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Kidney Cancer

Kidney Cancer - What it is

kidney cancer conditions & treatments

The kidneys are two fist-sized organs located behind the abdominal organs, located on either side of the spine. Kidneys form urine to clear some of the toxins produced by the body. Urine drains from the kidneys into the bladder and is then passed out of the body. 

Kidney Cancer 

Kidney or renal cell cancer is a disease in which malignant (cancer) cells form in the kidney. Kidney cancer is a disease that commonly affects the elderly, where nearly 2 out of 3 people diagnosed are over the age of 65. It also affects more men than women. 

In Singapore, kidney cancer is the 8th most common cancer among men. Kidney cancer accounts for 1-2% of all cancers, and the prevalence of this disease has been rising at an annual rate of approximately 2-3%. This rising trend has been attributed to the use of imaging techniques such as computerised tomography (CT) scans and ultrasonography for other complaints, leading to the accidental discovery of more kidney cancers.

Kidney Cancer - Symptoms

Kidney cancer does not usually show signs or symptoms in the early stages. It is usually diagnosed when patients are investigated for other complaints (e.g. during an ultrasound or CT scan). Kidney cancer diagnosed this way is usually small and at an early stage. However, about one-third of kidney cancers are discovered at an advanced stage. 

Possible symptoms include: 
  • Blood in the urine 
  • A mass in the abdomen 
  • Pain in the lower back or side (just under your ribs), that does not go away 
  • Loss of appetite or unexplained weight loss 
  • Anaemia (low blood count) 

 

When to see a doctor 

Make an appointment with your doctor if you experience any signs or symptoms that worry you.

Kidney Cancer - How to prevent?

There is no known way to prevent kidney cancer, but the following factors may reduce risk: 
  • Quit smoking. If you've never smoked, don't start. 
  • Maintain a healthy lifestyle – have a nutritious diet, regular exercise and maintain a healthy weight.
  • Control high blood pressure.

Kidney Cancer - Causes and Risk Factors

Kidney cancer commonly affects the elderly, with nearly 2 out of 3 people aged over 65 years old when diagnosed. Kidney cancer is rare in people under the age of 50. 

In most cases, there is no identifiable cause for the disease, although there are some associated risk factors:

  • Smoking - smokers have approximately double the risk of non-smokers. 
  • Obesity 
  • High blood pressure (hypertension) 
  • End-stage kidney diseases that require dialysis 
  • Chronic intake of mild painkillers, such as paracetamol, and nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen and aspirin. 
  • Family history of kidney cancer. Those who have a family history of kidney cancer have a higher risk. A hereditary form of the disease occurs in a small group of patients due to the presence of faulty genes. Inherited conditions that predispose one to kidney cancer include von Hippel-Lindau (VHL) syndrome, tuberous sclerosis, Birt-Hogg-Dube syndrome, and hereditary non-VHL clear cell and papillary renal cell cancer. 
  • Contact with certain chemicals – exposure or contact with chemicals such as aniline dye and heavy metals.

Kidney Cancer - Diagnosis

Tests and procedures used to diagnose kidney cancer include: 

  • Ultrasound or Computed Tomography (CT) scan
    - Detailed images of the kidney are taken to show the size, characteristics and extent of spread of the kidney tumour. 
  • Magnetic Resonance Imaging (MRI) scan
    - A scan that uses strong magnetic fields and radio waves to produce a detailed image of the kidneys. 
  • Biopsy
    - Samples of kidney tumour tissue are removed and examined under the microscope to confirm the presence of cancer. 
  • Positron Emission Tomography (PET) scan
    - A detailed body scan that can help to investigate confirmed cases of kidney cancer to see if the cancer has spread and how well it is responding to treatment. 
  • Cystoscopy
    - Cystoscopy is a test to look at the inside of the bladder. It is usually used for patients who have a kidney tumour and blood in the urine. A cystoscope contains a lens and light system that helps the doctor see the inside of the urethra, prostate and bladder to identify any additional tumours.

Kidney Cancer - Treatments

Kidney cancer treatment usually begins with surgery to remove the cancer. For early-stage cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney (advanced stage), additional treatments may be recommended. 

An individual with cancer should be assessed by a specialist to determine which modality of treatment is best suited for them. 

Treatment options for early-stage kidney cancer 

Surgery 
Surgery is the standard treatment option for those with kidney tumours who are fit for surgery. Depending on the kidney tumour characteristics and patient suitability, kidney surgery may be performed using conventional open surgery, laparoscopic (keyhole surgery) or robot-assisted techniques. 

The extent of surgery is categorised into two types: 

  • Partial nephrectomy - the tumour is removed with a margin of normal tissue, preserving the rest of the unaffected kidney. Partial nephrectomy is performed either when the tumour is small or if the patient has impaired kidney function or a single kidney left. 
  • Radical nephrectomy - the whole kidney including the tumour is removed. Radical nephrectomy is performed when the tumour is large and very close to the blood vessels or ureter. 

It is possible to lead a normal, active life with only one good kidney. Most people with one kidney removed do not end up with kidney failure requiring dialysis. Your treating doctor will advise you on the risks of impaired kidney function after surgery, which depends on the presence of other factors such as diabetes, high blood pressure and advanced age. 

Targeted ablation 
This is a minimally invasive ablative procedure that uses thermal energy to destroy tumour cells. 

Active surveillance 
Selected patients with a very small kidney tumour may be monitored closely with regular kidney scans to assess the growth rate or changes in the tumour appearance. 

Radiofrequency ablation and active surveillance are more suited for elderly patients with multiple medical problems, who are not fit for surgery. 

Treatment options for advanced kidney cancer 

Radiotherapy 
Radiotherapy uses powerful energy beams to kill cancer cells. It is sometimes used to relieve pain when the cancer is advanced and cannot be removed surgically. Another use for radiotherapy is to stop the cancer from bleeding. 

Systemic therapy 
For some patients who present late with kidney cancer that has spread to other parts of the body, surgery to remove the kidney in combination with systemic therapy has shown to be effective. 

Systemic treatment for this group of patients includes: 
  • Targeted therapy - drugs that target specific tumour growth pathways in the cancer cell 
  • Immunotherapy - drugs that incite the body’s immune response towards the cancer 

If a patient is not fit for surgery, immunotherapy or targeted therapy may be given to control the disease (with or without surgery), depending on the patient’s response to treatment.

Kidney Cancer - Preparing for surgery

Before surgery, your surgeon will perform comprehensive medical assessments including blood tests and scans, to see if you are suitable for surgery and advise on the risks involved. Your treatment recommendation is often based on consensus by a group of medical specialists' opinions (the tumour board), who come together to discuss the pros and cons of every treatment strategy. 

Before surgery, the anaesthesia team will assess your fitness for surgery and advise you on various aspects of general anaesthesia and pain control after surgery. 

Specialist nurses will also provide pre-surgery counselling so that you know what to expect.

Kidney Cancer - Post-surgery care

After surgery, you will be given regular outpatient appointments to see your team of doctors. During these appointments, you may have blood tests and scans to check if the cancer recurs. 

It is important to follow your doctor's advice, keep to your clinic visits and do the recommended scans and tests, so that timely treatment can be administered if the cancer recurs or other problems occur.

Kidney Cancer - Other Information



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The information provided is not intended as medical advice. Terms of use. Information provided by SingHealth

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