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Wellstar Health System provides superior care for kidney cancers, offering a comprehensive spectrum of top-notch physicians, treatment options and diagnostic tools. In addition Wellstar offers innovative advances in the fight against kidney cancer, including:
The kidneys are located in the abdominal cavity, on either side of the spine. Roughly the size of a fist and bean-shaped, the tops of the kidneys are protected by the lowest ribs, and are surrounded by two layers of fat.
The kidneys filter the blood, removing waste products, and excrete excess water from the blood, thereby regulating water volume and blood pressure. The artery that leads the blood to the kidneys is called the renal artery, and takes about 20% of the blood flow from the heart. Each kidney contains roughly one million nephrons, within which proximal convoluted tubules carry out secretion from and reabsorption to the blood. The filtrate from these tubules is ducted to a funnel called the renal pelvis, which leads to the ureter and the urinary bladder.
Another function of the kidney is a gland: it secretes erythropoietin, a hormone that regulates production of red blood cells. Atop each kidney is an adrenal gland, which helps to regulate metabolism, blood pressure, inflammation, and response to stress, and produces small amounts of sex hormones.
People are born with two kidneys, but can survive with only part of one, or none if they undergo artificial dialysis.
The most common kidney cancer, comprising over 90% of cases in adults, arises in the lining of the proximal convoluted tubules. It is called renal cell carcinoma (RCC), and occurs in several subtypes, based mainly on the appearance of the cancer cells. These include:
Between 5 and 10% of kidney cancers begin in the renal pelvis, and are called transitional cell carcinomas (TCC) or renal pelvis carcinoma. TCC of the kidney is sometimes not considered a true kidney cancer, sharing characteristics instead with other urothelial (lining of the urinary tract) cancers, like bladder cancer, which is much more common. If TCC is discovered before the tumor has grown into the ureter wall or the kidney proper, the survival rate is about 90%, but this drops rapidly as the tumor spreads.
Another type of kidney cancer is Wilms Tumor, also called nephroblastoma. They occur almost exclusively in children under 5, with roughly 500 diagnosed annually in the United States. They grow very large—often several times larger than they kidney to which they are attached—and are so dense with blood vessels that their rupture risks hemorrhage. Wilms tumors are usually found before they have spread to other organs, and have a 90% survival rate.
Renal sarcoma is a rare (less than 1%) type of kidney cancer that begins in the blood vessels or connective tissue of the kidney.
Kidney cancer was diagnosed in about 58,000 people in the United States in 2010, and about 13,000 people died from it in that year. It is very rare in people under 45; the average age at diagnosis is 64. The incidence of kidney cancer has been rising slowly since the 1970s; at least part of this is due to improving detection.
Hereditary risk factors are rare, but greatly increase the risk of kidney cancer. They include:
Other risk factors include:
Wellstar supports scientific research that shows certain lifestyle choices can lower a person’s risk of some cancers, including kidney cancer.
Screening tests, like mammograms for breast cancer, are used to detect illness in a general population, including people who have no symptoms.
There are no screening tests for kidney cancer. A routine urine test sometimes reveals small amounts of blood that may indicate kidney cancer, but there are many diseases that can cause blood in the urine, and many kidney cancers do not.
Imaging like computed tomography (CT) and magnetic resonance imaging (MRI) scans can find small renal cell carcinomas, but these tests are expensive and cannot always distinguish benign from cancerous tumors, so they are generally recommended only for people with hereditary risk factors or who have been on long-term dialysis. Ultrasound is less expensive and may also detect kidney cancer, but it has not been demonstrated that any of these tests improve survival for those not at substantially elevated risk.
Kidney cancers are sometimes found during tests for other illnesses. These cancers are usually at a very early stage and have no symptoms; the survival rate of these cancers is very high.
If you have any symptoms of kidney cancer, your Wellstar physician will take a complete medical history to discern your risk factors and symptoms. A physical examination can find signs of kidney cancer, like an abnormal mass in the abdomen.
If your medical history and/or the physical examination indicate the possibility of kidney cancer, imaging and/or laboratory tests will be conducted.
A computed tomography (CT) scan can find and examine kidney tumors, and can reveal whether a cancer has spread to other organs and tissues.
Magnetic resonance imagery (MRI) scans are used less often than CT scans in detecting kidney cancer. They may be used in such cases as when a person is allergic to the CT contrast dye; if the cancer might have grown into major blood vessels, since MRI provides a better picture of blood vessels; or if the cancer might have spread to the spinal cord or brain.
Ultrasound can help determine whether kidney mass is solid or filled with fluid. The echoes from most kidney tumors look different from those from normal kidney tissue, and can distinguish some types of tumors from one another. If a kidney biopsy is needed, ultrasound can guide the biopsy needle.
An intravenous pyelogram (IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein is removed by the kidneys and is sent to the bladder. Similarly, an angiography uses a dye injected directly into the renal artery to reveal the blood vessels to the kidneys.
If the kidney cancer is advanced, a chest x-ray or CT scan can reveal if it has spread to your lungs, a common site of kidney cancer metastasis. If there is an indication that the cancer may have spread to the skeleton, a bone scan can reveal damaged bone using a low-level radioactive substance.
Lab tests do not often diagnose kidney cancer, but they can provide a hint of its presence and to help determine whether a cancer has spread.
Urinalysis is one of the first tests done if kidney cancer possible. About half of all patients with RCC have detectable blood in their urine, and a microscopic examination of urine sometimes shows kidney cancer cells.
A complete blood count (CBC) measures the quantities different cells in the blood. Anemia (too few red blood cells) is very common in people with kidney cancer; less often, they have too many red blood cells. The blood count is also important to ensure that a person is healthy enough for surgery.
Blood chemistry tests detect abnormal levels of blood chemicals, like liver enzymes, that may indicate kidney cancer; a high calcium level may reveal that the cancer has spread to the bones.
Since imaging usually provides sufficient information to diagnose kidney cancer, biopsy is not often used. However, in those cases where imaging is not conclusive, a fine needle aspiration (FNA) biposy may be used to obtain a small sample of cells from a suspicious area. Biopsy may also be used in patients too frail for surgery, or if non-surgical treatment is being considered.
The Fuhrman grade is found by examining at kidney cancer cells with a microscope. It quantifies on a scale of 1 to 4 how similar the cancer cells' nuclei look to normal kidney cells. Grade 1 RCC nuclei look much like normal nuclei; these cancers usually grow slowly. Grade 4 nuclei look quite different, and usually grow much more aggressively.
When a cancer of the kidney is diagnosed, your Wellstar physician will categorize it by its current stage. Each stage describes the progression of the disease and whether the cancer has spread to other parts of the body. You should talk to your Wellstar physician to understand each stage, and what it means for your treatment plan.
Once kidney cancer has been detected, graded, and categorized by stage, your team of specialists in oncology, radiation oncology, surgery and pathology will work together to assess your best course of treatment for your specific type of kidney cancer. This will include formulating a coordinated plan of personalized treatment consistent with the highest standards of care. Your treatment will be tailored to the type, grade, and stage of kidney you have, and may include a combination of surgery, radiation, targeted therapy, immunotherapy, and chemotherapy.
Surgery is the main treatment for most kidney cancers, and the only treatment for the 40% of kidney cancers that are confined to the kidney. Without surgery, chances of survival are very small, and even patients whose cancer has spread may benefit from removal of the tumor. Depending on the type, grade, and stage of the cancer, surgery may remove just the cancer and some surrounding kidney tissue or an entire kidney, and may remove nearby lymph nodes, adrenal gland and protective fat as well.
Laparoscopic nephrectomy is the preferred method for removing an entire kidney (radical nephrectomy). The operation is done through several small incisions, into one of which a camera is inserted, and from one of which the kidney withdrawn. Most people do fine with just one kidney.
With earlier-stage tumors (generally, smaller than 4-7 cm), often only the tumor and some surrounding tissue is removed (partial nephrectomy). Studies indicate that long-term results are about the same as with radical nephrectomy. This is considered difficult surgery; WellStar surgeons are very experienced with this procedure.
Sometimes, the lymph nodes and/or adrenal gland near the kidney will be removed to see if they're cancerous as well. Patients whose imaging tests indicate well-localized cancer that does not involve the lymph nodes and adrenal gland may be spared this surgery; this should be discussed with your Wellstar physician before surgery.
Nephrouterectomy is the the standard treatment for transitional cell carcinoma (TCC), the ureter (which conducts urine from the kidney to the bladder) and the bladder cuff (which connects the ureter to the bladder) will also be removed.
In about 25% of patients with kidney cancer, the cancer will have spread before diagnosis. The lungs, bones, brain and liver are the most common sites of spread. In some patients, surgery may still be helpful. In rare cases where there is only one of a few points of spread, they may be removed along with the kidney or at a later time. Otherwise, removing the tumors may relieve some symptoms, but this doesn't usually extend life.
For patients unable to undergo surgery, there are a few treatments that are used to destroy kidney tumors. However, there is much less clinical evidence of their effectiveness than there is for surgery.
Radiation therapy uses high-powered beams of energy to kill cancer cells. Kidney cancers are relatively insensitive to radiation, so it is generally used only in people who cannot undergo surgery, or to ease the pain caused by cancers that have spread.
Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells. It can be used to assist in the cure of cancer patients or to prolong life or the quality of life.
Kidney cancers are usually resistant to chemotherapy, but it may be useful to combat cancers that have spread to other organs.
Target therapy differs from standard chemotherapy in that it focuses on the genetic and molecular mechanisms underlying the cancer. It is particularly useful for advanced kidney cancers because they resist radiation and chemotherapy; while they may shrink or slow the cancer, they have not yet been shown to be curative.
Immunotherapy works by stimulating the immune system to fight the cancer. The two most frequently used types of immunotherapy are Proleukin® (interleukin-2) and alfa interferon.
Since immunotherapy's side-effects may be severe, and even fatal, is used to treat only advanced, metastatic cancers.
Proleukin® (interleukin-2): Prior to the FDA-approval of new targeted therapies, Proleukin was the standard of care for patients with renal cell cancer. It is typically administered in high doses as an inpatient treatment and has historically been associated with severe side effects. However, the safety of high-dose Proleukinhas significantly improved over the past decade.
Unfortunately, long-term results of clinical trials indicate that only approximately 15% of patients with advanced renal cell carcinoma have an anticancer response when treated with high-dose Proleukin. For this reason the combination of targeted therapy plus Proleukin is being evaluated in clinical trials.
Interferon: Interferon is naturally produced in the body and stimulates the immune system. Interferon-alpha is produced in a laboratory, and mimics the action of natural interferon. It has been shown to stimulate the immune system to recognize and destroy some types of cancer cells.
Treatment of renal cell carcinoma with interferon appears to produce anticancer responses in fewer than 15% of patients with advanced renal cell cancer. Because side effects can be severe and it has not been shown to improve survival, the use of interferon alone in the treatment of renal cell carcinoma remains controversial.
You’ll be referred after your recovery from kidney cancer to Wellstar’s medical oncology team for treatment, surveillance and survivorship programs. These comprehensive programs focus on diet, exercise and nutrition to help you reduce the risk of recurrence.
Cancer care at Wellstar is more than advanced technology, clinical research, and highly specialized physicians and nurses. It includes an array of supportive care services to improve the patient experience before, during and after treatment. All of these services are available within the WellStar system, including:
Wellstar’s certified palliative care physicians and certified registered nurses are dedicated to providing compassionate, quality care in various settings, including home hospice, inpatient hospice nursing homes, assisted living facilities and nursing homes. Wellstar offers caring and compassionate hospice care for patients and their families in one of Georgia’s oldest hospice programs serving Bartow, Cherokee, Cobb, Douglas and Paulding counties.