Kidney cancer

DR SATYENDRA PERSAUD

Over the last few months we have discussed various genitourinary cancers so I thought that today we should consider talking about kidney cancer which is not uncommon in TT. This cancer is also called renal cell cancer.

What causes renal cell cancer?

Well, most cases happen spontaneously. A few cases are genetic, meaning they run in families or occur as a result of mutations (changes) in genes. There are a number of risk factors including smoking, obesity, high blood pressure, genetics, advanced kidney disease and certain chemicals. The most common age of presentation is 60-70 years old.

What are the symptoms of kidney cancer?

Often, kidney cancer shows no signs or symptoms and is fact picked up while investigating for something else. Other symptoms include a mass in the side, blood in the urine or pain in the side. The patient may also have fever, anaemia and weight loss.

How is kidney cancer diagnosed?

If kidney cancer is suspected, you will require imaging in the form of a CT scan or MRI to look at the nature of the cancer and to determine whether there is spread – this is called staging. You will also require imaging of the chest. A number of blood tests, including kidney and liver function will also be requested. Usually, the doctor can confidently tell that this is kidney cancer from its appearance on imaging tests. However, in rare instances a biopsy (taking a small sample with a needle) may be necessary and this will be discussed with you.

How is kidney cancer treated?

One option in small tumours and especially in poor surgical candidates is to do nothing and to keep an eye on the mass with repeat CT scans. There is a small chance that the mass may spread outside the kidney during this time and so this is not suitable for everyone.

The mainstay of treatment is surgery. Removal of the kidney is called nephrectomy and this is the most common operation performed for kidney cancer. It may be done with a cut or via keyhole surgery. Keyhole surgery has a faster recovery time for the patient. With smaller tumours, the preferred approach is to remove the tumour and spare the rest of the kidney – this is called partial nephrectomy. Not everyone is suitable for partial nephrectomy and your urologist will determine if this is an option for you.

In some places, smaller tumours are destroyed by cold (cryoablation) or by heat (radio frequency ablation). Again, this is not suitable for everyone and should be discussed with your urologist.

What if the cancer has spread?

Your urologist will discuss your case with a radiologist and oncologist (cancer specialist) and determine your best options. What happens next will depend on several factors including how extensive spread is, the type of tumour and your overall health as well as your blood test results. They may decide to remove the kidney still as this may have benefit in selected cases – this is called cytoreductive nephrectomy.

There are several drugs your doctors can choose from. Some use the immune system to fight the cancer and others block specific substances produced by the tumour which helps it to spread. Recently several drugs have been developed and this is good news for kidney cancer patients.

Satyendra Persaud MBBS DM (Urol) FCCS FRCS (Eng) lecturer in urology/DM urology co-ordinator University of the West Indies,

St Augustine, TT

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