A Family Doctor's Tale - KIDNEY CANCER

DOC I HAVE KIDNEY CANCER

Kidney cancer is very rare but so far I have seen 2 cases. Both cases are detected through bleeding in the urine and kidney biopsy.
Treatment of choice is surgical removal of the cancer portion of the kidney or immunotherapy. In both cases the treatment was successful because they were detected early.
Chemotherapy and radiotherapy has not been found to be effective in the treatment of the kidney cancer.


Kidney Cancer is a malignant disease of the kidney.
Causes may be:
1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.

2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells

3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer

4.Obesity has been found to have some causal effect

5.Age - more common in in 50-70 age group

6.Long term dialysis for kidney failure.

Symptoms are non-specific and silent.
In the early stage there is no symptoms.

By the the time the symptoms appeared, the cancer is usually in the advanced stage.
1.painless hematuria or blood in urine

2.pain in the renal flanks

3.Fever

4.weight loss

Signs:
1.tenderness in renal area of backs

2.palpable mass in the side of abdomen

Diagnosis can usually be made by :
1.hematuria
2.Renal flank pain
3.Weight loss
4.Liver function tests
may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.
5.Ultrasound or abdominal CT
may be used to identify tumors.
6.Kidney Biopsy
biopsy of kidney may be done to determine types of Kidney cancer:

Clear Cell Type: 75%
Papillary type:  20%
Chromophole type: 4%
Others:           1% 

Treatment of Kidney cancer can be
Surgery
If the cancer is localised within the kidney , then it is surgically resectable and curable.

No treatment after surgery has been proven to prevent recurrence.

Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III

Once recurence occur then the cancer is considered as a Stage IV cancer and therefore incurable.

The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.

Immunotherapy
High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.

It is however toxic and potentially life threatening and is used for patients not suitable for surgery.

Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.

Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.

Biological targeted  therapy
These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .

These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.

There has also being an improved overall survival rate with a reduced risk of death by 28%.

Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.

The approved drugs are sorafenib, sumitinib and tensirolimus.

Chemotherapy and radiotherapy
Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.

The prognosis of Kidney cancer is poor
1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 1 year

3.5-year survival is lower than 5%.

4.Kidney cancer has one of the highest mortality of all the cancers.






Prevention is by doing the following:
Avoid smoking
Reduce weight in obese patients
Control high blood pressure to prevent damage to the kidney
Avoid taking toxic substances which may damage or injure the cells of the kidney.