Kidney cancer refers to oncological diseases that most often occur in people aged 55 to 60 years.
This pathology begins with the appearance in the renal tubules of malignant cells capable of dividing uncontrollably, thereby forming a tumor.
Without timely diagnosis and effective treatment, cancer can metastasize to neighboring organs and lead to death.
In nine cases out of a hundred, renal neoplasms are malignant, and only in one case does a cyst develop - a formation containing fluid.
Kidney cancer in men is much more common than in women. This type of oncology occurs mainly after 55 years. The causes of kidney cancer are not exactly known, but there are factors that can trigger the development of a cancer process in the kidneys:
- age after 50 years
- uncontrolled hormonal drugs, diuretics, analgesics,
- prolonged exposure to chemical toxins (work on rubber-rubber, paper, weaving industries, as well as work with petroleum products, heavy metal salts, dyes),
- viral infection
- polycystic kidney disease, nephrosclerosis,
- eating fatty foods
- chronic renal failure
- kidney injuries
- genetic predisposition (the next of kin has kidney oncology),
In smokers, the likelihood of developing an oncological process in the kidneys, as well as in the lungs, larynx, stomach, and bladder increases greatly (by a factor of 2).
Morphological variants of neoplasia are extremely variable, which explains the presence of several histological classifications. According to the histological classification adopted by WHO, the main types of malignant kidney tumors include:
- Renal cell tumors (clear cell carcinoma, tubular carcinoma, medullary carcinoma, papillary carcinoma, granular cell carcinoma, etc.)
- Nephroblastic tumors (nephroblastoma or Wilms tumor)
- Mesenchymal tumors (leiomyosarcoma, angiosarcoma, rhabdomyosarcoma, fibrous histiocytoma)
- Neuroendocrine tumors (carcinoid, neuroblastoma)
- Herminogenic tumors (choriocarcinoma)
The 1997 International TNM Classification is common for various types of kidney cancer (T is the size of the primary tumor, N is the prevalence of lymph nodes, M is the metastases to the target organs).
- T1 - tumor site less than 7 cm, localization limited to the kidney
- T1a - the size of the tumor site to 4 cm
- T1b - the size of the tumor site from 4 to 7 cm
- T2 - tumor site more than 7 cm, localization is limited to the kidney
- T3 - a tumor node grows into the parotid tissue, adrenal gland, veins, but invasion is limited to Gerota's fascia
- T3a - invasion of perirenal tissue or adrenal gland within the borders of the Gerota fascia
- T3b - germination of the renal or inferior vena cava below the diaphragm
- T3c - germination of the inferior vena cava above the diaphragm
- T4 - tumor spread beyond the renal capsule with damage to adjacent structures and target organs.
According to the presence / absence of metastatic nodes, it is customary to distinguish the stages: N0 (there are no signs of damage to the lymph nodes), N1 (metastasis is detected in a single regional lymph node), N2 (metastases are detected in several regional lymph nodes). The following stages are distinguished by the presence / absence of distant metastases: M0 (distant metastases in target organs are not detected), M1 (distant metastases are found, usually in the lungs, liver or bones).
What is kidney cancer metastasis and how does it threaten?
Metastasis is the spread of a tumor through the blood or lymphatic vessels. Tumors, like all living things in the body, require food provided by the vessels. Here in these vessels and get 1-2 cells from the main tumor, which spread to various organs. Cancer of the kidney is characterized by metastasis to the bones and lungs, as well as to the liver, adrenal glands and brain. Metastasis of kidney cancer, like the main tumor, impairs the function of the organ where it develops.
For example, metastasis of kidney cancer to the lungs causes a persistent cough, metastasis to the bone causes terrible, debilitating pains, which only potent narcotic drugs help. Unfortunately, some patients who go to a doctor already have metastases to distant organs. This dramatically worsens the prognosis of the course of the disease, since it is necessary to fight not with one tumor, but, in fact, with tumors in several organs.
Kidney cancer symptoms
An asymptomatic course is quite characteristic for the early stages of kidney cancer. One of the earliest manifestations of kidney cancer can be pain during urination and renal colic. Since the retroperitoneal space is difficult to palpate, often the first clinical signs are detected in the later stages, when the neoplasm already has solid dimensions.
The most important signs of kidney cancer:
- pain syndrome (appears when germinating in nearby tissues or when the ureter is blocked),
- hematuria (blood and blood clots in the urine),
- palpable abnormalities in the lumbar region,
- increased blood pressure (the cause of hypertension is compression of the ureter or great vessels, as well as the production of renin by the tumor),
- hyperhidrosis (excessive sweating),
- leg swelling,
- violation of the functional activity of the liver (liver failure),
- febrile reaction
- varicocele (varicose veins of the spermatic cord is the result of obstruction or compression of the inferior vena cava by a tumor).
Dull pain suggests a stretching of the capsule, and acute often indicates bleeding in the region of the renal pelvis.
Non-specific clinical signs:
- anemia (anemia),
- general weakness and fatigue
- loss of appetite,
- weight loss or cachexia (exhaustion).
These symptoms are common to all types of cancer.
One of the specific features of kidney cancer is that the tumor often leads to an increase in the level of secretion of a number of biologically active compounds (including hormones and vitamin D).
Symptoms disappear after radical surgery, but reappears with relapse.
Kidney Cancer Diagnosis
The following methods are used in the diagnosis of kidney cancer:
- Ultrasound examination of the kidneys (ultrasound)
- X-ray examination using contrast agents - intravenous urography
- CT scan
- Magnetic resonance imaging (MRI)
- The final diagnosis of any cancer is made only on the basis of a histological examination of a tumor sample (biopsy) or the entire tumor.
The spread and introduction into clinical practice of high-tech methods for diagnosing tumors (ultrasonography, multispiral computed and magnetic resonance imaging) have led to an increase in the detection of incidental renal cell carcinoma (incidental kidney tumors are tumors that did not manifest themselves clinically and were found by chance other diseases). If in the 1970s, such tumors were detected in less than 10% of cases, then at the turn of the XX — XXI centuries. they accounted for almost 60% of all kidney cancer cases.
Detection of kidney cancer in the early stages of the disease continues to be desired. So, in 2012, in Russia, 21.5% of patients turned to oncological facilities already in the presence of distant metastases, and another 20.1% had initial stage III disease. Given that approximately 50% of patients who have undergone radical nephrectomy at the early (M0) stage of the disease, subsequently develop metastases, the need for antitumor drug therapy sooner or later occurs in more than half of patients.
Partial nephrectomy of the kidney is carried out by limiting the tumor to the upper or lower parts of it, or when patients have only one functioning kidney.
Radical (complete) nephrectomy of the kidney is performed together with the adrenal gland using general anesthesia. If necessary, remove the surrounding tissue along with adjacent lymph nodes. The operation is performed by means of a large laparotomy or 4-5 smaller incisions (laparoscopic radical nephrectomy), so that the doctor can see his manipulations in the peritoneal cavity using a laparoscope. It has a light source and a lens that reproduces an image on the monitor. A tool is inserted through the holes to separate the kidneys from the structures that surround them. When one of the incisions is enlarged, the kidney is removed by a doctor. This method of surgical treatment accelerates recovery after rehabilitation.
After nephrectomy, complications are possible:
- bleeding occurs, pneumothorax (air outside the lungs - in the sternum), hernia, infection,
- the remaining kidney fails,
- surrounding organs are damaged: spleen, pancreas, large or small intestine, as well as blood vessels (vena cava, aorta).
Patients with severe heart disease may not undergo surgery on the kidney, so arterial embolization in the groin area is used: insertion of a catheter into the artery that supplies blood to the pathological kidney. A small gelatinous sponge is inserted into the catheter to shut off the blood supply. This will destroy the tumor and the kidney itself. It is then removed if the patient can undergo surgery.
Regression after surgery may be 0.5%. Survival rate over 5 years is up to 40%.
Chemotherapy for kidney cancer
In patients with kidney cancer, chemotherapy is prescribed in most cases.
The patient according to a certain scheme should take special preparations. When a patient enters the bloodstream, special medicines begin to affect the body. Chemotherapy brings a positive effect only in conjunction with other medical techniques. Its main purpose is to affect not only malignant neoplasms, but also metastases that can affect any internal organ of the patient.
Doctors are very cautious in the choice of medicines that will be used for the patient to undergo chemotherapy. They are trying to choose those drugs that are able to maximize life, slowing the rate of division of cancer cells.
To date, the most effective drugs for chemotherapy are:
- Nexavar - is able to completely stop the formation of new blood vessels of a malignant neoplasm, which provide it with nutrition. This drug is even prescribed to patients who are at 4 stages of kidney cancer,
- Sutent - able to block the blood vessels that provide nutrition to a malignant neoplasm. This drug is prescribed in courses, each of which lasts no more than 4 weeks,
- Inhibitor - has a detrimental effect directly on the malignant neoplasm. While taking this medication, the adjacent tumor tissues are not damaged. Patients tolerate chemotherapy very well with this medication.
It is a therapy used in the treatment of kidney cancer to increase the body’s resistance to cancer cells.
Used in advanced stages of cancer. There are cases of regression of kidney cancer in patients with metastases. Immunotherapy may be discontinued due to the large number of side effects. These include: nausea, vomiting, fever, weight loss, loss of appetite, headaches and muscle pain, fatigue.
8 cm carcinoma located at the lower pole of the kidney.
Nutrition and Diet
In case of any oncological disease, especially in case of kidney cancer, the patient must eat properly. Doctors strongly recommend that patients adhere to the diet.
You must completely eliminate the following products:
- smoked products
- pickles and pickles
- carbonated drinks,
- coffee and strong tea
- confectionery, especially with cream,
- fish and canned meat,
- beans, peas, chickpeas and other legumes,
- meat and fish broths,
- sausages and sausages,
- lard and fatty meat, etc.
A kidney cancer patient should completely abandon the use of alcohol and alcohol-containing beverages.
The following foods should be present in the daily diet of a patient with a malignant neoplasm:
- dairy and dairy products,
- chicken and quail eggs,
- germinated cereals,
- plant food,
- fruits, etc.
The following foods should be consumed in limited quantities:
- lean meat (boiled),
- lean fish (boiled),
- salt and spices, etc.
The daily diet of the patient (consisting of 4-6 meals), in the aggregate, should not exceed 3 kg. The amount of fluid you drink should be reduced to 1 l, so as not to put a large load on the kidneys.
Unfortunately, nobody is insured against oncological diseases (including kidneys). But you can save your body. Follow the simple rules:
- try to live without nicotine,
- watch the weight. This is important not only for appearance, but also for health,
- eat right and love fruits with vegetables
- treat all benign neoplasms of the kidneys in time,
- Do not forget to undergo a physical examination and examination of the entire body regularly,
- just increase the body's defenses and your own immunity.
Kidney cancer is completely treatable. Moreover, the survival with the proper treatment of this disease is quite high. This means that you and your loved ones are obliged to fight this disease.
Prediction for life
The prognosis for kidney cancer is determined by the stage of the disease.
At stage 1, 90% of patients are completely cured, while the prognosis of the disease at stage 4 is poor, it is difficult to achieve even one-year survival.
The prognosis after the removal of cancer remains often disappointing, and the survival rate is no more than 70%, while about half of the patients have a high risk of local recurrence, often very malignant in their course. Most patients after radical treatment of kidney cancer are given a disability group, which is associated with organ loss and possible impairment of their habitual lifestyle and work capacity later.
The cause of kidney cancer is rarely detected, but many risk factors can be eliminated and the risk of the onset of this disease can be reduced significantly:
- Smoking - The main cause of cancer is not only the kidneys, but also other organs. The probability of developing a malignant tumor in a smoker increases by 30-60%. When you try to quit smoking, this risk is reduced by 15%. Have a throwing state of health gradually returns to normal.
- Obesity also increases the likelihood of kidney cancer. In overweight people, the risk of cancer increases to 20%. In vegetarians, oncology of the kidney is much less common than in active meat eaters.
- Arterial hypertension. There is evidence that high blood pressure is also a provocateur. But doctors still can not figure out what exactly causes cancer - hypertension or drugs that take hypertension.
- Constant contact with chemicals. Work on industrial production, where chemical ingredients are widely used, increases the likelihood of developing kidney cancer. Dangerous places for workers are rubber plants, paper mills. Specialists who, by virtue of their employment, work with oil products, paints and salts of heavy metals, are also at high risk.
- Dialysis procedure. Patients with chronic renal pathologies undergo hemodialysis for a long time. At the same time, their probability of renal oncology significantly increases. Also, those patients who have gone through a kidney transplant operation may also get cancer.
Important! Clinical studies have shown that the presence of cysts or kidney stones does not increase the risk of illness. The most "favorable" conditions are smoking, extra pounds and hypertension.
Stages of Oncology
There are four stages of renal tumors. Each stage is characterized by individual dimensions that influence the treatment process of the patient.
In addition, the prognosis of recovery depends on the spread of atypical cells to the tissues and organs adjacent to the kidney, lymph node lesions and deep metastasis of malignant neoplasms:
- First the stage of renal oncology is developing rather slowly. Tumor cells are localized exclusively in the kidney itself and do not metastasize to the lymph nodes and other organs. The size of the neoplasm of the first stage does not exceed 7 centimeters.
- Second the stage of cancer in the kidney is developing somewhat more actively than the first. Malignant cells are still within the affected organ and do not move to adjacent tissues and lymph nodes. The size of the tumor of the second stage exceeds seven centimeters. At this stage, the neoplasm has a confirmed malignant status.
- Third the stage is characterized by the penetration of atypical cells into the main blood vessels, as well as into the lymph nodes. At the same time, neighboring organs are still not affected. The main part of the formation is located in the kidney. The size at this stage is more than 10 centimeters.
- Fourth stage is the hardest. In many cases, the disease is inoperable and the prognosis for curing the patient is very disappointing. At the last stage, the tumor metastasizes to other human organs. Also, the cancer begins to touch the adrenal glands. The size of the tumor is quite large.
A malignant disease metastasizes to a wide variety of internal organs:
- 76% are in the lungs,
- 64% of the lymph nodes
- 40% - liver
- 25% - contralateral kidney,
- 11% - adrenal glands,
- 10% - the brain,
- 43% are bones.
In addition to malignant tumors of stages 1-4, there is also a Williams tumor. It is small and rarely metastases to other organs and lymph nodes. The prognosis for the recovery of patients with Williams' neoplasm is very optimistic.
At the first stage, 98% of patients are completely cured, at the second stage - 94%, at the third stage - 95%, and at the fourth stage - about 90% of patients.
Proper diagnosis and treatment
Effective fight against malignant cells requires prior correct and accurate diagnosis.
Patients with complaints of pain in the lumbar region should come to the urologist for an initial examination. In addition to the necessary tests and palpation, a hardware study will also be scheduled:
- laboratory and other.
If the diagnosis is confirmed, the doctor may prescribe:
- computed or magnetic resonance imaging,
- radiopaque urography,
- radionuclide scanning,
- nephroscintigraphy and more.
These types of diagnostics will help specialists determine not only the structural features of the tumor, but also its localization, the presence of metastases, and sizes.
Various methods are used to remove cancer:
- surgical intervention,
- hormone therapy
- drug treatment,
- exposure, etc.
The most effective treatment for renal oncology is surgery. The type of surgery may vary depending on the stage of the disease, the size of the tumor and its location. If only the affected part of the kidney is removed, this method is called resection. Nephrectomy removes a completely diseased organ.
Surgical nephrectomy is performed using a laparoscope. Due to this, the patient passes the postoperative period much faster and restores his usual way of life.
According to statistics, after laparoscopic resection of a malignant tumor, the number of relapses is significantly reduced compared with abdominal surgery.
Before laparoscopy, the patient must pass all tests, undergo a medical examination. On the eve of the operation, the patient is stopped to be given food and the intestines are cleaned with an enema or an eruptive medication.
Chemotherapy for Renal Oncology
Patients with a malignant tumor of the kidneys are most often prescribed chemotherapy. The patient is determined by the individual scheme, according to which he must take the designated medical device. Getting into the blood, drugs begin to have a specific effect on the entire body.
Together with other methods of treatment, chemotherapy can bring the expected positive effect. Its main goal is an aggressive impact not only on the tumor itself, but also on the metastases that have appeared.
Doctors select drugs for chemotherapy very carefully. The drugs should slow down the division of malignant cells as much as possible, which will positively affect the life of the cancer patient.
Modern medicine identifies several effective drugs for chemotherapy:
- Nexavar - prevents the formation of new blood vessels of the tumor, thanks to which it feeds. This medicine is even attributed to patients with stage four cancer.
- Sutent - blocks blood vessels and closes the supply of blood to cancer cells. The drug is taken in courses for 4 weeks.
- Inhibitor - adversely affects the cancer. When applying a therapeutic agent adjacent to the formation of tissue is not affected. Inhibitor is well tolerated by cancer patients.
Cancer of any organ implies strict adherence to the diet. The mode and composition of the diet is determined by doctors. They recommend removing foods that put pressure on the kidneys from the diet:
- smoked food
- carbonated drinks,
- pickled and salted dishes,
- strong tea, coffee,
- canned fish and meat,
- different types of legumes,
- fish and meat rich broths,
- fatty meat dishes.
Patients with cancer can not drink alcoholic and low alcohol beverages.
Proper diet should include:
- plant food
- cereal dishes
- eggs of chickens and quails,
- milk products.
In small quantities, you can use:
- boiled lean meat and fish,
- butter and cream,
- salt and spices.
You also need to limit the amount of fluid consumed to 1 liter to avoid stress on the kidneys.
During treatment, any methods are good, but at the same time it is necessary to follow the recommendations of the treating doctor regarding the use of prescribed medications and proper nutrition.
Therefore, in combination with traditional medicine, you can try the treatment of folk remedies.
Many patients successfully struggle with oncology with herbal tinctures, decoctions, balms, ointments and compresses.
The most effective herbs in the fight against oncology are:
- Hypericum root and many others.
You can use only a well-designed collection that can stabilize the functionality of the internal organs. Tinctures help to rid the diseased kidney of harmful substances and traces of the breakdown of cancer cells.
Before using herbs, it is necessary to consult the attending doctor. He will determine the appropriate dosage and select the most effective herbs in this case.
The duration of rehabilitation of the operated patient depends on the stage of the disease, the complexity of the operation, the age of the patient and his general condition. After removal of the kidney, there may be some complications in the form of pneumonia, thrombophlebitis, problems with the cardiovascular system.
In the first few days after nephrectomy, a person is contraindicated to move, drink plenty of fluids and eat.
Over time, with the permission of the doctor, you can increase physical exertion, temper the body, drink more clean warm water or rosehip broth and gradually introduce new products into the diet.
A prerequisite for a high-quality and full life after the operation is regular visits to oncologists, passing examinations and passing all the necessary tests.
Prognosis to recovery
The prognosis to complete recovery or improvement in the quality of life in renal oncology depends on the stage at which the therapy was initiated. In medicine, there is a standard criterion for the effectiveness of cancer treatment - five-year survival.
If the tumor began to be treated at the first stage, then more than five years, about 90% of patients live. In the second stage, this figure drops to 65-70%. In the third stage, the number of people who have lived for more than 5 years is 50%. The most disappointing prognosis for patients with fourth stage cancer.
Their percentage does not exceed 10. With Wilms tumor, without the presence of metastases, 90% of patients fully recover. This is only average data.
That is why the prognosis for complete recovery is affected by the location of the tumor, its size, the number of metastases and the time of relapse.
What is kidney cancer?
Kidney cancer is a disease in which the growth of a malignant neoplasm occurs. The tumor can develop both in one and in both kidneys of the patient. In most cases, patients who have been diagnosed with kidney cancer will develop metastases in various organs. Most often, this disease occurs in the male half of the population, women are less likely to face this problem.
How many live with kidney cancer? World statistics
For many decades, doctors and scientists from different countries of the world have been doing painstaking work on the improvement of medical techniques that will make it possible to more successfully treat cancer. According to statistics published in the media, every year more than 40,000 cases of kidney cancer are diagnosed in the world. To date, the death rate from kidney cancer remains quite high. About 12,000 deaths are recorded every year in different countries of the world.
The danger of this cancer is that in the early stages it may be asymptomatic, and therefore, patients seek medical help too late. Even a brilliant surgical operation to remove a malignant neoplasm or kidney cannot guarantee a patient a long life. This is because a few years after surgery, the patient may develop metastases. The process of metastasis of the body almost always deprives the patient of a chance for recovery.
According to world statistics, patients with kidney cancer have the following life expectancy:
in kidney cancer 1st stage - the survival rate of 81%
in kidney cancer stage 2 - the survival rate of 74%,
in kidney cancer of the 3rd stage - the survival rate of 53%,
in 4th stage kidney cancer, the survival rate is only 8%.
Currently, doctors use the latest techniques in the fight against kidney cancer, thanks to which the life expectancy of patients has increased to 71.5%:
53% of patients live to 5 years after cancer is detected,
after cancer is detected, up to 10 years, 43% of patients live.
Kidney cancer symptoms
In most patients diagnosed with kidney cancer, this disease is accompanied by the following symptoms:
strong pain in the lumbar region,
during bowel movement the patient detects blood in the urine,
appearance of renal colic,
general weakness and lethargy
sharp weight loss
pain when urinating,
swelling of the lower extremities,
deep vein thrombosis,
an increase in the size of the affected kidney (the tumor becomes palpable), etc.
When metastasis of the internal organs in patients with kidney cancer, there are certain symptoms:
brain metastases - severe headaches, neuralgia development,
metastases in the lungs - severe coughing, hacking in blood,
liver metastases - jaundice, pain in the right hypochondrium, bitter taste in the mouth,
bone metastases - fractures, pain in movement of limbs, etc.
Small malignant neoplasms often develop asymptomatically, and therefore, patients are diagnosed with cancer already at the stage at which other organs are affected by metastases.
Causes of Kidney Cancer
The reasons for the appearance of malignant neoplasms in the kidneys include the following:
bad habits. Smoking causes great harm to the human body, since nicotine contains carcinogens that have a detrimental effect on the renal tissue. According to the available statistics, among people diagnosed with kidney cancer, the majority of patients had this addiction,
excess weight. Even in the early stage of obesity, people may develop malignant neoplasms in the kidneys. Eating fatty and junk food significantly increases the risk of a cancer,
injuries and falls. Any mechanical effect on the kidneys can trigger a malignant neoplasm,
medicines. Constant medication in the treatment of various diseases increases the risk of a tumor,
genetic predisposition. In some cases, the cause of kidney cancer is poor heredity,
contact with chemistry and radiation,
serious chronic diseases, etc.
Stages and extent of kidney cancer
Modern medicine identified the stage of development of kidney cancer. Due to the existing classification, specialists can determine with high accuracy:
the structure of a malignant neoplasm
the degree of its development, etc.
Most narrowly specialized specialists involved in the treatment of kidney cancer use the international classification of this disease called TNM in diagnosis, where:
M - allows you to detect the presence of metastases in the patient’s body (even distant ones),
N - assesses the patient’s lymph nodes,
T - allows a specialist to assess the primary lesion of a malignant neoplasm.
In addition to the international classification, the classification of Robson, which distinguishes 4 stages of this disease, helps to assess the state of the cancer.
Stage 1 kidney cancer
The first stage of development of a malignant neoplasm very often passes unnoticed by the patient. Cancer in most cases does not exceed 2.5 cm in diameter. It is located within its capsule and does not extend beyond the edges of the kidney, which is why it is difficult to detect during palpation. If patients are diagnosed with this disease at the first stage, then in 90% of cases they will be guaranteed recovery and a quick return to the usual rhythm of life.
Stage 2 kidney cancer
In the second stage, the size of the cancer begins to increase. Malignant neoplasm grows slightly. At this phase of development, the tumor is still difficult to diagnose (hardware and laboratory tests are required).With timely detection of cancer for patients, there is still a favorable prognosis.
Kidney cancer stage 4
The fourth stage of development is accompanied by an active growth of a malignant neoplasm. Patients develop metastases in various organs: lungs, liver, intestines, etc. This stage of the development of a cancerous tumor requires immediate surgical intervention. Patients have significantly reduced chances for a successful recovery.
Kidney cancer metastases
After 40-60% of patients diagnosed with kidney cancer, metastases are found that affect various organs, depending on the severity of the disease and the localization of the malignant neoplasm.
Most often, cancer patients develop metastases in the following organs:
In the brain,
In the lymph nodes,
In the skeletal system,
In the costo-clavicular space, etc.
In modern medicine, the process of metastasis refers to the manifestation of clinical signs of secondary foci of malignant tumors. In some cancer patients, metastases are detected 10 years after the onset of stage 1 cancer. In the case when the lungs affect single metastases, then there is a chance for patients that they regress independently. Early diagnosis gives patients a high chance of successful treatment and a speedy recovery.
Kidney cancer treatment
In the treatment of kidney cancer, doctors use various constructive techniques:
The most effective method of treating a malignant neoplasm on the kidney is surgery.
Depending on what stage of the disease, its size and location, surgeons can perform:
resection - part of the kidney is removed, on which a cancerous tumor is found,
nephrectomy - the entire kidney is removed.
Before you choose a method for treating a malignant neoplasm, a specialist should carry out the necessary diagnostic measures:
collect a full history of the disease,
examine the results of analyzes and histology,
determine the stage of the disease,
take into account the age of the patient
to identify comorbidities, etc.
Usually surgeons try to preserve the organ of the patient as much as possible, using more benign techniques. In recent years, experts have tried not to perform abdominal surgery, in which an incision is made of the skin. Since the mid-90s, leading clinics have begun to use the latest trends in medicine. Thanks to the emergence of a cyberknife, surgeons have the opportunity to remove as well as stop the growth of malignant tumors. Patients who underwent surgery using a cyber-knife do not need to undergo exhausting chemotherapy. The principle of this device is to destroy the DNA of tumor cells.
In recent years, experts have tried in any way to preserve the organ of the patient. They use the latest techniques in the treatment:
The choice of a specific medical technique directly depends on the following parameters of a malignant neoplasm:
stage of cancer,
age of the patient, etc.
In the case when the patient was diagnosed with a malignant tumor of small size (up to 4 cm in diameter), then specialists perform a resection of the kidney. When a patient is performing a surgical procedure, biological material is collected, which is immediately transferred to the laboratory for histological examination.
A more radical method of surgical treatment of kidney cancer is nephrectomy, during which a kidney and a number of located tissues are excised to the patient: renal fascia, pararenal fatty tissue, regional lymph nodes, etc. The doctor decides on the amputation of the adrenal gland.
After surgical treatment, patients undergo postoperative rehabilitation. They are prescribed chemotherapy, radiotherapy, immunotherapy, etc. In some cases (with a single kidney), patients are sent for hemodialysis, and as a result, organ transplantation is recommended.
If the tumor did not have time to spread beyond the limits of the organ, then the patient has all the chances to overcome this disease forever. When metastasis occurs in patients before or after treatment, there are unfavorable prognoses for them. The life expectancy of the patient will directly depend on what stage of the cancer he applied to the medical facility.
Recently, patients who have been diagnosed with kidney cancer have been treated by using targeted therapy. This technique allows the drug to have the desired effect on the cancer. Targeted drugs provoke the death of tumor cells. Their intake is not accompanied by strong side effects. They practically do not have a negative impact on healthy cells of the affected kidney and nearby organs.
In some clinics, targeted drugs are used in conjunction with traditional methods of treating renal malignancies. They work well in parallel with chemotherapy or radiotherapy. Many specialists prescribe targeted drugs to their patients in order to prevent the recurrence of cancer.
Target drugs at the molecular level stop the development of malignant tumors. This therapy helps prevent the growth of cancerous tissue in the healthy part of the organ. The course of treatment with targeted drugs depends on the severity of the disease, as well as on the general condition of the patient.
Kidney removal in cancer
The first laparoscopy, the purpose of which was to remove a kidney, took place in 1990. Since that time, clinics from around the world began to actively implement this technique for surgical nephrectomy of kidney cancer. At present, every modern clinic, in which there is an operating unit, is necessarily equipped with a laparoscope.
Laparoscopy allows patients to significantly reduce the postoperative period and return to a normal rhythm of life much faster. According to statistical data, the recurrence rate after laparoscopic removal of a cancer tumor is much lower than after nephrectomy of a malignant neoplasm during abdominal surgery.
Before performing laparoscopy, the patient must undergo special training:
mandatory to pass tests (biochemical and clinical blood analysis, urinalysis, etc.),
blood coagulation test,
undergo a general medical examination and receive admission to surgery from a therapist.
A week before the surgery, the patient must stop taking medications - anticoagulants. The day before the operation, the patient must clean the bowels and stop eating.
This can be done in two ways:
with the help of special medications that stop the bowels and cause severe diarrhea (in most cases, Fortrans is prescribed).
Immediately before laparoscopy (within a few hours), the patient is inserted into the bladder a catheter, which will be removed the next day after surgery. Laparoscopy, as well as conventional abdominal surgery, is performed under general intravenous anesthesia (with a breathing tube connection). After the patient is delivered to the postoperative ward, intravenous injections and droppers will be assigned to him. Immediately after surgery, potent drugs are injected into the patient that block any pain. The next few days (after the operation), the anesthetic injections are done overnight, after the patient is examined by an anesthesiologist, who from a conversation with the patient makes a conclusion about his condition.
What is a kidney tumor?
Like any other tumor in the human body, a kidney tumor is a mass of cells whose progenitor has lost the ability to stop its own division. As a result, the cell began to divide uncontrollably, and there was already an accumulation of cells that also had no mechanisms to stop division.
The second characteristic of a kidney tumor, as well as most other tumors, is the loss of cell specification - since the cell divides quickly, it simply does not have time to specialize. Thus, a kidney tumor in the first approximation can be characterized as a mass of cells that are uncontrollably dividing and have lost the ability to specialize. The less specialized a tumor cell is to perform its function, the faster it divides and the more its ability to spread through the blood and lymphatic vessels, the more malignant the tumor.
Are kidney tumors malignant?
Nearly 90% of kidney tumors are malignant. The remaining 10 percent comes from angiomyolipomas and other, much more rare benign kidney tumors. Meanwhile, even benign kidney tumors may well be dangerous to health. For example - an angiomyolipoma can damage kidney vessels, causing bleeding. As for malignant tumors or cancer of the kidney, then we are faced with damage to the functioning renal tissue, its vessels and bleeding, with metastasis to the bone, lungs, brain, and, accordingly, unbearable pain.
What to do if a kidney tumor is found during an ultrasound?
If a kidney cancer is suspected, a patient is prescribed a general urinalysis, general and biochemical blood tests.
One of the most informative methods for diagnosing kidney cancer is computed tomography. It helps to assess the size, shape and localization of a malignant neoplasm, to detect foci in the lymph nodes and other anatomical structures outside the kidneys. The study is often supplemented by intravenous contrast. Contrast is contraindicated in renal dysfunction.
Magnetic resonance imaging is used less frequently than CT. It is shown when the patient cannot be performed with CT scan with contrast, if there is a suspicion of tumor invasion in the inferior vena cava or other large vessels, to detect metastatic foci in the brain and spinal cord.
Angiography - radiography with contrasting vessels, kidneys. It helps in the diagnosis of the disease and the planning of surgical treatment.
Positron emission tomography helps detect secondary foci of cancer in different parts of the body. The essence of the method is that a substance is injected into the patient's body, which has a weak radioactivity and accumulates in the tumor cells. Then take pictures with the help of a special apparatus, and on them tumor foci are clearly visible.
Unlike other oncological diseases, biopsy for kidney cancer is rarely performed. Usually the results of other studies are enough to make a decision about the need for surgical intervention. After the operation, the removed tumor is sent to the laboratory to confirm the diagnosis. A biopsy is performed if other studies do not allow to figure out whether the operation is indicated. In cases where surgical intervention is contraindicated, the study of tumor tissue helps to determine the treatment strategy.
Is surgery always necessary for kidney cancer?
In medicine, there are no categorical, one hundred percent answers. What is the purpose of kidney cancer removal surgery? Remove the tumor? Remove the kidney with the underlying structures? Remove only the primary focus of the tumor, and then deal with metastases in one way or another? Will the patient undergo surgery, what is his general condition? What kind of operation to choose for a particular patient? The oncourologist must answer these questions before offering surgical, conservative or combination treatment. Basically, it depends on the stage of kidney cancer, the location of the tumor, the presence of lymph node metastases, and the patient’s general health.
Kidney cancer after surgery
How many people live after surgery for kidney cancer? It depends mainly on the stage at which the tumor was diagnosed and treatment started. Five-year survival (the percentage of patients who survived after 5 years) is highest for stage I and is 81%. At stages II and III, respectively, it is 74 and 53%. At stage IV - 8%.
How does the doctor determine the stage of kidney cancer and what is the basis for suggesting a particular treatment?
The stage of kidney cancer depends on the size and location of the tumor. So, kidney cancer of the first stage is a tumor smaller than 7 cm, not extending beyond the limits of the kidney. Cancer of the second stage kidney is a tumor smaller than 10 cm, also not extending beyond the limits of the kidney. But third stage kidney cancer is already a tumor of any size, limited to the kidney, or damaging the adrenal gland, the renal vein, but having metastasis in the nearest lymph nodes. Cancer of the fourth stage can be of any size, but at this stage the tumor either extends beyond the renal fascia, or there is more than one metastasis in the nearest lymph nodes, or there are metastases to the lungs, bones, liver or brain.
The stage of kidney cancer is determined in accordance with the international classification of TNM. Next to each of the three letters of the abbreviation indicate an index describing the characteristics of the primary tumor (T), damage to regional lymph nodes (N), the presence of distant metastasis (M):
T1 is a tumor located within the borders of the kidney and having the largest diameter of not more than 4 cm (T1a) or 4–7 cm (T1b).
T2 - a tumor located within the borders of the kidney and having the largest diameter of 7–10 cm (T2a) or more than 10 cm (T1b).
T3 - a malignant neoplasm spreads to the renal vein and its branches, to the adrenal gland on the side of the same name, perirenal fiber, without germinating Gerotay's fascia (T3a), to the inferior vena cava below (T3b) or above the diaphragm or growing into the vein wall.
T4 - the tumor spreads beyond the fascia of Gerota.
N0 - tumor foci in regional lymph nodes are absent.
N1 - detected tumor lesion in one lymph node.
N2 - detected tumor foci in two or more regional lymph nodes.
M0 - no distant metastases.
M1 - distant metastases are present.
Depending on the values of T, N and M, four stages of kidney cancer are distinguished:
- Stage I: the tumor in the kidney is not more than 7 cm (T1), the lymph nodes are not affected, there are no distant metastases.
- Stage II: primary tumor more than 7 cm (T2), there are no lesions in the lymph nodes and distant metastases.
- Stage III: a malignant tumor spreads to adjacent structures (T3) and / or one regional lymph node (N1) is affected.
Stage IV: the tumor spreads to adjacent structures (T4), or 2 or more regional lymph nodes (N2) are affected, or distant metastases (M1) are found.
Why in one case, when a kidney tumor is 2 cm in size, a kidney removal is proposed, and in another case a tumor reaches 5 cm, but the doctor says that only a tumor can be removed with a kidney preservation?
A 2 cm kidney tumor may be located near the renal vessels and its removal may technically not be possible. However, literature data indicate that if there are no metastases to the lymph nodes and distant organs, then a kidney tumor up to 7 cm can be removed with preservation of the kidney, which is certainly better than complete removal of the kidney and disability of the patient.
What methods are available for the treatment of kidney cancer?
Conventionally, the methods can be divided into surgical and therapeutic. As for surgical methods, this is the traditional “open” surgery, when through a large incision the surgeon gains access to the kidney and removes either a tumor (resection of a kidney tumor) or a kidney with underlying structures (radical nephrectomy).
In our practice introduced radiofrequency ablation of a kidney tumor - a method of treating kidney cancer in patients who for one reason or another will not undergo "open" or laparoscopic surgery. The essence of the method consists in the introduction of a special instrument into the kidney tumor under the control of an ultrasound and the destruction of this tumor. To perform radiofrequency ablation does not require a large incision, since the thickness of the tool does not exceed 3-4 mm. This method allows you to get rid of the tumor so-called "inoperable" patients.