Kidney cancer or renal cell carcinoma - an oncological disease that most often affects people in the age range of 55 to 60 years. Among all malignant neoplasms, according to the level of morbidity, this disease ranks tenth.
Unambiguous answers to the question of the causes of this oncological disease to date, no. There was a suggestion that people involved in the production of aniline dyes (with their production of carcinogens) are at a much higher risk of developing this disease. These same carcinogens are considered as a trigger for the development of bladder cancer. High-risk patients include patients with Hipple-Lindau disease, people with acquired cysts, polycystic ovary and horseshoe-shaped kidneys.
The main factors contributing to the development of kidney cancer include:
- Age and gender. In men, this pathology is observed twice as often, and the incidence reaches its maximum by seventy years.
Adiposity. As a result of numerous studies, it was confirmed that excessive body weight affects the possible development of kidney cancer.
- Smoking. Smoking tobacco is a proven risk factor for the development of all malignant neoplasms. In smokers (both men and women), the risk of developing kidney tumors, as compared with non-smokers, increases from 30 to 60%.
- Arterial hypertension.
- Kidney disease. There was a marked increase in the risk of renal cell carcinoma in patients with a terminal stage of chronic renal insufficiency (chronic renal insufficiency).
- Diuretic drugs. Some researchers associate the oncology with the use of diuretic drugs.
- Diabetes. There was an increase in the incidence of kidney cancer in people with diabetes.
- Food. According to most researchers, the use of fruits and vegetables significantly reduces the risk of developing this malignant tumor.
Kidney cancer metastasizes with lymphogenous and hematogenous pathways. At the time of diagnosis, every fourth patient is diagnosed with metastases. The life span of such patients is no more than one year and only about ten percent are experiencing two years. Somewhere in 30-50% of patients, after a nephrectomy, metachronous metastases develop. The prognosis in such patients is slightly better, but their five-year survival does not exceed nine percent.
The most common sites of localization of metastases are: the brain, adrenal glands, contralateral kidney, liver, lymph nodes, bones, lungs.
Types of kidney cancer
The most common type of malignant neoplasm is renal cell carcinoma or renal cell carcinoma, which affects the part of the kidney, which is called renal parenchyma.
Transient-cell kidney cancer in most cases captures the part of the kidney, which is called renal pelvis.
The most common form of cancerous kidney damage in children is the Williams tumor that affects the entire kidney.
In the initial stages, the disease proceeds asymptomatic and turns out to be completely accidental in a computer or ultrasound examination of the presence of other diseases. As a result, the classic triad of symptoms, which is described in patients with kidney cancer (palpated tumor, blood in the urine, pain in the lumbar region), is today extremely rare.
The most common symptom is blood in the urine (hematuria), which appears constantly or periodically and with massive bleeding can manifest itself in the form of bumps. When squeezing or germination of the tumor surrounding the tissues and in the renal colic there are pain in the abdomen and lower back. The presence of acute pain may be due to hemorrhage in the tumor or as a result of its rupture with subsequent formation of retroperitoneal hematoma. The third local symptom of kidney cancer is a tumor that can be blurred (at the time of diagnosis there is one in every sixth patient).
In the later stages of the disease, the tumor begins to lacerate through the anterior abdominal wall, dilated subcutaneous veins of the abdomen, swelling of the legs appear, men develop veins of the spermatic cord (varicocele), there is thrombosis of the veins of the lower extremities, weakness, loss of appetite and weight loss.
Stages of kidney cancer
Stage 1 - the tumor does not extend beyond the kidneys.
Stage 2 - the tumor remains within the renal fascia, but germinate the renal capsule.
Stage 3 - the tumor metastasizes to the lymph nodes of the renal sinus, or sprouts the lower hollow or renal veins.
Stage 4 - The tumor has distant metastases or sprouts adjacent organs (except the adrenal glands).
In the case of the appearance of blood in the urine, an urgent consultation of the urologist is required, which will require the conduct of the examination in these cases (ultrasound examination of the genitourinary organs, urine and blood tests).
Ultrasound (kidney ultrasound) is a primary method of examination in the presence of macrogemetery. Very often the malignant neoplasm of the kidneys is detected precisely in this study, which is carried out for another disease. Significant disadvantages of ultrasound are the dependence of the results obtained on the qualifications of the doctor and the lack of visualization in people with excessive body weight. When detecting small in size (up to three centimeters) of tumors, there are also some difficulties.
In the case of suspicion of the presence of human kidney neoplasms, an additional examination is indicated.
Excretory urography (after the introduction of intravenous contrast agent X-ray examination) is used to evaluate the function of the kidneys and to diagnose possible tumors. After the appearance of magnetic resonance and computer tomography, the value of this research has decreased significantly, as new diagnostic methods can detect kidney tumor almost any size, set its prevalence and function of healthy and diseased kidneys.
A prerequisite for the examination of a patient suspected of having a cancer of the kidney is the conduct of radiography of the chest, pelvic bones and lungs. In the event of a suspicion of metastatic bone defeat, radionuclide bone scan is indicated, which makes it possible to clarify the presence of metastatic lesions.
The differential diagnosis spend with inflammatory infiltrates (abscess, pyelonephritis), benign tumors (onkotsytoma, anhaomiolipoma, adenoma), cysts, primary malignant tumors of the kidney (nefroblastoma, lymphoma, sarcoma).
Treatment of kidney cancer
The most common method of treating kidney cancer is surgical intervention, which is carried out in all possible cases. The operation consists in removing the kidneys, the surrounding fatty tissue and the ureter (radical nephrectomy).
At present, organ-preserving operations with cancer of the kidneys are developed and successfully applied. They are carried out in the early stages of tumor development, in case of impossibility for some reason eliminating the kidney itself. Such surgical intervention consists in removing only parts of the kidney and, as research shows, organo-secretion operations differ little from nephrectomy. The only significant drawback in conducting these operations is the high risk of further development of local recurrence.
After radical nephrectomy, in patients 1 stage, the five-year survival rate is about 75%. In the case of a tumor of the hollow vein (stage 2), the five-year survival rate is about 45%. If the process involves renal vein (stage 2), the five-year survival rate is about 55%. When involved in the process of surrounding adipose tissue (stage 3), the five-year survival rate is about 75%. In case of lesion of regional lymph nodes (stage 3-4), the five-year survival varies from 5 to 18%. When germination of neighboring organs and distant metastasis, the five-year survival rate is less than 5%.
Chemotherapy (medical treatment) for kidney cancer is ineffective.
Radiation therapy as an independent method of treatment of this malignant neoplasm, due to inefficiency, is also used, but only to prevent further progression, reduce pain, prevent and stabilize pathological fractures.