Facts and figures about kidney cancer
Cancer of the kidney 8th most common cancer in the UK, accounting for 3% of all new cases. Male to female ratio of 16:10. Age related, the incidence rises sharply from 45 years of age, 75% diagnosed in those over 60 years of age and 35% in the 75+ years age group.
Risk factors include smoking, being overweight/obese and some medical conditions; chronic kidney disease, hypertension (may be related to the drug treatments), use of diuretics, kidney stones (41% increased risk in men but no increase risk in females), sickle cell disease, high doses of non aspirin non-steroidal anti-inflammatory drugs and paracetamol and having a first degree relative diagnosed with renal cancer.
85% of these tumours are renal cell carcinomas.
Kidney cancer symptoms
- Blood in the urine (haematuria).
- Unexplained, rapid weight loss.
- High temperature/night sweats.
- Chronic fatigue.
- Leg and ankle swelling (oedema).
- Pain in the side of lower back.
- Lump in the area of the kidney/abdomen.
Diagnosis of kidney cancer
Investigations may include:
- Urine tests (likely to be carried out initially to investigate for possible urinary tract infection or blood in the urine if not apparent).
- Physical examination.
- CT scan –may be a CT urogram (CT scan of the urinary tract).
- Intravenous urogram (IVU) –x-ray of the urinary system.
- Ultrasound scan.
Kidney cancer treatment
Depends on several factors:
- The type of kidney tumour.
- The stage of the cancer.
- General health.
Surgery is the main treatment for early stage renal cancer (stage 1 and 2) where the disease is contained in the kidney. This may involve partial or complete removal of the kidney (nephrectomy); the whole kidney is usually removed if the tumour is larger than 7cms.
This is normally a simple nephrectomy which includes the kidney and ureter. This may be adequate treatment for these cases. In later stage tumours that have spread to the lymph nodes or adrenal gland (locally advanced) these can sometimes be cured by radical nephrectomy which involves removing the kidney, adrenal gland, surrounding tissues and lymph nodes.
Radiotherapy is not often used for renal cancer as kidney cancer cells are not sensitive to radiation, post-operative radiotherapy is rarely recommended. It may be used palliatively to control symptoms such as pain or bleeding.
Also, renal cancer tends to spread to the brain so patients may receive palliative radiotherapy to the brain.
Chemotherapy is not standard treatment for renal cell carcinoma as biological therapies are found to be more effective, but it may be used for transitional cell carcinomas (usually includes mitomycin C and possibly a new drug called vinflunine).
These are targeted therapies that stop the cancer cells from making new blood vessels and therefore inhibit cell growth. Sunitinibis is often used for patients with stage 3 or 4 renal cancer.
Bevacizumab is a monoclonal antibody that stops the development of blood vessels and is used with interferon to treat advanced renal cancer.
Cryotherapy is most likely to be used if the patient is not fit for surgery.
Needles containing liquid nitrogen are passed through the skin near the kidney, CT or ultrasound imaging is then used to move the needles into position. The liquid nitrogen freezes and destroys the cancer cells when they come into contact with it.
Radiofrequency ablation (RFA)
This uses radio waves to heat up the cancer cells until they are destroyed.
Under local or general anaesthetic, a needle is put through the skin (guided by ultrasound or CT scan) and then radio waves are sent down the needle to the tumour site.