Renal Cell (Kidney) Cancer
What Is Kidney Cancer (Adult) – Renal Cell Carcinoma?
Kidney cancer is a cancer that starts in the kidneys. To understand more about kidney cancer, it helps to know about the normal structure and function of the kidneys.
About the kidneys
The kidneys are a pair of bean-shaped organs, each about the size of a fist and weighing about 4 to 5 ounces. They are fixed to the upper back wall of the abdominal cavity. One kidney is just to the left and the other just to the right of the spine. Both are protected by the lower ribcage.
Renal Cancer, Von Hippel-Lindau Syndrome, VHL Syndrome Surgery, Von Hippel-Lindau Disease
The kidneys’ main job is to filter blood and rid your body of excess water, salt, and waste products. The filtered waste products are concentrated into urine. Urine leaves the kidneys through long slender tubes called ureters that connect to the bladder. Urine flows down the ureters into the bladder, where it is stored until you urinate.
The kidneys also help make sure the body has enough red blood cells. It does this by making a hormone called erythropoietin, which tells the bone marrow to make more red blood cells.
There are several subtypes of RCC, based mainly on how the cancer cells look under a microscope: –
Clear cell renal cell carcinoma : –
This is the most common form of renal cell carcinoma. About 8 out of 10 people with renal cell carcinoma have this kind of cancer. When seen under a microscope, the cells that make up clear cell RCC appear very pale or clear.
Papillary renal cell carcinoma : – This is the second most common subtype — about 10% to 15% of people have this kind. These cancers form little finger-like projections (called papillae) in some, if not most, of the tumor. Some doctors call these cancers chromophilic because the cells take in certain dyes used so the tissue can be seen under the microscope, and look pink.
Chromophobe renal cell carcinoma : – This subtype accounts for about 5% of RCCs. The cells of these cancers are also pale, like the clear cells, but are much larger and have certain other features that can be recognized.
Collecting duct renal cell carcinoma : – This subtype is very rare. The major feature is that the cancer cells can form irregular tubes.
Unclassified renal cell carcinoma : – In rare cases, renal cell cancers are labeled as unclassified because the way they look doesn’t fit into any of the other categories or because there is more than one type of cell present.
Renal Cell Cancer Causes
The exact cause of renal cell cancer has not been determined. A number of different factors seem to contribute to renal cell cancer.
These factors include the following: –
* Cigarette smoking doubles the risk of renal cell cancer and contributes to as many as one third of all cases. The more someone smokes, the greater the risk is of that person developing renal cell cancer.
* Obesity is a risk factor. As body weight increases, so does the risk of developing renal cell cancer. This is especially true in women.
* Occupational exposure to petroleum products, heavy metals, solvents, coke-oven emissions, or asbestos
* Cystic kidney disease associated with chronic (long-term) renal insufficiency
* Cystic changes in the kidney and renal dialysis
* Tuberous sclerosis
* Von Hippel-Lindau (VHL) disease, an inherited disease associated with several cancers
* Hereditary renal cancer
Renal cell carcinoma risk factors
The majority of kidney cancers are renal cell carcinomas. Risk factors for renal cell carcinoma include: –
* Age. Your risk of renal cell carcinoma increases as you age. Renal cell carcinoma occurs most commonly in people 60 and older.
* Sex. Men are more likely to develop renal cell carcinoma than women are.
* Smoking. Smokers have a greater risk of renal cell carcinoma than nonsmokers do. The risk increases the longer you smoke and decreases after you quit.
* Obesity. People who are obese have a higher risk of renal cell carcinoma than do people who are considered average weight.
* High blood pressure (hypertension). High blood pressure increases your risk of renal cell carcinoma, but it isn’t clear why. Some research in animals has linked high blood pressure medications to an increased risk of kidney cancer, but studies in people have had conflicting results.
* Chemicals in your workplace. Workers who are exposed to certain chemicals on the job may have a higher risk of renal cell carcinoma. People who work with chemicals such as asbestos, cadmium and trichloroethylene 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. People who have a kidney transplant and receive immunosuppressant drugs also are more likely to develop kidney cancer.
* Von Hippel-Lindau disease. People with this inherited disorder are likely to develop several kinds of tumors, including, in some cases, renal cell carcinoma.
* Hereditary papillary renal cell carcinoma. Having this inherited condition makes it more likely you’ll develop one or more renal cell carcinomas.
Transitional cell carcinoma risk factors
Risk factors for transitional cell carcinoma include: –
* Smoking. Smoking increases your risk of transitional cell carcinomas.
* Chemicals in your workplace. Working with certain chemicals may increase your risk of transitional cell carcinoma.
* A withdrawn medication. Phenacetin, which was removed from the market in the United States in the early 1980s, has been linked to kidney cancer. Phenacetin was used in prescription and over-the-counter pain relievers.
The following steps may be taken for a health care provider to make a correct diagnosis: –
* Medical interview: – A health care provider asks questions about the symptoms and how they started, current and previous medical problems, medications, family medical history, work and travel history, and habits and lifestyle.
* Physical exam: – This exam is performed to look for abnormalities that suggest a cause of the symptoms.
* X-rays, a CT scan, and lab tests: – These studies are usually performed after the interview and physical exam. If the results suggest that renal cell cancer or another cancer may be present, referral to a surgeon, a radiologist, and/or an oncologist (a doctor who specializes in cancer) may be needed.
* Biopsy: – A biopsy involves taking a small sample of the tumor. The sample is usually removed via a large needle inserted into the tumor. The sample is examined by a pathologist (a doctor who specializes in diagnosing diseases in tissues and body fluids). Cancer cells in the biopsy sample confirm the diagnosis of cancer. If the diagnosis of kidney cancer is strongly suspected based on x-ray/CT scan studies, biopsies of the kidney are not always done because of the risk of bleeding. The definitive diagnosis of kidney cancer is made at the time of surgery to remove the kidney (nephrectomy).
* Staging: – Another series of imaging studies and lab tests are performed to learn more details about the cancer and whether it has spread to other parts of the body. Careful staging is extremely important for planning treatment and predicting the course of the disease.
Renal Cell Cancer Treatment
The likelihood that renal cell cancer will be cured depends on its stage when it is diagnosed and treated. Renal cell cancers found in the early stages are cured over half the time. Unfortunately, this cancer often is not found until it has reached an advanced stage. The chance of curing metastatic (stage IV) renal cell cancer is small.
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