Advances in Kidney Cancer Treatment: Everything You Need to Know
Renal cell cancer, or kidney cancer, is the abnormal growth of cells in your kidney tissue. These cells gather together into a mass known as a tumour. When a cell undergoes a transformation and starts to divide uncontrollably, renal cell carcinoma is the result. A malignant or cancerous tumour can spread to nearby tissues and crucial organs. Metastasis is the medical term for this. High blood pressure, blood in urination, and other symptoms are common in individuals with kidney cancer. Surgery, chemotherapy, and radiation therapy are all forms of kidney cancer treatment. Early diagnosis is essential for effective therapy, as it is with all malignancies.
- What are the signs and symptoms of kidney cancer?
During the initial phase, kidney cancer may not show any signs at all. But, when the tumour spreads, symptoms might start to show. Because of this, kidney cancer frequently isn't discovered until it begins to spread.
Symptoms of kidney carcinoma can include:
- Urine with blood in it or hematuria.
- A small tumour or lump around your kidneys.
- Leg ache.
- Tiredness.
- A feeling of being unwell.
- loss of appetite
- Loss of weight.
- A low fever.
- Muscle pain
- Elevated blood pressure.
- Anaemia.
- Excessive calcium.
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| Renal Cancer Treatment |
There are divergent types of kidney cancer, including:
- Renal cell carcinoma (RCC): RCC accounts for roughly 86% of adults and is prevalent. Renal cell carcinoma often manifests as a singular tumour in just one kidney and can affect both. Cancer first manifests in the lining cells of your kidney's tubules (tiny tubes that return nutrients and fluid to your blood). The most common renal cell carcinoma is clear cell RCC (ccRCC).
- Transitional cell cancer: 6% to 7% of all kidney malignancies are transitional cell carcinomas. Often, this cancer starts where your ureter joins the prime portion of your kidney. Your renal pelvis is this region. Transitional cell carcinoma can develop in the ureters or bladder.
- Renal sarcoma: About 1% of instances of kidney cancer are renal sarcoma, making it the least prevalent kind. If untreated, it can spread from your kidney connective tissues to adjacent organs and bones.
- Wilms tumour: The most typical kind of kidney cancer in children is a Wilms tumour. Nephrologists observe about 5% of kidney malignancies in Wilms tumours.
What are the best options for Renal cell carcinoma treatment?
- Treatment for renal cell carcinoma depends on the stage and extent of the cancer.
- Surgery is the primary treatment for localized renal cell carcinoma.
- Total nephrectomy (removal of the entire kidney) is the standard surgery for larger tumours. Nephrosurgeons perform Partial nephrectomy (removal of the tumour while preserving healthy kidney tissue)for smaller tumours.
- Advanced renal cell carcinoma may require systemic therapy, including immunotherapy and targeted therapy.
- Immunotherapy drugs stimulate the body's immune system to attack cancer cells, while targeted therapy drugs block the signalling pathways that allow cancer cells to grow and divide.
- Nephrosurgeons perform Radiation therapy to treat renal cell carcinoma, particularly for palliative care or when surgery is not feasible.
- Clinical trials are ongoing to explore new treatment options for renal cell carcinoma, and early detection and prompt treatment can lead to better outcomes and a higher chance of cure.
Immunotherapy is a cancer treatment that uses drugs to stimulate the immune system to fight cancer cells.
- Nephrologists use immunotherapeutics to treat advanced kidney cancer alone and with other treatments like targeted therapy.
- The most common chemoprevention for kidney cancer is checkpoint inhibitors, which block proteins that prevent the immune system from attacking cancer cells.
- Checkpoint inhibitors used for kidney cancer include nivolumab, pembrolizumab, and avelumab.
- Immunotherapy can have side effects, including fatigue, skin rash, diarrhoea, and inflammation of the lungs, liver, or other organs.
- Doctors manage the side effects of anti-angiogenic with medications or other treatments, and most are reversible.
- Immunotherapy can be an effective treatment for some patients with advanced kidney cancer, and clinical trials are ongoing to explore new approaches to radioimmunotherapy for this disease.
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| Happy patient after kidney cancer treatment |
- Nephrectomy is a surgical procedure to remove all or part of a kidney.
- Nephrosurgeons perform nephrectomy to treat kidney cancer and other conditions like kidney damage, infections, or tumours that are not cancerous.
- There are two types of nephrectomy: partial nephrectomy (removal of only the tumour and a small margin of healthy tissue) and radical nephrectomy (removal of the entire kidney, nearby lymph nodes, and sometimes surrounding tissue or organs).
- Laparoscopic or robotic-assisted nephrectomy is a minimally invasive surgery that uses small incisions and a camera to remove the kidney, which can lead to faster recovery and less scarring than traditional open surgery.
- Nephrectomy is a surgery that carries risks, including bleeding, infection, and damage to nearby organs.
- After a nephrectomy, patients may need to stay in the hospital for a few days and experience pain or discomfort. Doctors manage it with medication.
- Depending on the extent of the surgery, patients may also need to avoid heavy lifting or strenuous activity for several weeks or months. It requires follow-up monitoring to ensure the remaining kidney is functioning properly.
Targeted therapy is a type of cancer treatment that uses drugs to block specific molecules or signalling pathways involved in the growth and spread of cancer cells. Targeted therapy drugs for kidney cancer minimize damage to normal cells while targeting cancer cells.
Targeted therapy for kidney cancer can include drugs like:
- Tyrosine kinase inhibitors (TKIs) block proteins called tyrosine kinases that are involved in the growth and spread of cancer cells. TKIs used for kidney cancer include sunitinib, pazopanib, axitinib, and cabozantinib.
- mTOR inhibitors block a protein called mTOR involved in cell growth and division. mTOR inhibitors used for kidney cancer include everolimus and temsirolimus.
Doctors use targeted therapy drugs orally or intravenously and may be used alone or in combination with other treatments like immunotherapy or chemotherapy. Side effects of targeted therapy can include fatigue, nausea, diarrhoea, high blood pressure, and skin rash. Surgeons control most side effects with medication or other treatments, and they may be reversible.
Overall, targeted therapy is an effective treatment option for some patients with advanced kidney cancer, and ongoing research is exploring new targeted therapies and combinations of treatments to improve results.
Advanced kidney cancer is typically associated with bloody urine, weight loss, and loin ache. CT scan is the diagnostic test of choice, and a biopsy is unnecessary to confirm cancer. With the increasing use of ultrasound screening, doctors can detect early small cancers more frequently. The standard surgery for kidney cancer is total nephrectomy. A partial nephrectomy is an option for small tumours less than 4 cm in size, providing the same cure rate while preserving more of the kidney to avoid kidney failure in later years. Laparoscopic partial nephrectomy is technically challenging but feasible with the da Vinci robot.
Kidney cancer staging describes how advanced the cancer is and how far it has spread within the body.
- Various factors determine staging, including the size and location of the tumour, whether it has spread to nearby lymph nodes or organs, and whether it has metastasized (spread) to other parts of the body.
- Nephrologists use the frequent staging system for kidney cancer as the TNM system, which stands for tumour size, lymph node involvement, and distant metastasis.
- The TNM system is divided into stages I through IV, with stage, I being the earliest and stage IV being the most advanced.
- Stage I kidney cancer is typically a small tumour confined to the kidney and has not spread to nearby lymph nodes or distant sites.
- Stage II kidney cancer is a substantial tumour that may have grown into nearby tissues but has not spread to nearby lymph nodes or distant sites.
- Stage III kidney cancer may be a smaller tumour that has spread to nearby lymph nodes or an enormous tumour that has grown into nearby blood vessels or other tissues.
- Stage IV kidney cancer has metastasized to other parts of the organs, such as the lungs, bones, or brain.
- The stage of kidney cancer helps guide treatment decisions and can provide information about prognosis and survival rates.
It is imperative to detect kidney cancer at Stage 1 because this gives the most favourable prognosis. It would be even better if the detected tumour when is small (less than 4 cm in size) because a partial nephrectomy may still be possible. This approach spares as much of the kidney as possible, reducing the risk of kidney failure later in life. Robotic-assisted laparoscopy is the choice because it allows for precise, minimally invasive surgery that can reduce recovery time. The goal of minimizing ischemia time during surgery is to reduce the risk of damage to the kidney tissue due to a lack of oxygen. While it is vital to keep ischemia time as short as possible, the duration may vary depending on the individual patient's needs and the specifics of their surgery.
@kishor deo (Pune)
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