Kidney Cancer
What is it?
Cancer is when cells in a particular organ, such as the kidney, begin to abnormally grow and divide, forming a lump, which is called a tumour. Tumours can either be benign or malignant. Benign tumours do not spread to other parts of the body, although they can press on surrounding organs, affecting their function. Malignant tumours are able to spread beyond the original site, and if they are not treated, can invade and destroy surrounding tissues. Sometimes cells can break off from the original tumour and spread to other organs in the body through the blood stream or lymphatic system, growing new tumours there.
Over 5,700 people in the UK are affected by kidney cancer each year and the numbers are increasing. The underlying cause for developing kidney cancer is not usually discovered. Usually only one kidney is affected.
Cancer of the kidney is most common in middle-aged and older people, although there is an uncommon form (Wilms' tumour, also known as nephroblastoma) that affects very young children.
What are the symptoms?
The most common presentation of kidney cancer is as a chance finding when having a scan or ultrasound for some other reason. These patients have no symptoms from their kidney cancer and the tumours are often small.
Blood in the urine is often the first symptom of kidney cancer, although this can be a symptom of many other conditions. The blood may appear suddenly, only be there for one day and then go away again for a while, although it does come back eventually. Blood clots may form and give you spasms in your ureters or bladder, which can be painful. You may notice a lump in your abdomen or feel a dull ache in your side. A high fever that does not go away, high blood pressure and weight loss can also be symptoms of kidney cancer.
If you have any of these symptoms you should visit your GP to check their cause. There are many conditions other than cancer that can give you similar symptoms, such as an infection or stones in the bladder or kidneys. Most people with the above symptoms will not have cancer of the kidney.
How is it diagnosed?
When you first present with your symptoms to your GP, a physical examination and a urine test will be carried out. You may also have a blood test. If your GP needs more information on the cause of your symptoms, you may be referred to a hospital for further tests. These tests may include:
Cystoscopy and nephro-ureteroscopy
A tiny tube is passed into your bladder through the urethra and up into the kidney. A small camera on the end allows the doctor to see inside your kidney. This process can also remove samples of cells, and, in some cases, small tumours.
Imaging Tests
Intravenous pyelogram (IVP)A dye is injected into your bloodstream, usually through a vein in your arm. The dye shows up your kidney, ureters and bladder on x-ray. The x-ray can show changes in these organs.
Ultrasound scanA small device that produces sound waves is passed over your abdomen. The soundwaves are then converted into a picture of the inside of your abdomen by using a computer. Ultrasound can check if your kidneys have changed shape, which may mean there is a cyst or tumour. It can also measure the size and position of a cancer. The doctor may use the ultrasound picture to guide a needle into the tumour to perform a biopsy.
Computerized Tomography (CT) scan or magnetic resonance imaging (MRI)Computerised tomography, also known as a CT scan, takes x-rays of the body from different angles to make a detailed, cross-sectional image. Sometimes a dye is injected to make the images more detailed. Magnetic resonance imaging, also known as MRI, uses magnetic fields instead of x-rays to produce images.
Chest x-rays and bone scansIf kidney cancer has already been diagnosed, these tests can help determine whether the kidney cancer has spread.
ArteriographyDye is injected into the large artery that leads to your kidney. This shows up blood vessels that might be feeding a tumour.
Biopsy
It the doctor finds a tumour that might be kidney cancer, a biopsy may be performed. This is when tissue or cells from a suspected tumour are taken out using a thin needle. The cells are sent to a laboratory to be tested for cancer.
How is it treated?
The type of treatment you have will depend on a number of factors, including your general health, the type and size of the tumour and how far it has spread, if at all. The main treatment for cancer of the kidney is surgery. Sometimes your doctor may recommend that you have radiotherapy as well. Hormonal treatment or biological treatment are also occasionally used either instead of, or after surgery.
Surgery
The most common way of treating kidney cancer is to remove the whole kidney (and surrounding tissue) by surgery. This is called a nephrectomy. If the tumour is very small, the surgeon may only remove part of the kidney. This is called a partial nephrectomy. It is possible to continue to live a completely normal life with only one kidney, as the remaining kidney is able to cope with the work of two kidneys.
A relatively new technique is to perform these operations through very small holes (‘keyhole surgery') with a telescope called a nephroscope.
Radiotherapy
Radiotherapy is the use of x-rays (and other rays) to destroy cancer cells, while avoiding harming the normal cells. It is relatively rare nowadays to treat the kidney tumour in this way, but can be very helpful if the tumour has spread to other areas such as the bones.
Hormone treatment
In some cases you may be given a tablet containing the hormone progesterone. This hormone may help to control cancer cells that have spread beyond the kidney.
Biological treatments
Biological treatments (or immunotherapy) encourage the body's immune system to attack the tumour.
Interferon alphaInterferon is a substance normally produced by the body to fight infections such as 'flu. It also has a number of effects on the immune system. Interferon can now be produced in the laboratory.
Interferon-2a (Roferon-A) is the type of interferon used to treat kidney cancer. It is usually given by injection under the skin, three times a week, using a very fine needle. You can be taught to give these injections at home.
Interferon alpha can give you side effects similar to 'flu symptoms, for the first couple of weeks. You may also experience nausea, loss of appetite and tiredness. These side effects usually improve the longer you have the treatment.
Interleukin-2Interleukin-2 is another type of biological treatment for cancer of the kidney. This substance also occurs naturally in the body. It acts as a messenger to make special white blood cells fight infection. The body only produces small amounts of Interleukin-2, so research scientists have discovered how to make large quantities of the substance in the laboratory. Interleukin-2 is given as an injection under the skin.
Side effects of interleukin-2 treatment are temporary and disappear as soon as the treatment has been finished.
Chemotherapy
Chemotherapy is the use of special anti-cancer (cytotoxic) medicines to destroy cancer cells. These medicines stop the growth and division of cancer cells. In cases of kidney cancer, chemotherapy is usually offered if the cancer has spread beyond the kidneys. It may be given as part of a trial of new medicines or combined with biological treatment. Chemotherapy can be given as tablets (orally) or, more usually, by injection into a vein (intravenously). Nausea, vomiting and hair loss are the most usual side effects, although not all types of chemotherapy have side effects.
Further information
Your local GP surgery is the best place for you to find information on kidney cancer, especially if you have specific concerns about your symptoms and treatment. Charities related to the kidney can also be useful sources of information and support.
Cancer Bacup www.cancerbacup.org.uk
National Kidney Research Fund www.nkrf.org.uk
UK National Kidney Federation www.kidney.org.uk
