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What is Kidney Cancer?
Fundamentals of Pathophysiology
Professor Michael Huwe
By: Debora Collard
Kidney Cancer is when malignant cells form is the tissue of the kidneys. Our kidneys perform many life-sustaining roles. They keep our blood clean of wastes and excess fluid, maintain our balance of salt and minerals, regulate our blood pressure, produce renin, erythropoietin, and vitamin D for good bone health. If cancer forms in our kidneys it can also spread to other parts of our body. It is very important that we be aware of any changes in our kidneys so that we may catch this at an early stage. In this paper I hope to explain the different types of kidney cancer, understanding the risk factors, how to diagnose kidney cancer and how it is staged, treatment options and survival rates and prognosis for the disease. My father had a kidney removed with kidney cancer when I was young and I wanted to learn if I might also be at risk and if so what I need to do.
Renal Cell Carcinoma
Renal cell carcinoma (RCC) is the most common type of Kidney cancer. Malignant cells begin to develop in the lining of tubules in the kidneys, which them becomes a tumor. Like all tumors it will begin small and after a period of time it will become large, but is usually only one single mass. There have been cases where the kidney contains more than one tumor and both kidneys contain a mass. There are five subtypes of renal cell carcinoma
?Clear cell which is about 80% of RCC is where the epithelial tumors cells are pale or transparent when you look at them under a microscope.
?Papillary RCC have a distinct growth pattern of finger-like projections throughout the tumor. Some clear cell RCC can have this similar pattern, but cannot be diagnosed as papillary RCC because of other technical criteria.
?Chromophobe RCC is like clear cell, but the tumor cells have transparent cytoplasm, and have larger cells, making them look unique under a microscope.
?Collecting Duct Carcinoma (CDC) is very rare and is only about 1% of kidney cancers. It is a very fast growing cancer that develops in the distal collecting tubules, and it does not respond well to systemic therapy.

? Unclassified RCC is very rare and is not easily classified. It is a type of cancer that does not fit into any of the above listed types.
Other Cancerous Kidney Tumors
There are three types of other cancerous tumors; Transitional cell carcinoma, Wilms tumor and Renal sarcoma.

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?Transitional cell carcinoma is known as urothelial cancer or renal pelvis. This type of cancer does not start in the kidney, but begins in the renal pelvis. It is usually caused by smoking or being exposed to certain chemical in the workplace.
?Wilm?s Tumor only happens in children and are classified as favorable (usually can be cured) and unfavorable (harder to cure).
?Renal Sarcoma is a rare type of cancers that develops in the blood vessels or connective tissue of the kidney and is also known as soft tissue cancer. These account for less than 1% of cancers.
Having a healthy lifestyle will decrease your change of getting kidney cancer. If you smoke you are increasing your chance of kidney cancer because smoking makes your arteries harden and narrows your blood vessels. This decreases the amount of blood that flows to your kidneys and keeps them from working as well. Smoking can also cause you to have high blood pressure, and this only makes it worse. If you have diabetes and you smoke you are doubling your chance of kidney cancer, because these cause you to have kidney problems even sooner.
There are many thing in our environment that are not good for our body such as; Asbestos, Benzene and solvents, Cadmium (used in making batteries, plastic and other industrial items) and herbicides.
Health Factors
Obesity is a cause of Kidney Cancer, because it can cause you to have high blood pressure and diabetes. If you have a family history of Kidney Cancer you should be very careful and have regular checkups.
Other Factors
A person?s age, gender, diet and if you have long-term dialysis also affect the chance of developing Kidney Cancer. A diet high in fat can also play a part in developing Kidney Cancer, because they run the risk of becoming obese. Men and women over the age of 50 may be at a high risk, but men are usually higher than women.
If you have a change in urination such as; need to urinate at night, frothy or bubbly urine, urinating more often with pale urine, urinating less often with dark color, blood in the urine and pressure or difficulty urinating, swelling of the legs, ankles, feet face and/or hands, fatigue, skin rash/itching, Ammonia breath or metallic taste in your mouth, nausea/vomiting, shortness of breath, cold feeling, dizziness or trouble concentrating, leg and side pain. If you are having many or all of these you should see a doctor.

Diagnostic Tests
?An ultrasound examination can be used and this is where sound waves are transmitted into your body and reflected back to a transducer to give an image of your kidneys.
?Positron Emission Tomography (PET) produces 3D images of activity in the tissues. Computerized tomography (CT) transmits x-rays through your body enabling a doctor to see cross-sectional images of your kidneys. When these two images are combined together a physician can see abnormal activity and see exactly where it is taking place.
?Magnetic resonance imaging (MRI) uses magnetic fields and radio waves to produce cross-sectional views of the kidneys.

?Core Needle Biopsy or Fine Needle Aspiration Biopsy this is where a needle is inserted into the suspected tumor and a sample of tissue is taken, it is then examined under a microscope for diagnosis and staging.
?BUN and creatinine are measured to see if the disease is getting worse
?Calcium, Phosphorus and electrolytes are measured, because they are affected by kidney disease.

?Hemoglobin is measured because the kidneys produce a hormone called erythropoietin, which controls red blood cell production.
?Urine total protein (TP) is used to test the affect of treatment in diabetes.
?Parathyroid hormone (PTH) controls the calcium level and is checked to see if enough vitamin D and calcium are being taken in so as to prevent bone damage.
Once you have been diagnosed with Kidney Cancer it is assessed with a staging process. In early stages it is usually small tumors that have remained in the point of origin. In advanced stages it has spread to other organs.

TNM System
?TNM System ? The American Joint Commission on Cancer?s (AJCC) uses a system with three components. T ? stands for tumor and they are rated on a scale of 0-4 and T0 means no evidence of a primary tumor. N ? stands for node and is used if cancer is found in the lymph nodes. The number of cells found are rated using N1 or N2 and N0 if no lymph nodes are affected. M ? stands for metastasized and is indicated by M1, M0 is used is it has not metastasized.
Kidney Cancer Staging Group
?Stage I Kidney Cancer is less than 7cm across and still limited to the kidney (T1,N0, M0)
?Stage II Kidney Cancer is larger than 7cm but still remains in the kidney and has not spread to the lymph nodes or other sites. (T2, N0, M0)
?Stage III Kidney Cancer has grown beyond the kidney and maybe in the adrenal glands, nearby tissues or other organs. It may or may not be in the lymph nodes. (T1, N1, M0)
?Stage IV Kidney Cancer has grown beyond the kidney and may be any size. It can be in the lymph nodes and other sites such as; liver, lung or bladder. (Any T, Any N, M1)
Surgery is the main treatment for Kidney Cancer and your chances of surving without surgery are very small. Even if the cancer has spread to other organs it is beneficial to have the kidney removed. It will depend on how much it has spread as to how much will be taken out along with surrounding tissue and even the adrenal gland. There are many types of surgery: Radical nephrectomy, Laproscopic nephrectomy, Partial nephrectomy, Regional Lymphadenectomy, Removal of adrenal gland and removal of the metastases.
In radiation therapy they use high energy radiation to kill the cancer cells. The procedure is painless and is like getting an x-ray, but much more intense. Radiation therapy is not of much use as kidney cancer is very sensitive to radiation. It is used more as palliative for people who are too sick to have surgery, and to help reduce the symptoms. Radiation can cause you to feel like you are sunburned on the skin and you can have nausea, diarrhea, tiredness and hair loss. All of these symptoms go away after a period of time, but it can also increase side effects from other medications and treatments.

Chemotherapy is anti-cancer drugs that are given orally or by IV and are used to kill cancer that has metastasized to other organs. These drugs attack cells that are dividing quickly which is what cancer cells do, but we also have cells in our body that divide quickly and chemotherapy affects them also. Some of the side effects of chemotherapy are: nausea/vomiting, loss of appetite, hair loss, sores in the mouth, increased chance of infections, fatigue and bruising easily. These side effects usually go away after treatment and medications can be given during treatment to ease the severity.
By stage
?Stage I the prognosis is good due to a complete resection of cancer is possible.
?Stage II 65%-75% for five years.
?Stage III 40%-70% due to spreading to lymph nodes.
?Stage IV If it has metastasized it is barely 5%
By size of tumor
?Less than 4cm 90%-95%.
?Large tumor 80%-85%
?Larger and has spread 5%-15%
American Cancer Society, Learn about Cancer, Kidney Cancer (Adult) – Renal Cell Carcinoma,
Mayo Clinic, Polycystic Kidney Disease,
Cancer Treatment Centers of America, Kidney Cancer Risk Factors,
Cancer Treatment Centers of America, Kidney Cancer Diagnosis and Detection,
WebMD, Information and Resources, Understanding Kidney Disease ? the Basics,


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