors & most common type of kidney CA in
adults.
UCC accounts the majority of the remainder (20%). It is a
type of CA that typically occurs in the urinary system: the
kidney, urinary bladder & accessory organs.

is a kidney cancer that originates in the lining of the
proximal convoluted tubule.
arises from the transitional epithelium, a tissue lining the
inner surface of these hollow organs

Men have a higher incidence than women (approximately
1.6:1) and the vast majority of sufferers are diagnosed after
65 years of age. And factors that affect includes hereditary
& lifestyle.
Less common type of kidney CA found in adult and a rare
type. Misusing certain pain medicines, exposed to certain
dyes and chemicals used in making leather goods, textiles,
plastics, and rubber and smoking cigarettes.

An accurate diagnosis may be difficult to establish given
that the early stages of renal cancer are asymptomatic
Transitional cell carcinoma (TCC) can be very difficult to
treat. Treatment for localized stage TCC is surgical resection
of the tumor, but recurrence is common.
DIFFERENT TYPES OF KIDNEY CANCER:
Clear cell carcinoma is the most common form of renal cell carcinoma, accounting for about 80%
of people with kidney cancer. When viewed under a microscope, the individual cells that make up
clear cell renal cell carcinoma appear very pale or clear.
Papillary cell (chromophilic) carcinoma is the second most common type about 10% to 15% of
people have this form. These cancers form little finger-like projections (called papillae).
Chromophobic carcinoma is the third most common form of renal carcinoma is chromophobe RCC,
accounting for about 5% of cases. Like clear cell carcinoma, the cells of these cancers are also
pale, but are much larger and have certain other distinctive features.
Translocation carcinomas are a type of kidney cancer that can occur in children who have
received chemotherapy for malignancy, bone marrow transplant preparation or autoimmune
disorders.
Renal sarcoma is a rare type of kidney cancer.
Wilms tumour is a rare type of kidney cancer that affects children.

SIGNS & SYMPTOMS:
One of the reasons that kidney cancer is often not diagnosed until its later stages is that
there are few symptoms it is associated with it.
Additionally, the signs of kidney cancer can easily be confused with other health
conditions or physical problems.

Blood in the urine, which may be pink, red or cola-colored
Abdominal pain
Swelling of the abdominal area
Chronic back pain below the ribs
Intermittent fever
Unintentional weight loss
Fatigue
Pale skin
Intolerance of cold temperatures
Excessive hair growth in females
Swelling of the veins around a testicle in men
Vision problems

TUMOR MARKERS OF KIDNEY CANCER:
Tumor markers can be detected by immunohistochemistry.


Carcinoembryonic antigen
HMB-45
Tumor M2-PK
Vimentin

CAUSES:
Kidney cancer is triggered by a mutation in
the DNA of the cells found in the kidney.
When this occurs, those cells begin to grow
and divide very quickly, causing an
accumulation of abnormal cells.
The resulting mass is a tumor, which will
continue to grow and may spread to other
areas of the body when cells break off and
metastasize to other parts of the body.

RISK FACTORS:
Older age. Your risk of kidney cancer increases as you age.
Being male. Men are more likely to develop kidney cancer.
Smoking. Smokers have a greater risk of kidney cancer than nonsmokers do. The risk
decreases after you quit.
Obesity. People who are obese have a higher risk of kidney cancer than do people
who are considered average weight.
High blood pressure (hypertension). High blood pressure increases your risk of kidney
cancer.
Chemicals in your workplace. Workers who are exposed to certain chemicals on the
job may have a higher risk of kidney cancer. Some evidence suggests people who
work with chemicals such as asbestos and cadmium may have an increased risk of
kidney cancer.
Treatment for kidney failure. People who receive long-term dialysis to treat chronic
kidney failure have a greater risk of developing kidney cancer.
Von Hippel-Lindau disease. People with this inherited disorder are likely to develop
several kinds of tumors, including, in some cases, kidney cancer.
Hereditary papillary renal cell carcinoma. Having this inherited condition makes it
more likely you'll develop one or more kidney cancers.

DIAGNOSTIC EXAMINATIONS:
Urinalysis or urine test: the most common symptom and sign of a kidney tumour is
blood in the urine.
This test can also detect other irregularities in the urine such as protein and cancer
cells.
About half of all patients with kidney cancer will have blood in their urine.
Microscopic examination of urine samples (called urine cytology) can also detect
cancer cells in the urine.

Blood tests: a thin needle is used to take a small piece of tissue from the cancer
cells. The tissue is then examined under a microscope.
This is the best way to confirm the type of cancer cells.
Ultrasound: this scan uses sound waves to detect if a kidney irregularity is a fluid-
filled cyst or a tumor.
If there is blood in the urine, an ultrasound of the abdomen with special
attention to the kidneys, ureters, and bladder may be ordered.
It utilizes sound waves to produce images of internal organs, helping the
radiologist detect any masses that may be present.
A wand called a transducer is passed over the skin, and emits sound waves that
are detected as echoes bouncing back off internal organs.
The echo-pattern images produced by kidney tumors look different from those
of normal kidney tissue.
This test may be used for initial diagnosis of a kidney mass or to help visualize a
mass when a fine needle biopsy is done (see Biopsy Procedure).
Chest X-ray: a plain X-ray of organs and bones within the chest may be done to
see if the cancer has spread to the lungs.

Computed Tomography (CT scan): a modified x-ray that takes pictures of the
body at different angles then combines them to produce a detailed cross-
section of the body.
A CT scan is a highly specialized x-ray that is used to visualize internal organs and
provides a very accurate cross section picture of specific areas of the body.
Angiography: this procedure is used to visualize location and function of arteries.
A catheter is usually threaded up a large artery in the leg into an artery leading
to your kidney (renal artery).
A contrast dye is then injected into the artery to outline blood vessels.
Angiography can outline the blood vessels that supply a kidney tumor, which
can help a surgeon better plan an operation.
Bone scan: a small amount of
radioactive material is injected into a
vein and travels through the
bloodstream to the bones so the
scanner can detect the tumor.
A bone scan is used to check for the
spread of cancer to the bones.
It is done by injecting small amounts of
a special radioactive material through
a vein into your bloodstream.
This material is carried to the bone,
where it collects in areas where there is
a lot of bone activity.
The test can identify both cancerous
and non-cancerous diseases but the
test cant distinguish between cancer
and other conditions such as arthritis
when used it is used alone.
Biopsy procedure: if, after diagnostic tests are complete, there is a strong
clinical suspicion that the kidney mass is cancerous (malignant), surgical
removal of the kidney (nephrectomy) will be performed without delay.
If the diagnostic test results are not clear, a biopsy may be performed.
During a biopsy procedure a small sample of tissue is removed from the mass
and examined to determine whether it is benign or malignant.
Kidney cancer staging:
Once your doctor diagnoses kidney cancer, the next step is to determine
the extent, or stage, of the cancer. Staging tests for kidney cancer may
include additional CT scans or other imaging tests your doctor feels are
appropriate.
Then your doctor assigns a number, called a stage, to your cancer. Kidney
cancer stages include:
Stage I. At this stage, the tumor can be up to 2 3/4 inches (7 centimeters) in
diameter. The tumor is confined to the kidney.
Stage II. A stage II kidney cancer is larger than a stage I tumor, but is still
confined to the kidney.
Stage III. At this stage, the tumor extends beyond the kidney to the
surrounding tissue and may also have spread to a nearby lymph node.
Stage IV. Cancer spreads outside the kidney, to multiple lymph nodes or to
distant parts of the body, such as the bones, brain, liver or lungs.


TREATMENT:
Treatment would be different as kidney cancer patients in different stages.
And a doctor would plan out the treatment according to the physical
condition of a patient.
Clinically, the treatments now apply to kidney cancer are various, for
instance:
Surgery
Radiotherapy
targeted therapy
Immunotherapy
chemotherapy or a combination of those treatments.
SURGERY:
Depending on the stage of the cancer the surgeon may remove part of the
kidney (partial nephrectomy), the whole kidney (simple nephrectomy), or the
kidney as well as nearby lymph nodes and the adrenal gland (radical
nephrectomy).

Partial nephrectomy
This operation is commonly used for small kidney cancers that have not spread.
The surgeon removes the cancer and part of the kidney surrounding it.
Some of the kidney is left behind.
Doctors call this nephron sparing surgery.
The nephron is the filtering unit of the kidney, so you have some working kidney
left after the operation.

Simple nephrectomy
The surgeon removes the whole kidney and the urine collecting tube
(ureter) on that side.

Radical nephrectomy
The surgeon removes the whole
kidney with the tissues around it,
including the adrenal gland.
The adrenal gland is attached to the
kidney.
The surgeon also removes some lymph
nodes in the area.
The surgery is fairly major but if your
cancer has not spread, this is all the
treatment you will need.

AR-HE CRYOTHERAPY
Ar-He cryotherapy is a treatment develops fastest and matures in past few
years. It performs under the guide of CT to inject Argon air and helium air
alternatively to freeze and heat the tumor, so as to kill the cancer cells.
Cryotherapy (also called cryosurgery) is a way of killing cancer cells by
freezing them.
The medical name for this procedure is percutaneous cryotherapy for renal
cancer.
Percutaneous just means that the freezing probe is put in through the skin.
Doctors can use cryotherapy as a treatment for people with small, early
stage kidney cancers, less than 4cm across.
Doctors are most likely to use it for people who are not fit enough for surgery.
For some people cryotherapy offers the chance of curing the cancer
without the risks of having to remove a kidney. You may need to have the
treatment again if the cancer comes back or if any tumour is left behind.

RADIOFREQUENCY ABLATION:
This procedure uses radiofrequency waves
and converts them into heat, resulting in
thermal (heat) damage to the kidney
tissue.
The radiofrequency electrodes are
introduced either percutaneously or
laparoscopically under radiological or
visual guidance.


LAPAROSCOPIC SURGERY:

Keyhole surgery is also called minimal access surgery or laparoscopic surgery.
It means having an operation without needing a major incision (wound site).
The surgeon uses an instrument a bit like a telescope.
This is called a laparoscope. It has a camera at one end and an eyepiece at
the other so that the surgeon can see inside the body.
The surgeon will usually make a number of small cuts through your skin.
They can put the laparoscope and other small instruments through these to
carry out the surgery.
So you will end up with 3 or 4 small wounds, each a centimetre or so long.
The surgeon can manipulate the instruments and watch what they are doing
on the camera.
It is possible to remove a whole kidney or part of a kidney using laparoscopic
surgery.

ROBOTIC SURGERY:
Assisted robotic surgery is a type of keyhole (laparoscopic) surgery.
It is also called da Vinci surgery. A surgeon does the surgery through small
cuts in the abdomen and uses a special machine (robot) to help.
During the surgery a robotic machine is beside you.
The machine has 4 arms. One holds the camera and the others hold the
surgical instruments.
The surgeon makes small cuts in your abdomen.
The camera and instruments are put in through the cuts to do the surgery.
The surgeon then carries out the surgery using a machine to control the
robots arms.
The surgeon has a 3D view of the operating area that they can magnify up
to 10 to 12 times.

Biological therapy (immunotherapy) uses your body's immune system to fight
cancer.
Drugs in this category include interferon and aldesleukin (Proleukin), which
are synthetic versions of chemicals made in your body.
Side effects of these drugs include chills, fever, nausea, vomiting and loss of
appetite.

Radiation therapy uses high-powered energy beams, such as X-rays, to kill
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.

Clinical trials. Clinical trials are studies of new treatments and new
techniques for treating kidney cancer and other diseases.
Participating in a clinical trial may give you a chance to try the latest
treatments, but it can't guarantee a cure.
NURSING INTERVENTION:
Therapeutic communication is essential.
Encourage independence in self care & decision making.
Assist in grieving process, some cancers are curable and some are not. Grieving can be due to
loss of health, income, sexuality and body image.
Answer and clarify information about cancer and treatment options.
Identify resource people and refer to support groups.
Health teachings.
MANAGEMENT COMPLICATION: INFECTION:
Fever is the most important sign. (38*C and above)
Administer prescribed antibiotics.
Maintain aseptic technique & hand washing.
Avoid exposure to crowds.
Avoid giving fresh vegetable or fruits.
Monitor I & O and untoward bleeding.




Complementary and alternative treatments that can help to cope with
distress include:
Art therapy
Dance or movement therapy
Exercise
Meditation
Music therapy
Relaxation exercises

REFERENCES:
http://www.cancerresearchuk.org
www.Asian-cancer.com
http://kidneycancer.org.au/risk-factors/