Discover all the details related to kidney cancer, a more widespread condition in men than in women and which involves complex treatment.
What is it?
The main cancer that can affect the kidney (90%) is renal adenocarcinoma, also called renal cell carcinoma or hypernephroma. It usually affects twice as many men as women , especially in patients between 40 and 60 years old.
Other less common tumors that can affect the kidney can be either malignant, such as rhabdomyosarcoma, fibrosarcoma, or renal metastases, or benign, such as cortical adenomas, angiolipomas, or oncocytomas.
How is it produced?
Renal cell carcinoma has several risk factors, such as tobacco smoke or toxic agents such as cadmium or asbestos. Likewise, it has been associated with two hereditary pathologies , familial papillary renal cell carcinoma and Von Hippel-Lindau syndrome, as well as other less frequent phakomatosis.
In multiple cases, alterations have been observed at the level of chromosome 3 . On the other hand, a higher incidence of renal cell cancer has been observed in patients with polycystic kidney disease, with cystic disease secondary to chronic renal failure, and in kidneys with anatomical malformations.
The renal tumor usually originates at the level of the renal cortex and grows until it invades the perirenal fat and the local nodes. From there it can generate metastases, mainly at the level of the lung, liver, bones or brain.
The classic presentation of the renal tumor is the presence of a mass at the level of one of the flanks accompanied by pain and hematuria. When all these symptoms occur, it is usually an advanced disease. 30% of patients present metastases at the time of diagnosis, although in many cases they are diagnosed accidentally when performing an abdominal ultrasound for other reasons in asymptomatic patients.
The hematuria is the most common alteration (it occurs in 60% of cases). Also, a dull ache, weight loss, a feeling of occupation in the flank, fever, night sweats or high blood pressure may appear.
In rare cases, the tumor can produce hormonal secretion, such as parathyroid hormone, prostaglandins, prolactin, renin, gonadotropins or corticosteroids, which will give different manifestations depending on the hormone produced.
In advanced stages, the tumor can occupy the renal vein, which if it is on the left side can cause the appearance of an ipsilateral varicocele of sudden origin.
The diagnosis of renal cell cancer should be suspected in patients who present symptoms compatible with it (feeling of occupation in the flank, hematuria, pain). A correct examination will allow us to observe if there is a palpable mass on one of the flanks or if there is a left varicocele.
The ultrasound is the initial imaging test, then it allows you to see if it is a simple cyst or a solid mass. If there are doubts and it cannot be classified as a clear simple cyst, a computerized axial tomography (CT) scan should be performed, which will allow us to see if it is a solid mass or not. Likewise, the CT scan will provide information on the involvement of the renal vein, the vena cava and the adjacent lymph nodes and organs. However, to evaluate the involvement of adjacent vessels, magnetic resonance imaging (MRI) provides better information.
If the presence of metastases is suspected, the extension study will be based on a chest radiograph, a study of liver function and, if suspected, a bone scan.
Sometimes, especially to plan surgery, a selective renal arteriogram may be done.
In the blood test, several alterations can be seen, such as anemia, hypercalcemia or polyglobulia . A fifth of patients may have liver enzyme abnormalities without liver metastases: this is known as Stauffer syndrome.
For a renal cell carcinoma that does not present lymph node involvement or distant metastases, the treatment option of choice is radical nephrectomy, including the adrenal gland. If possible, it will be performed by laparoscopy, which allows a faster postoperative recovery.
On special occasions, such as in bilateral involvement (extremely rare) or in single-kidney patients, a partial nephrectomy will be considered. Likewise, in the case of single, small tumors (less than 4 cm in diameter) and well located without involvement of the perirenal fat, some authors suggest the possibility of a partial nephrectomy, although there is a risk of local recurrence.
The regional lymphadenectomy does not improve survival and only practiced for staging.
In the case of patients with disseminated disease, no intervention will be made and palliative measures such as chemotherapy, radiotherapy or immunotherapy will be chosen . However, in the case of single, well-localized metastases, surgical removal of the metastasis may be considered. It should be noted that renal adenocarcinoma can lead to metastases and local recurrences (if partial nephrectomy has been performed) late, up to more than 10 years after nephrectomy.
There are few preventive measures to avoid renal cell carcinoma except to stop smoking and try not to expose yourself to tobacco and other toxins such as the aforementioned cadmium or asbestos. In case of suffering diseases that can predispose to suffering it, such as certain phakomatosis, a periodic control should be done by means of an ultrasound.