Localised Kidney Cancer

LOCALISED KIDNEY
CANCER
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WHAT IS KIDNEY CANCER?
Kidney cancer is a type of cancer that arises from the cells of the kidney. Another name
for kidney cancer is “renal cell carcinoma”. The most common type of kidney cancer is
“clear cell carcinoma”.
Kidney cancer is caused by changes in DNA in cells within the kidney. Our bodies are
always making new cells: for us to grow, to replace worn-out cells, or to heal damaged
cells after injury. This process is controlled by instructions and recipes coded in the DNA
called “genes”. All cancers are caused by changes to genes.
Changes to genes that cause cancer usually happen during our lifetime, although a small
number of people inherit these changes from a parent. The average age of people found
to have kidney cancer is 55 years. Kidney cancer is rare in children.
Like most cancers, kidney cancer begins small and can grow larger over time. Kidney
cancer usually grows as a single mass but more than one tumour may occur in one or
both kidneys. If kidney cancer is treated in its early stages, it is most likely to be cured.
If kidney cancer cells spread, they may spread into surrounding tissue or to other parts
of the body. When kidney cancer cells reach a new organ or bone they might continue
to grow and form another tumour (a “metastasis”) at that site.
•
Primary cancer is a cancer that has formed in an organ (in this case the kidney)
but has not spread elsewhere. Other words like “localised” or “early” apply if
the primary cancer has not spread.
•
Secondary cancer or "metastases" or “metastatic” or “advanced” cancer is a
cancer that has spread from somewhere else in the body. It is very rare for a
cancer from another part of the body to spread to the kidney.
WHAT ARE THE RISK FACTORS?
Some factors that may increase the risk of developing kidney cancer include:
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Age: Like most other cancers, kidney cancer most often arises in older people,
usually seen in adults over 40.
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Smoking: People who smoke have almost double the risk of
developing kidney cancer than non-smokers. This additional
risk reduces to zero over time, if the person stops smoking.
Quitting at any time, at any age is a great idea. It’s never
too late.
•
Gender: Men are at higher risk of developing kidney cancer than women.
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Obesity: Being very overweight or obese appears to be associated with an
increased risk of developing kidney cancer in both men and women. It is
thought that excess body fat may cause changes in certain hormones, which
can lead to kidney cancer.
•
High blood pressure (hypertension): High blood pressure
has been found to be a risk factor for kidney cancer.
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Kidney stones: Having kidney stones is associated with a higher risk of developing kidney cancer
in men.
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Occupational exposure to toxic compounds: People regularly exposed to certain chemicals
including asbestos, lead, cadmium, dry-cleaning solvents, herbicides, benzene or organic solvents,
and petroleum products, as well as people who work in the iron and steel industries may have
an increased risk of kidney cancer.
•
Long-term dialysis and acquired cystic disease: Being on dialysis treatment over a long period
of time may cause kidney cysts. Kidney cancer may develop from the cells that line these cysts.
•
Family history of kidney cancer: People who have family members with kidney cancer, especially
a sibling, are at increased risk. This can be due to genes that pass down from parent to child. Only
3-5% of kidney cancer is caused by inherited genes.
•
Specific genetic and hereditary conditions: There are several genetic and hereditary conditions
which, if inherited, may make it more likely for benign or malignant cells to develop.
WHAT ARE THE SYMPTOMS OF KIDNEY CANCER?
Many kidney cancers do not cause symptoms; they are found incidentally during a scan, X-ray or
ultrasound that was ordered for another problem. When kidney cancer does cause symptoms these
can be non-specific, that is, many of the symptoms that kidney cancer might cause can be mistakenly
attributed to other causes, like a urine infection or a muscle twinge. Most kidney cancers do not cause
pain until advanced stages when they have started to spread. Many people with kidney cancer are not
aware they have a tumour until they have a test for another health problem. However, always talk to
your doctor if you are experiencing any of these signs or symptoms:
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•
•
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•
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blood in the urine or changes in urine colour to dark, rusty or brown (haematuria),
lower back, abdominal or flank pain which is not linked related to an injury,
weight loss,
newly developed high blood pressure,
constant tiredness, or
fever or night sweats which are not linked with any other conditions.
HOW IS KIDNEY CANCER DETECTED?
Kidney cancer is most often detected by chance, but if you have some of the symptoms listed above,
speak with your doctor. As with all cancers, early detection can improve the chance of successful
treatment and long-term outcomes. Your doctor may use different approaches, tests and investigations
to diagnose kidney cancer, depending on the symptoms you display.
The most common tests that may be ordered include:
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Ultrasound: A type of scan where a probe slides over the skin and where the x-ray team looks
for irregularities in the kidney and other organs.
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Scans: Computer tomography (CT) scans or magnetic resonance
imaging (MRI) scans can be used to get detailed pictures of organs
in the body. This can help characterise a lump in the kidney, if one
is found.
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Chest x-ray: An x-ray of organs and bones within the chest.
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Urine test (urinalysis): The most common symptom and sign of a kidney tumour is blood in the
urine. This test can also detect other irregularities in the urine such as protein.
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Blood tests: Chemical tests of the blood can detect findings associated with kidney cancer.
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Intravenous pyelogram (IVP): A dye is injected into a vein and x-rays are used to map its path
through the kidneys and into the urine.
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Cytoscopy: A test that checks the bladder and urethra for cancers, using a telescope with a lens
and a light which is placed into the bladder through the urethra.
•
Bone scan: A small amount of radioactive material is injected into a vein and travels through the
bloodstream to the bones so that the scanner can detect if cancer has spread to the bones.
THE SCAN FOUND A “LUMP” IN MY KIDNEY – WHAT DOES
THAT MEAN?
Whether you had symptoms or had a scan for another reason, once kidney cancer is suspected because
of a “lump” in the kidney, the next steps depend on the scan results. Your doctor might use other
words to describe this lump, like a mass, a lesion, a growth, a shadow, a “neoplasm”, or a tumour.
Sometimes these lumps in the kidney can be benign (not actually cancer). These benign lumps can
include growths of fat (“angiomyolipoma”) or a non-cancer growth (“oncocytoma”). Benign lumps do
not spread to other parts of the body. However, they can sometimes cause trouble locally in the kidney
so specialist’s advice is still necessary.
The next step after finding a lump in the kidney on a scan is for you and your doctor to discuss if a
biopsy is needed. Sometimes the appearance of the lump on the scan is suspicious enough for your
doctor to recommend surgery without a biopsy first. One way to confirm if a lump is actually cancer is
to put a thin needle into the lump. The cells or tissue that is removed with this needle will be then
examined under a microscope by a doctor (a pathologist). This is called a biopsy and is almost always
performed by an x-ray doctor (a radiologist) using ultrasound or CT scans.
DIFFERENT TYPES OF KIDNEY CANCER
Kidney cancer can be subdivided into several different types based on the appearance of the cancer
cells under a microscope and other genetic factors. The type of kidney cancer is not usually important
for surgery, but can be very important if more treatment is needed. Different levels of aggressiveness
of cancer can also be described within each type of kidney cancer. This helps understand the cancer
and plan follow-up care.
The main subtypes are:
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Clear cell carcinoma: The most common form of renal cell carcinoma, accounting for about 75%
of people with kidney cancer. When viewed under a microscope, the individual cells that make up
clear cell renal cell carcinoma appear empty or clear.
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Papillary cell carcinoma: About 10% to 15% of people have this form of kidney cancer. These
cancers form little finger-like fronds called papillae (hence “papillary”).
•
Chromophobe carcinoma: Accounts for about 5% of cases. The cells of these cancers are large
and pale, and have certain other distinctive features.
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Translocation carcinoma: A type of kidney cancer that occurs more often in children and
young adults. In some cases, it can occur in people with autoimmune disorders or those who
have previously received chemotherapy for malignancy or bone marrow transplant preparation.
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Sarcomatoid carcinoma: Several of the other subtypes of kidney cancer can turn into
“sarcomatoid” kidney carcinoma. The appearance of the cancer cells under the microscope is
more aggressive and disorganised.
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Urothelial carcinoma: Also called transitional cell carcinoma (TCC) are cancers that can form
in the kidney from the lining of the drainage system of the kidney, rather than the cells of the
kidney itself. These cancers are very similar to bladder cancers.
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DIFFERENT STAGES OF KIDNEY CANCER
Once kidney cancer has been diagnosed by looking at the biopsy or at the cancer after it has been cut
out of the body, the next step is to determine the “stage” of the cancer. The stage of a cancer describes
the size of the cancer and whether or not it has spread. This helps to guide treatment and can help
plan long-term follow-up care. When staging is based on clinical assessment alone, it is referred to as
the clinical stage. Microscopic examination of the affected tissue determines the “pathologic” stage.
A staging system is a standardised way in which the cancer care team describes the extent of the cancer.
Your doctor will determine the "stage" of your kidney cancer based on:
• the size of the tumour - “T-stage”,
• spread of the cancer to the nearby lymph nodes - “N-stage”. (A lymph node is like a police station;
it is a small round gland that makes up part of the immune system and houses white blood cells
(the police officers) that remove bacteria, cancer cells and foreign particles from the body.
Unfortunately cancer cells like to spread to lymph nodes)
• if there are signs of the cancer having spread to other organs, i.e. metastasised to, for example,
liver, lung, bone - “M-stage”.
The four main stages of kidney cancer below are based on this TNM staging system, which is one of the
methods for ‘staging’ kidney cancer in Australia.
Stage 1: The cancer is only within the kidney and has not spread. The cancer is less than 7cm in size.
If the cancer can be removed, it is most likely to be cured with surgery. 9 out of 10 people will be alive
and free of the cancer at five years after an operation.
Stage 2: The cancer is larger than 7cm but is still confined to the kidney and has not spread outside of
the kidney. Surgery is a good treatment option. The five year survival rate is still very high after surgery
for stage 2 kidney cancer.
Stage 3: The kidney cancer has moved nearby outside the kidney but has not spread to distant organs.
For example, the cancer might have spread into the fat around the kidney, into the blood vessel coming
out of the kidney, or into lymph nodes near the kidney. Surgery is often the right treatment. The chance
of being cured by surgery is lower, but not zero.
Stage 4: The kidney cancer has spread widely outside the kidney; to the abdominal cavity, to the adrenal
glands, to distant lymph nodes or to other organs, such as the lungs, liver, bones, or brain. This stage
of cancer is very unlikely to be cured, but various treatments can help.
TREATMENT OF KIDNEY CANCER
Your doctors will discuss treatment choices, the expected results, and will work with you, your family
and supporters to develop a plan that fits your situation. Your treatment will depend on the type of
kidney cancer, your general health and the stage of the cancer. All treatment has benefits and side
effects, which need to be discussed with your cancer care team. For information relating to advanced
kidney cancer, please refer to our Advanced Kidney Cancer fact sheet.
TREATMENT OF LOCALISED KIDNEY CANCER
Strange as it may seem, in some people with small (stage 1) kidney cancers, the first best treatment is
observation, or “active surveillance”. If you are older, or have significant medical problems, it may be
safer to first carefully watch the cancer, with multiple scans and multiple visits to the cancer specialist.
Because many kidney cancers are discovered by accident on scans that were recommended for other
reasons, a number of small kidney lumps can be detected. Kidney cancers that are smaller than 3cm
are very unlikely to spread elsewhere, and sometimes the risk of an operation outweighs the benefits.
People who choose active surveillance with their doctors must continue to have regular follow-up care,
in case the cancer starts to grow.
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With a larger or growing cancer in the kidney, surgery is usually the first course of treatment. Surgery
to remove kidney cancers is performed by a specialist surgeon called a Urologist. Surgery may either
remove a part of the kidney, in which case it is called a “partial nephrectomy”, or the entire kidney,
which is then called a “radical nephrectomy”. This might need to be done with a large incision (an “open
nephrectomy”) or might be able to be done by keyhole surgery (a “laparoscopic nephrectomy”), which
results in a shorter hospital stay and quicker recovery. If the cancer is small (stage 1, <7cm), a partial
nephrectomy may be possible, where the remaining normal kidney can be spared. If the cancer is larger
(stage 2) or has started to spread near the kidney (stage 3), then the whole kidney is usually removed
during a radical nephrectomy.
If you lose one kidney, your remaining kidney gets bigger and
heavier. It works harder and provides up to 75% of normal
kidney function rather than the expected 50%. Most people
are able to live quite normally with just one functioning kidney.
In some people an operation is not advised due to their age
or other medical problems. It may be still possible to treat a
localised kidney cancer without surgery using other procedures.
These include radiofrequency ablation, where a needle
containing a microwave antenna is inserted into the cancer
under local anaesthetic, and the cancer is “cooked” from the
inside. Other new procedures, like special targeted radiation
therapy, are being tested in clinical trials.
ALTERNATIVE OR COMPLEMENTARY THERAPIES
Alternative therapies might be proposed by well-intentioned friends, relatives or internet web-pages,
but they are called “alternative” because they have not been scientifically proven to shrink cancers or
help patients. Worse still, they might have been proven not to help or to even cause harm. Examples
of unhelpful or harmful alternative treatments include mega-dose vitamins, herbal products or extreme
diets. A good website to check if an alternative therapy has been debunked is www.quackwatch.org.
Some alternative therapies can interfere with medicines normally prescribed by a doctor, causing harm
to the patient. So it’s important to inform your doctor or nurse if you are considering these therapies.
On the other hand, complementary therapies can “complement” established medical treatments,
improving quality of life and symptoms. These might include mindfulness meditation, relaxation
techniques, homeopathy, remedial massage therapy, psychotherapy, prayer, yoga, acupressure and
acupuncture. If there were any chance that the kidney cancer has spread to bones, chiropractic or
osteopathy would not be a good idea.
FOLLOW UP CARE
All cancer survivors should have follow-up care. Once you have finished your cancer treatment, you
will establish a follow-up cancer care plan with your treatment team, which may include seeing a
range of health professionals.
In general, cancer survivors return to their specialist every three to four months during the first few
years after treatment, and once or twice a year after that. At these visits, your doctor will look for side
effects from treatment and will check to ensure you that cancer has not returned (recurred) or spread
(metastasised) to another part of your body. Like most cancers, the chance of the kidney cancer returning
is highest soon after treatment; the longer away from the treatment the more chance the cancer has
been cured. However, your treatment team will want to follow you for some time.
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SUPPORT SERVICES
If you have questions about any aspect of kidney cancer,
contact our Kidney Cancer Support Service – 1800 454 363
or email kidneycancer@kidney.org.au. Kidney Health Australia also has a forum called Kidney Cancer
Connect, where you can relate your stories, ask questions, share practical information and, most of all,
support each other. You can access Kidney Cancer Connect at www.kidneycancer.org.au/forum.
WHO CAN I CONTACT FOR MORE INFORMATION?
The Cancer Council Helpline (13 11 20) is a free, confidential telephone information
and support service run by Cancer Councils in each state and territory. The service
also provides information regarding support groups and networks, education
programs, practical assistance, and accommodation. Anyone can call Cancer Council
Helpline – cancer patients, people living with cancer, their families, carers and friends,
teachers, students and health professionals. Call 13 11 20 or visit www.cancer.org.au
for more information.
For more information about Kidney or Urinary health, please contact our free call Kidney Health Information
Service (KHIS) on 1800 454 363. Alternatively, you may wish to email KHIS@kidney.org.au or visit our website
www.kidney.org.au to access free health literature.
This is intended as a general introduction to this topic and is not meant to substitute for your doctor's or Health
Professional's advice. All care is taken to ensure that the information is relevant to the reader and applicable to
each state in Australia. It should be noted that Kidney Health Australia recognises that each person's experience
is individual and that variations do occur in treatment and management due to personal circumstances, the health
professional and the state one lives in. Should you require further information always consult your doctor or
health professional.
Kidney Health Australia gratefully acknowledges the valuable contribution of Dr. Craig Gedye, Medical Oncologist,
Calvary Mater Newcastle and University of Newcastle in reviewing this information.
Revised March 2015
If you have a hearing or speech impairment, contact the National Relay Service on 1800 555 677 or
www.relayservice.com.au. For all types of services ask for 1800 454 363.