Kidney Cancer
Kidney cancer is twice as common in men as in women. Roughly 27,000 Americans are diagnosed with this illness each year, with an associated 11,000 deaths yearly. Average age of patients with Kidney cancer is 50-60 years. It is most common in persons having a Northern European background.
Causes
Cigarette smoking, obesity and kidney dialysis have been associated with an increased risk of developing this illness. Also, a few genetic illnesses, e.g., Von Hippel-Lindau disease.
Signs and Symptoms
Patients do not exhibit any signs at very early stages. Blood in the urine is the early worrisome sign. Other signs of this illness could be anemia, fever, weakness, fatigue, weight loss.
Establishing Diagnosis
When the diagnosis is suspected, patients must be examined carefully by a qualified physician. A chest x-ray, a CT scan of abdomen, and a study of a urine sample should be the very first steps in making the diagnosis. If a tumor mass is seen on CT scan, the next step would be a Fine Needle Aspiration of the tumor, or an attempt to operate and surgically remove the cancer.
Staging Work-Up
Once a diagnosis of the kidney cancer is established, A thorough examination of the patient is necessary to disclose crucial information. A CT scan of chest and abdomen and a bone scan should be performed to determine the extent of the spread.
Patterns of spread
Kidney cancer may either spread locally and involve nearby tissues (such as spread to the space outside the kidneys) or travel to distant sites (such as local lymph glands or liver, bones, brain or the opposite). Another area where cancer can spread is the area near the spinal cord and vertebrae.
Treatment
Surgery is the only treatment that can cure this disease in its earlier stages, when the disease is confined to a an area within the kidney. Without surgery, a cure is not feasible. In such cases, Immunotherapy should be considered, as well as radiation therapy, if the cancer has spread to the bones. The most effective Immunotherapy drugs used to treat this condition are Interferon, Interleukin 2.
Since 2007, several drugs have been approved by FDA for treatment of metastatic kidney cancer. These drugs are effective in controlling the disease and delaying the recurrence of the cancer.
Nexavar (Sorafenib)
Sutent (sunitinib)
Torisel (temsirlomimus)
Affinitor (everolimus , RAD001)
Avastin (bevasuzimab)
Votrient (pazopanib)
Special Situations
Patients with advanced Kidney cancer may develop any of the following complications:
- Spinal cord compression
- Brain metastasis
- Bone metastasis
- Paraneoplastic syndromes
- High calcium level
- Pain
Survival
Survival of patients with kidney cancer will depend on the extent of the cancer at the time of initial diagnosis. One-third of patients with early stages of kidney cancer may be cured with surgery alone. In the majority of patients, in whom cure is not possible, survival could vary from months to years, depending on the extent of the cancer and overall condition of the patient, as well as his/her response to treatment and the duration of that response.
Follow-up
After completion of treatment, in any combination that might have taken place, patients need to remain under surveillance for the possibility of a recurrence of cancer. Follow-up should be scheduled on a regular basis, initially every one to three months for one to two years. The frequency of follow-up will depend on the condition of the patient and his/her disease. In each follow-up visit, patients are examined and normally a chest x-ray is obtained every few months. A CT scan of the chest and abdomen and bone scan are obtained once a year.
Treatment of the recurrent disease will depend on the stage and extent of the reoccurred disease. Most patients are then treated with Immunotherapy, using the same agents mentioned above. Radiation therapy may be helpful in managing painful or symptomatic areas where the cancer has spread. If patients experience pain, various pain medications may be used to alleviate the pain. For patients with advanced disease, where most treatments have failed, one could consider assistance from hospice.
