Kidney cancer: symptoms, causes and treatment

Definition

What is kidney cancer?

Kidney cancer is cancer that starts in the kidneys. The kidneys themselves are two organs of the urinary tract, shaped like a fist-sized bean.

Its function is to produce urine by removing waste products from digestion of food and excess fluid from your blood. In addition, this organ is also responsible for controlling blood pressure and ensuring that the body has enough red blood cells by making the hormones renin and erythropoietin.

Cancer that attacks the kidneys is divided into several types, namely:

• Renal cell carcinoma: The most common type of kidney cancer in adults. Abnormal cells usually begin to grow in the kidney characterized by 2 or more tumors in one or both pairs of kidneys simultaneously.
• Clear kidney cell carcinoma: This type of cancer is quite common and when seen in the laboratory, the abnormal cells appear clear and pale.
• Non-clear kidney cell carcinoma: This type of cancer is divided into capillary renal cell carcinoma (cancer of the capillary shaped like a finger), chromophobic renal cell carcinoma and rare types such as medullary carcinoma, spindle cell carcinoma, and tubular carcinoma.
• Wilms' tumor (nephroblastoma): This type of cancer is common in children aged 3-4 years.
• Other types of cancer: Other types of cancer that are quite rare include transitional cell carcinoma (the lining where the urethra meets the kidneys) and kidney sarcoma (blood vessel or kidney connective tissue).

How common is this cancer?

This cancer, including cancer can occur in children and adults. It's just that in adults, the most common type of cancer is renal cell carcinoma, while in children it is Wilms' tumor type.

Based on 2018 Globocan data, the number of new cases of this cancer in Indonesia is 2112 people with a death rate of 1225 people.

Signs & symptoms

What are the signs and symptoms of kidney cancer?

In the early stages, this cancer generally does not cause any characteristics. Symptoms will appear when the cancer has entered an advanced stage.

Symptoms of this type of cancer that are commonly experienced by adults are:

• There is blood in the urine (hematuria).
• Lower back pain on one side.
• There is a lump on the lower back or side back.
• Weight loss for no apparent reason and poor appetite.
• Fever that doesn't go away.
• Anemia (low red blood cell count).

Meanwhile, Wilms' tumor type kidney cancer in children causes other symptoms, such as:

• There is swelling in the stomach accompanied by pain.
• Experiencing nausea, vomiting, or constipation.
• Shortness of breath and high blood pressure.

Everyone experiences symptoms differently, so there may be other symptoms not listed above.

When to see a doctor?

If you or your little one experiences the above symptoms and suspects them to be a sign of cancer, see a doctor immediately. Especially if the symptoms don't get better after weeks and you've been doing simple treatments.

Cause

What causes kidney cancer?

In many cases, the cause of kidney cancer is not known with certainty. However, scientists believe that the cause of this cancer is related to DNA mutations in cells.

DNA itself contains a series of commands for cells to divide, grow, and die on a regular basis. When a mutation occurs, the order of the cell is damaged so that the cell functions abnormally. Cells will continue to divide uncontrollably and do not die. As a result, this condition will cause a buildup of cells and form tumors.

Gene mutations can also be inherited from parents and this is what scientists believe causes this type of cancer in children, namely Wilms disease; tumor.

One of them is the VHL gene, which is a gene that causes non-Hippel-Lindau disease (VHL). Gene mutations can cause abnormal cell growth so that this cancer is more likely to develop.

In addition to the VHL gene, there are also genes that are inherited from parents and are prone to mutations so that it can cause kidney cancer, such as:

• The FH gene causes fibroids in the skin and uterus.
• The FLCN gene can cause Birt-Hogg-Dube syndrome.
• The SDHB and SDHD genes are the cause of the high risk of developing this type of cancer in the family.

Risk factors

What increases the risk of kidney cancer?

Although the cause of this type of cancer is not known with certainty, scientists have found various factors that can increase the risk of this disease, including:

• Smoking habit

Cigarette smoke contains carcinogenic substances that can increase the risk of renal cell carcinoma. The risk is even greater if the bad habits last for years.

• Obesity

This overweight condition can increase the risk of renal cell carcinoma. Most likely this is caused by imbalanced hormone levels due to the body being overweight.

• Hypertension

People with hypertension are more likely to develop cancer of the bladder tract. The risk does not decrease, even if the person is taking blood pressure-lowering drugs.

• Heredity or genetics

A person who has a family member with this type of cancer has a higher risk of developing the same disease.

• Drugs and chemical exposure

Long-term use of pain relievers and exposure to trichlorethylene can increase the risk of renal cell carcinoma.

• History of kidney disease

People who have kidney disease and need dialysis have a higher risk of renal cell carcinoma.

Diagnosis & treatment

The information provided is not a substitute for medical advice. ALWAYS consult your doctor.

What are the usual tests to diagnose kidney cancer?

In order to make a diagnosis of cancer the doctor will ask you to undergo a series of medical tests, including:

• Physical examination.The doctor will look at your and your family's medical history as well as check for signs of changes in your body, such as a cancerous lump.
• Blood test. The recommended types of blood tests are the CBC (complete blood count) test to measure the number of blood cells and blood chemistry tests to see the levels of enzymes and calcium in the blood. Sometimes, a urine test is needed because of symptoms of bloody urine.
• Imaging test. In order to get the location of the tumor and determine its size, imaging tests are needed, ranging from ultrasound, chest X-rays, and angiography (X-rays of blood vessels).
• Kidney biopsy. The doctor may do a kidney biopsy, which is to take a small piece of abnormal tissue to see if it is cancerous or not.

What is the stage of kidney cancer?

The above health tests are not only done to confirm the diagnosis, but also help determine the stage of the cancer. The stages of kidney cancer range from stage 1 (early), 2, 3, to 4 (advanced).

In the results of the test report, usually the stage number will be completed with the TNM system (tumors, lymph nodes, and metastases). This system indicates how large the tumor is, how many lymph nodes are affected, and how far they have spread.

Here are some examples of the results of a cancer stage diagnosis:

• Stage 1 T1 N0 M0: tumor size 7 or smaller, present only in the kidney.
• Stadium 2 T2 N0 Mo: tumor larger than 7 cm but still in the kidney.
• Stage 3 T1-T3 N1 Mo: the tumor is larger, may be outside the kidney, and has spread to nearby lymph nodes.
• Stadium 4 T4 any N Mo: tumor has grown out of the kidney right into the adrenal glands, may or may not have spread to nearby lymph nodes.

Understanding the results of the diagnosis is not easy, so don't hesitate to ask further questions from the doctor who treats your condition.

What are the treatment options for kidney cancer?

So that the cancer does not get worse and does not spread, kidney cancer treatments that are usually done, include:

Operation

Surgery is the main kidney cancer treatment option. This medical procedure is called a nephrectomy and aims to remove tumors in the kidneys or cancer cells that may have spread to the surrounding area.

The surgeon can remove part of the kidney. Can also remove the entire kidney and adrenal glands, fat tissue, and lymph nodes that have been affected by cancer. This patient will live with only one kidney.

This cancer surgery can cause side effects, such as bleeding, infection, blood clots, and kidney failure.

Radiotherapy

Radiotherapy relies on radiation to shrink tumors as well as kill cancer cells. This treatment is an option if a person does not allow surgery.

However, radiotherapy but can cause side effects, such as burns, nausea and vomiting, and body fatigue.

Targeted therapy

Targeted therapy uses drugs that work to directly target cancer cells so they don't develop and die.

Some of the drugs used in targeted therapy to treat kidney cancer are sunitinib, sorafenib, pazopanib, cabozantinib, lenvatinib, bevacizumab, axitinib, and temsirolimus.

Side effects that may occur due to targeted therapy are hypertension, blood clots, liver problems, and high cholesterol.

Chemotherapy

Kidney cancer usually does not respond well to drugs used during chemotherapy. Therefore, chemotherapy is used as an adjunct treatment once the patient has undergone targeted therapy.

Some chemotherapy drugs for kidney cancer, such as cisplatin, 5-fluorouracil (5-FU), and gemcitabine have been shown to help some patients. The side effects of this treatment are hair loss, nausea and vomiting, and diarrhea.

Home remedies

What are some lifestyle changes or home remedies that can be done to treat kidney cancer?

Apart from treatment, a healthy lifestyle that is suitable for cancer patients must also be applied. The goal is to support the effectiveness of the treatment as well as to support the patient's overall health.

2011 study in the journal Pharmacognosy magazinementioned that honey has the potential as a kidney cancer herbal medicine because it can stimulate cell apoptosis (death of cancer cells). Even so, the consumption of honey which is safe for cancer patients must still be supervised by a doctor.

Prevention

Knowing the causes of kidney cancer can help prevent the disease from developing. Unfortunately, in some cases the cause is not known with certainty.

If the cause of cancer leads to a gene mutation that is inherited from the parents, then this cannot be prevented. However, scientists say that this cancer prevention measure can be done by reducing the risk, such as:

• Stop smoking and stay away from secondhand smoke.
• Change your diet and stay active so that your weight is controlled. Increase consumption of vegetables and fruit and do regular exercise.
• Avoid exposure to hazardous substances such as trichlorethylene in the workplace.
• Further consultation with your doctor if you are indeed a risk group.