What are cancer cells?
Cancer cells are abnormal versions of healthy cells. In some ways they grow like normal cells but do so at abnormal rates with irregular shapes.
Kidney Cancer is a disease where cells in the tissues of the kidney start to grow uncontrollably and form tumors. Renal cell carcinoma (RCC) occurs in the epithelial cell (the cells lining the kidneys) and is the most common type of kidney cancer.
How do they grow and spread?
A single RCC cell grows and divides to form 2 cells. Theses 2 cells then form 4 cells and continue to repeat the process over and over.
Unlike the healthy cells, these cancer cells do NOT respond to the body telling them to stop multiplying.
A tumor is formed and can be detected when enough cancer cells are made.
Some cancer cells may enter the bloodstream, causing it to spread to other parts of the body.
When new tumors appear in other areas or organs, it is called metastatic. In other words, it has spread to other regions of the body.
No matter where the cancer spreads it is still called Kidney cancer.
How do Epithelial cells differ from other cells?
- Capillaries do not reside within epithelial cell tissues.
- Endings of neurons are present within epithelial cell tissues.
- Perceive external stimulus.
- Slough off and glide in order to replace dead cells. This function allows epithelial cells to maintain a closed barrier to the external environment.
Renal Cell Carcinoma starts in the Epithelial cells
Epithelium (Epithelial tissue shown here) is a type of tissue of which many glands are formed. Functions of epithelial cells include secretion, absorption, transcellular transport, sensation detection and selective permeability. In the adult kidney epithelial cells from the cortical collecting duct are differentiated in two ways:principal cells are involved in water, sodium, and potassium transport and intercalated cells mediate acid base transport.
The principal characteristics associated with epithelial cells are to defend the underlying cellular elements from harmful x-rays, different toxic compounds or potential physical injury. Other functions include intracellular transport, secretion of certain enzymes, and hormone release into vascular system.
Common Among Cancers
Also known as renal cell cancer (RCC) is the most common type of kidney cancer. About 9 out of 10 kidney cancers are renal cell carcinomas. Although RCC usually grows as a single mass (tumor) sometimes there 2 or more.
Main Types of Renal Cell Carcinomas
- Clear cell RCCs are the most common, accounting for 75 – 85% of these tumors. The cells within the tumor are mostly clear.
- Papillary cell RCCs are the second most common type, accounting for 10 – 15%. Papillary cells are distinguished by small rounded protuberances on the surface.
- Chromophobe cell RCCs are the third common form, accounting for 3 – 5%. These cells do not take colored stain very easily.
- Wilms’ tumor is a rapidly developing cancer found in children.
Do We Know the Cause?
Many risk factors may increase the chance of developing kidney cancer, however, it is not known exactly what causes kidney cells to become cancerous.
Changes (mutations) in genes
Researchers are beginning to understand how certain changes in DNA can cause normal kidney cells to become cancerous. However, we must fund research for the scientists to move forward.
- Blood in urine (hematuria)
- Low back pain on one side (not caused from injury)
- A mass or lump on the side or lower back Fatigue (tiredness)
- Weight loss not caused by dieting Fever that does not go away Swelling of ankles and legs (edemia)
If you have any of these consult a doctor so the cause can be determined!
Medical history, exams, tests…
- The doctor will want to take a complete medical history to check for risk factors and symptoms.
- A physical exam can provide information, or a mass might be felt.
- Blood tests check for anemia and kidney function level.
- Always take your medications with you. A Medication log form is available by clicking here.
CT Scan (Computed tomography)
Also referred to as CAT Scan, is an x-ray that produces detailed cross sectional images of the body. A CT scanner rotates while you lie on a table and takes many pictures. A computer combines these pictures into image slices of the part of body being studied. This allows for detailed images to be studied. The CT Scan is one of the most useful tests for finding and looking at tumors on your kidneys. It is also used to see if cancer has spread to other organs and tissues beyond the kidney. It provides information about the size, shape, and position of any tumors. It can be performed with or without contrast.
CT Scan with Contrast
- You may be asked to drink a liquid called oral contrast …..this helps outline the intestines.
- You may be given an IV contrast …..this helps outline structures in the body.
- If you are a diabetic make sure you understand the doctors instructions on what medications are impacted.
CT contrast has the potential to damage the kidneys. This happens in patients whose kidneys are not working well. Due to this your kidney function will be checked with a blood test before IV contrast is given.
MRI (Magnetic resonance imaging)
- MRI scans provide detailed images of soft tissues. They use radio waves and strong magnets instead of x-rays. A computer translates the pattern into detailed images for studying.
- MRI’s take longer than CT scans and some people get upset if they are claustrophobic (fear of enclosed spaces). MRI machines make loud noises, they buzz and click as images are processed.
- MRI’s are used less than CT Scans when dealing with kidney cancer. MRI gives your doctor options if there allergy problems with the CT contrast exist, or if the need to determine if cancer has grown into major blood vessels, brain or spinal cord.
Ultrasound uses sound waves to create images of internal organs. This test uses a transducer (small, microphone-like instrument) that is placed on the skin near the kidney. It gives off sound waves and picks up the echoes as they bounce off the tissues in the kidney. These echoes are converted by computer into an image that is displayed on a computer screen.
Ultrasound can aid in determining if a mass is solid or filled with fluid. The echo patterns produced by most kidney tumors look different from normal kidney tissue.
A standardized system was defined by the American Joint Committee on Cancer (AJCC); known as the TNM system and describes 3 key pieces of information.
- T indicates the size of the main tumor and has it grown into nearby areas.
- N describes the extent of the spread to nearby lymph nodes.
- M indicates if the cancer has metastasized (spread) to other organs
Numbers or letters after T, N, and M provide details about each factor. The numbers 0 – 4 indicate increasing severity, the letter X means it can not be assessed.
Within the T, the following letters and numbers are defined:
- TX – The primary tumor cannot be assessed.
- T0 – No evidence of a primary tumor.
- T1a – The tumor is 4cm or less and only in the kidney.
- T1b – The tumor is between 4cm and 7cm and is only in the kidney.
- T2a – The tumor is between 7cm and 10cm and is only in one kidney.
- T2b – The tumor is larger than 10cm and only in the kidney.
- T3a – The tumor is growing into a main vein (renal vein) leading out of the kidney or into the fatty tissue around the kidney.
- T3b – The tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen.
- T3c – The tumor has grown into the part of the vena cava that is within the chest or into the wall of the vena cava.
- T4 – The tumor has spread beyond Gerota’s fascia and may have grown into the adrenal gland.
- NX – Nearby (regional) lymph nodes cannot be assessed.
- N0 – No spread to nearby lymph nodes.
- N1 – Tumor has spread to nearby lymph nodes.
Indicates if the cancer has metastasized. (The most common sites for spread are the lungs, bones, liver, and distant lymph nodes)
- M0 – There is no spread to distant lymph nodes or other organs.
- M1 – Distant metastasis is present. This includes spread to distant lymph nodes and/or other organs.
Staging Grouping – Putting it all Together
|Stage 1||T1,N0,M0||The tumor is 7cm or smaller and is only in the kidney. There is no spread to lymph nodes or distant organs.|
|Stage 2||T2,N0,M0||The tumor is larger than 7cm but is still in the kidney. There is no spread to lymph nodes or distant organs.|
|Stage 3||T3,N0,M0 or T1-3,N1,M0||The tumor is growing into a major vein (like the renal or vena cava) or into the tissue around the kidney;it is not in adrenal gland or beyond Gerota’s fascia. There is no spread to lymph nodes or other organs.|
|Stage 4||T4, any N, M0 or any T, any N, M1||The main tumor is growing beyond Gerota’s fascia and may be growing into adrenal gland (on top of kidney); may or may not have spread to lymph nodes or other organs.|
Stage of Disease – A Predictor of Survival
- High blood lactate dehydrogenase (LDH) level
- High calcium level
- Anemia (low red blood cell count)
- Cancer spread to 2 or more distant sites
- Less than a year from diagnosis to the need for systemic treatment
- Low performance status (a measure of how well the person can do normal daily activities).
- People with none of these factors are considered to have a good prognosis.
- People with 1 or 2 factors are considered intermediate prognosis.
- People with 3 or more factors are considered poor prognosis.
- The type of treatment your doctor recommends depends on the stage and your overall health.
- Understand the difference between complementary and alternative therapies. Complementary refers to treatments that are used along with your regular medical care, whereas alternative treatments are used instead of a doctor’s medical treatment.
- Treatment options are based on the stage of the cancer and generally include those listed below.
- Radical Nephrectomy
In this operation, the surgeon removes the entire kidney, sometimes the adrenal gland, and the fatty tissue around the kidney. This involves a large incision and may require a rib to be removed. Discuss this with your doctor.
- Laparoscopid Nephrectomy
This operation is done through several small incisions. Special instruments are inserted through the incisions (about 1/2″ long). A laparoscope (long tube with a camera) allows the surgeon to see inside. The other incisions allow the surgeon to remove the tumor and the kidney. This procedure may not be an option for large tumors measuring 10cm or more for tumors that have spread to renal vein or lymph nodes.
- Partial Nephrectomy (nephron sparing surgery)
This procedure allows the surgeon to remove only the part of the kidney with the cancer. This is the preferred method with early stage cancer and is often done on tumors measuring 4cm or less. Not all doctors can do this procedure and it should be done by surgeons with a lot of experience performing this specific procedure.
- Regional Lymphadenectomy (lymph node dissection)
This procedure removes nearby lymph nodes to determine if the cancer has spread. This can be important for predicting outlook, survival, and further treatment plans. Discuss this with your doctor.
- Adrenalectomy (removal of adrenal gland)
If the adrenal gland contains cancer then the surgeon will remove it. However, it may not have to be removed. Discuss this with your doctor.
- Curative Surgery
When there is a single metastasis or a few that can be removed without serious side effects, surgery may lead to long time survival.
- Pallative Surgery
Surgery to remove the metastases can sometimes relieve pain and other symptoms. This generally does not help the patient live longer but provides some relief of symptoms like pain, blood loss, and nauseous.
- Metastases Removal
1 in 4 patients with renal cell carcinoma will have metastatic spread when diagnosed. The common sites for metastasis are lungs, bones, brain, and liver. Surgery may still be helpful. Discuss this with your doctor.
- Bleeding that may require blood transfusions
- Damage to blood vessels and other organs
- Pneumothorax (unwanted air in chest cavity)
- Incisional hernia
- Kidney failure
- Targeted therapy is the introduction of drugs to fight the cancer at the molecular level.
- Angiogensis is the process by which malignant tumors expand and metastasize; simply put, form new blood vessels.
- Antiangiogenic inhibitors keep blood vessels from forming in a tumor.
- Proliferation occurs when a cell divides to make more cells.
- The drugs that interfere with angiogenesis and proliferation are called multi-kinase inhibitors. They target the tumor cells and its blood vessels, and slow the growth rate.
- Nexavar (Sorafib) – a tyrosine kinases inhibitor. This drug is pill form. It blocks cellular enzymes that are necessary for cell growth and survival.
- Sutent (Sunitinib) – a tyrosine kinases inhibitor. This drug is pill form. It blocks both blood vessel growth and targets that stimulate cancer cell growth.
- Torisel (Temsirolimus) – blocks a cell protein called mTOR that promotes cell growth and division. This drug is IV (intravenous) infusion form. It has shown to be helpful against advanced cancer with poor prognosis.
- Afinitor (Everolimus) – blocks a cell protein called mTOR. This is used in advanced kidney cancer after other drugs have been tried. This drug is in pill form.
- Avastin (Benvacizumab) – slows the growth of new blood vessels. This drug is IV infustion form. Recent studies have shown it may be helpful when used along with interferon – alpha.
- Votrient (Pazopanib) – blocks several tyrosine kinases involved with cancer cell growth and the formation of new blood vessels. This drug is in pill form.
- Inlyta (Axitinib) – inhibits several tyrosine kinases involved with the formation of new blood vessels. This drug is in pill form.
- External Beam Therapy – From the outside of the body radiation is focused on the cancer. This therapy is often used to palliate or ease symptoms.
- Stereotatic Radiosurgery – This is a special type of radiation therapy sometimes used for single tumors that spread to the brain.
- Cryotherapy (cryoablation) – This method uses extreme cold to destroy tumor. A hollow needle (probe) is inserted into tumor and very cold gases are passed through the probe which creates an ice ball that destroys the tumor.
- Radiofrequency Ablation – This method uses high energy radio waves to heat up the tumor. A hollow needle (probe) is inserted into the tumor, then an electric current is passed through the probe. This heats up the tumor and destroys the cancer.
- Arterial Embolization – This method injects material into the artery to block the tumor’s blood supply, thereby killing the tumor and the kidney. This is rarely performed.
- Extreme fatigue
- Low blood pressure
- Heart attacks
- Trouble breathing, build up of fluid in the lungs
- Intestinal bleeding, diarrhea, abdominal pain
- Kidney damage
- Mental changes
Low Dose IL-2 or Interferon (Interon, Referon) – Alpha interferons bind to specific cell-surface receptors.
- Being told you have Kidney Cancer is bad enough but there may be a time that a clinical trial is an option. Clinical trials are research studies that patients volunteer for. They are done to look at promising new treatments or procedures.
- The trials have requirements that must be met in order to qualify to become a participant.
- Clincal trials are controlled research studies. A list of clinical trials can be obtained at the National Cancer Institute or call their Cancer Information Service toll free at 1-800-422-6237.
- Talk with your Oncologist about clinical trials as well. Clinical trials are a method to obtain “leading edge” treatment options.
- Pain medicines range from over-the-counter to drugs like morphine or other opioids.
- Your doctor may use a combination of drugs in pill form and patches. These are taken on a regular schedule that the doctor will go over.
- In some cases radiation therapy or palliative surgery may relieve pain when cancer spreads.
- Your doctor may call in a pain specialist to determine what the pain plan involves.
- Your doctor may use a combination of drugs in pill form and nauseous patches. Sometimes it takes a few attempts to get nauseousness under control.
- Review your pain plan as pain can be inter-related with nauseous.