Kidney cancer – surgical treatment

The kidneys are two bean-shaped organs, each about the size of a fist. They are located in the abdomen retroperitoneally on both sides of the spine in the area of the kidneys on the sides of the two lower thoracic and two upper lumbar vertebrae. Their main job is to clean your blood, remove waste products and produce urine, that is, to maintain the body’s chemical homeostasis.

Kidney cancer is a disease caused by the growth of one of several types of malignant cancer.
Renal cell carcinoma is localized in the kidney itself, develops from the epithelium of the collecting tubules in the kidney tissue, and comprises 90% of what people call kidney cancer.

Transitional cell carcinoma appears outside the tissue of the kidney itself in the area of ​​the transition to the ureter, which drains urine into the bladder, and arises from the epithelium of the cup-loaf system. This pathology is more reminiscent of bladder cancer than renal cell carcinoma.

Renal sarcoma originates in the connective tissue of the kidney and is much less common than renal cell carcinoma.

Nephroblastoma (Wilms tumor) is a highly malignant form of kidney cancer that originates from the tissue of the developing kidney in the fetal period and manifests itself in children up to the age of five.

Oncocytomas are benign kidney tumors. Over time, they can become malignant and are currently treated as if they were malignant tumors, meaning they should be surgically removed as soon as possible.

There is no way to distinguish on ultrasound or computer tomography from malignant tumors when they are found in the kidney!

The good news is that most kidney cancers are caught before they spread (metastasize) to distant organs.
And the treatment of kidney cancer detected at an early stage is easier and more successful. However, these tumors can grow to quite large sizes before they are detected.

Types of pathology

According to the latest, most common classification, based on morphological, cytogenetic and molecular studies, as well as immunohistochemical analysis, 5 types of renal cell cancer are distinguished:

Main subtypes

1. Clear cell — occurs most often (92% of cases) — a rapidly progressive and metastatic form of kidney cancer.
2. Chromophilic (papillary) – occurs in 4% of cases, there are two subtypes. In the first subtype of cancer, the cells are small with bright cytoplasm, which often occurs in a benign form. In the second subtype, there are large cells with eosinophilic cytoplasm (for this subtype, the probability of developing metastases is higher).
3. Chromophobic — occurs in 2.5% of cases, a poorly predicted form of pathology.

Additional subtypes

1.  Cancer of the collecting tubules – occurs less often than others, 0.2% of cases. The prognosis is unfavorable.
2. Oncocytic cancer of the kidney includes sarcoma-like cancer and undifferentiated forms, usually of a high degree of malignancy.

Risk factors

Modern medicine singles out several main reasons that provoke the development of kidney cancer:

• Genetic predisposition – in the course of numerous studies, specialists have discovered certain mutations in the genes of people who have had cancer. In addition, kidney cancer can be inherited.
• Kidney diseases – the formation of a malignant tumor in the organ can also be associated with chronic renal failure, the presence of cysts in the organ, and nephrosclerosis. A number of diseases that increase the risk of developing pathology in the kidney also include diabetes and pyelonephritis.
• Lifestyle – smoking and obesity – problems that everyone has heard about for a long time. But few people think that both factors can provoke serious pathological processes in the body. Kidney cancer is one of them. Abuse of analgesics and diuretics, uncontrolled use of hormonal drugs can also be attributed to risk factors.
• External factors are carcinogens and radiation exposure. Frequent contact with nitrates, dust, asbestos can lead to sad consequences.
• Injuries to the organ – previous kidney injuries increase the risk of pathological tissue formation on the organ.

Important. Despite the differences in the structure of the genitourinary system, the causes of kidney cancer in men and women are identical.

Surgical treatment of kidney cancer — clinic of progressive medicine AVICENNA MED.

Kidney cancer – symptoms and signs

In the early stage, kidney cancer usually does not show any symptoms and is very often diagnosed by chance when the patient undergoes an examination of the abdominal organs on a computer tomography or during an ultrasound examination.

When the cancer progresses or metastasizes (spreads beyond the kidney), a certain range of symptoms appears: pain in the side or back above the lumbar region and is felt as pain “in the depths”. This pain differs from superficial pains associated with muscles or damage to the intervertebral discs in the lower thoracic or lumbar region of the spine by its depth of origin, constant nature (not “shooting”), varying intensity (from slight to moderate or severe pain).

Visually appears blood in the urine (pink or red coloration of the urine, the appearance of blood streaks in the urine).
In some cases, kidney cancer can cause other systemic disorders remotely related to the primary tumor: night sweats, recurrent fever (increase in body temperature above 380C several times a day), weight loss, high blood pressure (BP more than 135-140/ 90 mm Hg), the appearance of anemia (paleness of the skin and mucous membranes, according to the general blood test – a decrease in hemoglobin less than 100-110 g/l, an increase in the sedimentation rate of erythrocytes – more than 20 mm/h), changes in the biochemical blood analysis in the form of increase in liver enzymes.

The following symptoms should look suspicious:

• Blood in the urine (hematuria) – traces of blood in the urine may appear for a short period of time and then disappear, but heavy bleeding may also develop, leading to anemia and low hemoglobin.
• Unexplained hypertension is an increase in blood pressure.
• Painful sensations in the area of the kidneys are caused by the growing tumor tissue, which puts pressure on the nearby nerve endings.
• Swelling in the lower back region, which can be felt during palpation, can be detected by the patient on his own (a person with a thin body, an overweight person is more likely not to feel the neoplasm through the fat layer).
• General symptoms of cancer — deterioration of well-being, general weakness, loss of appetite, low-grade fever, weight loss.

Kidney cancer is diagnosed on average at the age of 54. Men are twice as likely to be affected as women. If you experience any of the above symptoms and you are over 50 years old, come to our clinic for an ultrasound examination of the organs of the abdominal cavity, pelvis and retroperitoneal space, followed by a free consultation.

Kidney cancer treatment methods

Surgical

The main and most effective method of fighting kidney cancer. Even the presence of single metastasizing elements is not a contraindication for surgery. The type of surgical intervention is selected based on the specifics of the development of the pathology in each individual case.

1. Partial nephrectomy — involves removal of the affected part of the organ with coverage of a sufficient number of surrounding tissue tumors. This is the simplest type of operation that allows you to preserve the functionality of the kidney.
2. Nephrectomy is the removal of the organ completely by the tumor.
3. Radical nephrectomy — in addition to the kidney, the adrenal gland is removed, it is also possible to remove lymph nodes.

A practical case of an operation – laparoscopic resection of the right kidney</a >

Radiation, hormonal therapy and chemotherapy

Such treatment methods are used selectively for appropriate indications. Radiotherapy and polychemotherapy are relevant only as palliative methods (which ease the course of the disease in inoperable patients). Immunotherapy with a monoclonal antibody – nivolumab gives a positive result only in the treatment of clear cell metastatic renal cell cancer and is used to a limited extent in the form of an expensive drug.

Disease prevention

The main prevention of the development of kidney cancer is the rejection of bad habits, as well as the exclusion of contact with chemicals such as asbestos, cadmium and others. The presence of chronic kidney diseases is also not a sentence and should be monitored by the patient himself in the form of preventive examinations.