How Common Is Kidney Cancer
Each year an estimated 75,000 patients are found with a kidney tumor. Approximately 65,000 of these are ultimately found to be renal cell carcinoma .
The most common type is clear cell carcinoma. Renal cell cancer is not one disease but rather a collection of 15-20 types of renal tumors that can arise from the kidney. Kidney cancer is among the 10 most common cancers in both men and women, and the risk for developing kidney cancer is higher in men than in women.;More information about kidney cancer risk factors;>
Molecular Basis Of Clear Cell Rcc
Recent advances in the understanding of cancer as a genetic disease have allowed the identification of clonal genetic and epigenetic alterations, which accumulate during cancer progression, often in a general temporal order. However, relatively little is known about the secondary and later genetic alterations which drive progression after the initiating event of inactivation of VHL in clear cell RCC. Even less is known about the alterations that underlie the initiation and progression of sporadic papillary or chromophobe RCC, or the importance of different tumor suppressor and signaling pathways in renal cancer. It remains that much of what we know of the molecular basis of sporadic RCC arose from identification of the genes predisposing to inherited RCC .
With the exception of VHL, all these tumor suppressor genes appear to be inactivated in a minority of RCC, Indeed the number with clear evidence of inactivation of the retained allele by point mutation, homozygous deletion or hypermethylation is substantially less than the number with LOH. This may simply be due to not looking hard enough. The case of germline mutation of VHL is instructive because as investigators searched deeper for the second mutation, more were found . The target suppressor gene on several of the more frequently deleted chromosomal arms e.g. 6q, 8p or 14q in RCC have not yet been identified. Subtyping of RCC by tumor suppressor inactivation may prove important for prognostic stratification.
Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.
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Assessing The Extent And Spread
If you are found to have a kidney cancer then other tests are likely to be advised. These may include one or more of: a CT scan or magnetic resonance imaging scan of the abdomen and chest, a chest X-ray, kidney function blood tests;and sometimes other tests. This assessment is called staging of the cancer.
The aim of staging is to find out:
- How much the tumour in the kidney has grown and whether it has grown to the edge, or through the outer part of the kidney.
- Whether the cancer has spread to local lymph glands .
- Whether the cancer has spread to other areas of the body .
Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook . See the separate leaflet called Stages of Cancer for more details.
Foods High In Phosphorous
Phosphorousis a chemical element necessary for maintaining bone strength. But in people with kidney cancer, it may build up in your bloodstream and cause symptoms like itchiness and joint pain.
If youre struggling with these symptoms, you may want to reduce your intake of high-phosphorus foods like:
- seeds
- processed bran cereals
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Rcc In End Stage Renal Disease Patients
The benefit of early detection of RCC in ESRD would be that the RCC would be less likely metastatic and hence ultimately fatal. ESRD patients are not routinely scanned for RCC unless there are other issues. Transplantation also carries an increased risk for kidney cancer ; this is estimated to be 15-fold over the first three years following transplantation, and this risk increases with extent of exposure to immunosuppressive agents . The prevalence of RCC in native kidneys after transplantation is around 5% overall but 19% in ACKD patients or 54% in patients with complex cysts . The life expectancy of a transplant recipient has improved and cancer may soon be the leading cause of death late after transplantation. A marker of aggressiveness of RCC developing after transplantation could also aid in establishing priority for transplantation.
What Do Kidneys Do
A large renal artery takes blood to each kidney. The artery divides into many tiny blood vessels throughout the kidney. Tiny structures in the kidneys, called nephrons, filter the blood contained in the capillaries. Water and waste materials which filter through the walls of the capillaries into the nephrons form urine.
Urine passes along thin channels which are part of each nephron, into larger channels which drain the urine into the inner part of the kidney .
Urine passes down a tube called a ureter which goes from each kidney to the bladder.
Urine is stored in the bladder until it is passed out through the tube called the urethra when we go to the toilet.
The cleaned blood from each kidney collects into a large renal vein which takes the blood back towards the heart.
Some specialised cells in the kidneys also make some hormones, including:
- Renin – which helps to regulate blood pressure.
- Erythropoietin – which helps to stimulate the bone marrow to make red blood cells.
- Calcitriol – which helps to regulate the calcium level in the blood.
Although it is normal to have two kidneys, we can live perfectly well with just one healthy kidney.;
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Signs And Symptoms Of Kidney Cancer
Though renal and transitional cancer types affect the kidney in slightly different ways, the signs and symptoms are largely the same. In addition, kidney cancer often doesnât show any obvious signs, especially in the early stages. Plus, many possible kidney cancer symptoms, like blood in the urine, can also result from less serious illnesses, like a bladder infection or kidney stones.
But itâs a good idea to talk to your doctor if you notice:
- Blood in your pee
- Lower back or belly pain with no clear cause
- A fever that doesnât go away and has no obvious cause
- Youâre more tired than normal
- You arenât as hungry or donât eat as much
- Youâve lost weight without trying
- A lump on your lower back, side, or belly
Because kidney cancer sometimes has no early symptoms, the first sign might not show up until after the cancer has spread.
It can go almost anywhere in your body, and symptoms depend on the location. It might show up as a skin lesion. Or, if it spreads to a lung, you might cough up blood. If it reaches your brain, you might have balance or vision problems, among other symptoms in your nervous system.
Regular checkups can help catch early warning signs so that you and your doctor can create a treatment plan.
Urology Care Foundation: âKidney Cancer?â
American Cancer Society: âKidney Cancer,â âKidney Cancer Signs and Symptoms,â âWhat Is Kidney Cancer?â
Cleveland Clinic: âKidney Cancer Overview.â
Signs Of Renal Cell Cancer Include Blood In The Urine And A Lump In The Abdomen
These and other signs and symptoms may be caused by renal cell cancer or by other conditions. There may be no signs or symptoms in the early stages. Signs and symptoms may appear as the tumor grows. Check with your doctor if you have any of the following:
- Blood in the urine.
- A lump in the abdomen.
- A pain in the side that doesn’t go away.
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Tumor Behavior And Prognostic Molecular Markers
The stage of the tumor, grade within stage, the histological cell type as well as clinical indications are used for prognosis of RCC. Identification of the molecular alterations that contribute to the variation in tumor behavior and clinical outcome within organ-confined, locally advanced, or metatstatic RCC is needed for improved management of RCC. Molecular markers can be incorporated into nomograms for counseling of patients and for patient stratification in clinical trials . The majority of studies have examined prognostic markers, e.g. carbonic anhydrase IX , almost exclusively by immunohistochemistry usually in the context of advanced RCC. Other markers investigated include p53, p21, Hif-1 and Survivin reviewed by Lam et al 2008 . Some global array studies have examined expression signatures of progression but in small numbers of organ-confined RCC and as part of a wider analysis . Even so, genes previously implicated in the progression of RCC were identified e.g. elevated expression of the Caveolin-1 gene previously implicated as an immunohistochemical marker for poor disease-free survival in non-metatstatic RCC .
What Are The Types Of Kidney Cancer
Renal Cell Carcinoma ;is the most common type of kidney cancer, accounting for approximately 85% of all malignant kidney tumors. In RCC, cancerous cells develop in the lining of the kidney tubules and grow into a mass called a tumor. Like many other cancers, the growth begins small and grows larger over time. RCC typically grows as a single mass. However, there are cases where a kidney may contain more than one tumor, or tumors are found in both kidneys at the same time.
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Reduce Your Risk Of Infection
Living with advanced RCC also puts you at a higher risk of infection. Cancer, as well as some cancer treatments, can weaken your immune system, reducing your number of disease-fighting white blood cells.
To avoid your risk of illness, talk to your doctor to see if youre a candidate for the flu vaccine or pneumonia vaccine.
Other simple measures can also help you stay healthy. For example, wash your hands frequently, especially when out in public and before eating.
Make a concerted effort to keep your hands away from your eyes, mouth, and nose. Limit contact with people who are sick. And if you cant avoid crowds during cold and flu season, wear a face mask.
Pain is another complication of advanced RCC. The best relief methods will depend on the severity of your pain, which might range from mild to severe.
Some people can manage their pain with over-the-counter medications such as acetaminophen and ibuprofen .
Sometimes, doctors have to prescribe stronger medications like oxycodone , fentanyl , or morphine. Pain medications are administered either orally or intravenously .
If pain medication alone doesnt work, your doctor might suggest a corticosteroid or antidepressant to help provide relief.
You can also try other complementary therapies to increase blood circulation and reduce inflammation or pain. Examples include:
- massage therapy
Collecting Duct And Other Rare Forms Of Rcc
Collecting duct RCC is a rare but highly aggressive tumor of the distal nephron that shows LOH of chromosome 1q, 6p, 8p, 13q and 21q . Mapping of chromosome 1q , 8p and 13q have narrowed down the region but not yet identified the target suppressor genes. Renal medullary carcinoma described in African-Americans and associated with sickle cell trait, mucinous tubulocystic RCC and other rare forms of RCC have been reviewed in Srigley and Delahunt 2009 .
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How Is Hprc Inherited
Normally, every cell has 2 copies of each gene: 1 inherited from the mother and 1 inherited from the father. HPRC follows an autosomal dominant inheritance pattern, in which inheriting 1 copy of the altered gene is sufficient to put the individual at risk for developing cancer. This means that a parent with a gene mutation may pass along a copy of their normal gene or a copy of the gene with the mutation. Therefore, a child who has a parent with a mutation has a 50% chance of inheriting that mutation. A brother, sister, or parent of a person who has a mutation also has a 50% chance of having the same mutation. However,;if the parents test negative for the mutation , the risk to the siblings significantly decreases but their risk may still be higher than an average risk.
Adjuvant And Neoadjuvant Therapy
Adjuvant therapy, which refers to therapy given after a primary surgery, has not been found to be beneficial in renal cell cancer. Conversely, neoadjuvant therapy is administered before the intended primary or main treatment. In some cases neoadjuvant therapy has been shown to decrease the size and stage of the RCC to then allow it to be surgically removed. This is a new form of treatment and the effectiveness of this approach is still being assessed in clinical trials.
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Taking Care Of Yourself
You can do things during and after your treatment to feel stronger physically and emotionally.
- Eat well. You need calories and nutrients to stay strong for treatment. If itâs hard for you to eat, try smaller meals every few hours instead of three big meals.
- Keep moving.Exercise is good for your body and your mind. Your treatment may leave you feeling tired, so be sure to balance activity with rest.
- Follow your treatment plan. Keep your doctor in the loop about any changes in how youâre feeling.
- Get support. Itâs important to take care of your emotional health, too. Trained counselors and support groups can offer safe places to talk about how you and your loved ones feel. Also, ask for help from family, friends, and members of your community.
Other Types Of Kidney Cancers
Other types of kidney cancers include transitional cell carcinomas, Wilms tumors, and renal sarcomas.
Transitional cell carcinoma: Of every 100 cancers in the kidney, about 5 to 10 are transitional cell carcinomas , also known as urothelial carcinomas.
Transitional cell carcinomas dont start in the kidney itself, but in the lining of the renal pelvis . This lining is made up of cells called transitional cells that look like the cells that line the ureters and bladder. Cancers that develop from these cells look like other urothelial carcinomas, such as bladder cancer, when looked at closely in the lab. Like bladder cancer, these cancers are often linked to cigarette smoking and being exposed to certain cancer-causing chemicals in the workplace.
People with TCC often have the same signs and symptoms as people with renal cell cancer blood in the urine and, sometimes, back pain.
For more information about transitional cell carcinoma, see Bladder Cancer.
Wilms tumor : Wilms tumors almost always occur in children. This type of cancer is very rare among adults. To learn more about this type of cancer, see Wilms Tumor.
Renal sarcoma: Renal sarcomas are a rare type of kidney cancer that begin in the blood vessels or connective tissue of the kidney. They make up less than 1% of all kidney cancers.
Sarcomas are discussed in more detail in Sarcoma- Adult Soft Tissue Cancer.
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How Renal Cell Carcinoma Spreads
Renal cell carcinoma can spread from the kidney to other areas of the body. It can enlarge within the kidney and grow into the adrenal glands, which are adjacent to the kidneys. Adrenal glands are small organs that make and release hormones. Each kidney has one adrenal gland located right above it.
Cancer cells can also enter into the bloodstream or the lymphatic vessels, spreading to other areas of the body. The cancer can then grow in other organs, such as the lungs, bones, or brain, causing serious harm to these areas.;
Questions To Ask Your Doctor
- What stage is my cancer? What does that mean for me?
- Do I need any more tests?
- Do I need to see any other doctors?
- Have you ever treated this kind of cancer before?
- What kinds of treatments are there? Which would you recommend?
- How will those treatments make me feel?
- When should I start treatment?
- How will we know if it works?
- What will my recovery be like?
- What would you expect for me?
- Are there any clinical trials I can sign up for?
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Early Stages Of Kidney Cancer
Once kidney cancer is confirmed, your medical team will determine the stage of the cancer. The stage is based on how much or how little the cancer has spread.
- Stage 1 means the cancer is only in the kidney, and the tumor is 7 centimeters long or smaller.
- Stage 2 means the cancer is still contained to the kidney, but the tumor is larger than 7 centimeters.
How Do I Manage Medication Side Effects
Its all about keeping an open line of communication with your doctor. Dr. Liu says that having your doctor explain the potential side effects up front allows you to be on the lookout so that if they happen, you can immediately let your doctor know. There are many ways to deal with side effects, including reducing the dose, putting the drug on a temporary pause, or use other drugs to manage immune-related side effects.
Dr. Liu adds: It is also important to have a multi-disciplinary team that specializes in immune-related side effects they can be very challenging to manage. So in addition to your oncologistyour lead cancer doc and the expert when it comes to managing severe immune side effectsyou might also have input from MDs who specialize in immunology, dermatology, infectious disease, and other subspecialties to help your oncologist treat your side effects.
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