The cells that make up the kidney can become cancerous, but kidney cancer accounts for less than one percent of all cancers.
The two kidneys lie along the flanks of the body just behind the intestines, next to the spine. Kidneys form urine to clear some of the toxins produced by the body. The urine drains from the kidneys into the ureters and then into the bladder. From the bladder, the urine is passed out of the body.
Kidney or renal cell cancer is a disease in which malignant (cancer) cells form in the tubules of the kidney. In Singapore, it accounts for one to two percent of all cancers, and is mainly seen in people over the age of 50, with nearly two-thirds of those being over 65.
In most cases, there is no identifiable cause for the disease, although there are some risk factors:
• Smoking. Smokers have about twice the risk of non-smokers
• Contact with certain chemicals. Workers in contact with chemicals such as aniline dye and heavy metals are at greater risk
• Obesity
• End-stage kidney diseases that require dialysis
• Chronic intake of mild painkillers such as paracetamol, and non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin
• Hereditary kidney cancer. A hereditary form of the disease occurs in a small number of patients — less than five percent — due to the presence of faulty genes. The inherited conditions that put people at risk from kidney cancer include Von Hippel-Lindau (VHL) syndrome, tuberous sclerosis, Birt-Hogg-Dube syndrome and hereditary non-VHL clear cell and papillary renal cell cancer
About two-thirds of kidney cancers are discovered when the patient is being tested for other complaints, even if these do not include kidney cancer symptoms. At this stage, kidney cancer is usually at an early phase. Conversely, in the remaining third of patients, the disease is usually discovered at an advanced stage.
Possible signs include:
• Blood in the urine
• A mass in the abdomen
• A pain in the side that does not go away
• Loss of appetite or weight loss for no known reason
• Anaemia (low blood count)
Further tests to confirm if you have kidney cancer, and at what stage, include:
• Ultrasound or computed tomography (CT) scan. Detailed images of the kidney will reveal the size, characteristics and extent the tumour
• Kidney biopsy. Samples of kidney tumour tissue are removed and examined microscopically to confirm the cancer
• Cystoscopy. A small tube, a cystoscope, is passed through the opening of the urethra in the penis of men who have a kidney tumour and blood in their urine. It contains a lens and light system that helps the doctor see the inside of the urethra, prostate and the bladder to identify any additional tumours
Treatment for kidney cancer varies depending on the stage of the disease.
Treatment for kidney cancer varies depending on the stage of the disease. Kidney cancer treatment for early cancer may include:
Surgery
Surgery is the standard treatment option for those with kidney tumours who are fit for surgery. There are two types:
• Partial nephrectomy, where the tumour and surrounding tissue are removed, but the remainder of the kidney is left. This is performed when the tumour is small or if the person has only one kidney left or has impaired kidney function.
• Radical nephrectomy, where the whole kidney, including the tumour, is removed. This is done when the tumour is large and close to the blood vessels or ureter.
Kidney surgery can be performed using conventional open laparoscopic techniques (using a thin tube with a light and camera) or robot-assisted techniques. The choice depends on the characteristics of the tumour and the suitability of the patient for the surgery.
Radiofrequency Ablation
This is a minimally invasive procedure that uses thermal energy to destroy tumour cells.
Active Surveillance
Certain patients with a very small kidney tumour may receive kidney cancer care simply by being monitored closely with kidney scans to assess the growth rate of or changes in their tumour.
Radiofrequency ablation and active surveillance are more suitable for elderly patients with multiple medical problems who are not fit for surgery.
Treatment for Advanced Kidney Cancer
For some patients whose kidney cancer is discovered late and has already spread to other parts of the body, surgery to remove the kidney, in combination with systemic therapy, has often shown to be effective treatment — even in advanced kidney cancer.
Systemic treatment in this group of patients may include :
• Targeted therapy — uses drugs that target specific tumour growth pathways in the cancer cell
• Immunotherapy — uses drugs that incite the body’s immune response towards the cancer
If you are not fit for surgery, immunotherapy or targeted therapy may be given to control the disease with or without surgery later, depending on your response to treatment. It is reassuring to note that there are still very effective treatments for patients presenting late with advanced stage of kidney cancer.
As people can lead a normal life with one good kidney, most kidney cancer patients do not end up with kidney failure requiring dialysis. Your treating doctor will counsel you on the risks of impaired kidney function after surgery which depends on the presence of factors such as diabetes, high blood pressure and advanced age.
The causes of kidney cancer are not always known, though some are hereditary. But by being aware of certain risk factors, you can help protect yourself from the disease:
• Smokers have approximately twice the risk of developing kidney cancer than non-smokers
• Workers in contact with chemicals such as aniline dye and heavy metals are at greater risk
• Obesity is a factor; so eat a healthy diet and exercise regularly to keep to a healthy weight
• Long-term use of mild painkillers such as paracetamol, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and aspirin are associated with a higher risk of the disease
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