Renal Cell Carcinoma, is a cancer of the kidneys. It is the most common type of kidney cancer, occurring in 90% of kidney cancer patients.
Symptoms of Renal Cell Carcinoma are known as the ‘classic triad’ - blood in the uring (hematuria), pain in the sides or flank and a mass in the abdomen. Other signs that may indicate renal cell carcinoma are caused by a paraneoplastic phenomenon. Paraneoplastic phenomenon is not due to the tumor, but to substances that are secreted by the diseased kidney. The substances result in hormonal activity which may cause abnormal vision, unusual, excessive hair growth in women, pale face or pallor, sensitivity to cold, and constipation. Renal cell carcinoma is usually an ‘accidental’ discovery during medical imaging for another symptom or issue. Another symptom of renal cell carcinoma is the enlargement of one testicle - usually the left because of blockage of a vein due to tumor growth. If renal cell carcinoma has metastasized to the bone, it can cause a hip fracture - which could be the first time the disease is diagnosed. Weight loss -over five percent can also be an indication of renal cell carcinoma.
Renal Cell Carcinoma can be diagnosed using five tests. Each of these tests involves imaging.
The Intravenous Pyelogram uses dye to differentiate structures in the kidneys, ureters and bladder. The ureters are the tubes that carry urine from the kidneys to the bladder. Die is injected into the patient and then x-rays are taken to examine the affected area.
Arteriogram involves dye injected into a large blood vessel of the kidney. A catheter or narrow tube is inserted into the blood vessel and then dye is administrated. X-rays are taken to show the path of the dye through smaller blood vessels on and in the kidneys.
A CAT scan or CT is an imaging that provides cross sections of the kidney - the images are generated by computer.
Ultrasound is a test using high frequency sound waves aimed at the kidneys. The echoes of the sound waves produce a picture called a sonogram. Different structures such as tumors, normal tissue and cysts will appear on the sonogram.
A Magnetic Resonance Imaging, known as MRI uses a magnet linked to a computer to develop cross section images of the area in question, in this case the kidneys.
A nephrotomogram is cross-section x-rays of the kidneys that create a series of images for examination. Images are taken at various angles and dye is also used to highlight areas of the kidneys. Initial dye-free images are collected to compare with the dyed images.
A biopsy of the tumor can be performed, but usually a physician can gain a lot of information about the tumor from imaging.
Treatment depends on the staging of the cancer. Staging of the cancer is based on the type of cancer cells in the tumor and whether the cancer has spread to other organs or structures within the body. The spread of cancer within the body is known as metastasized cancer.
Treatment for renal cell carcinoma can be a combination of surgery, chemotherapy, radiation therapy, biologic therapy, targeted therapy and hormone therapy. Pain control and care for depression are also part of treatment for renal cell carcinoma. Surgery is the main treatment for renal cell carcinoma. Prognosis is extremely poor without surgery. Surgery to remove a kidney is referred to as a nephrectomy. There are two types of nephrectomies performed for renal cell carcinoma. A radical nephrectomy involves the removal of the entire kidney, its renal gland and surrounding fatty tissue. A partial nephrectomy is also referred to as a nephron sparing surgery because it does not remove the entire kidney. The section of the kidney that has cancer is removed, leaving the healthy part of the kidney within the patient. Laparoscopic nephrectomy can be used to perform a radical nephrectomy using small incisions in the abdomen. This method has a shorter recovery time and less pain than the traditional radical nephrectomy.
A lymphadenectomy is usually performed during a radical nephrectomy and involves removing surrounding lymph nodes. The lymph nodes are used to stage the cancer.
In forty percent of renal cell carcinoma cases, the cancer is only in the kidneys and has not metastasized. In this case, surgery leads to a ninety percent chance of cure. Metastasized renal cell carcinoma is extremely resistant to chemotherapy and radiation therapy. Immuno-therapy, also referred to as biologic therapy, which is relatively new has been providing encouraging results for patients with renal cell carcinoma.
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