ВТОРОЕ МЕДИЦИНСКОЕ ЗАКЛЮЧЕНИЕ
Kidney Cancer

Kidney cancer is one of the most common urological cancers, along with bladder and prostate cancers. Common symptoms such as blood in the urine can be distinctive, although the diagnosis is late in most cases, as it generally does not show symptoms in the early stages. In patients diagnosed in the early period, successful results are obtained with treatment methods such as chemotherapy and radiotherapy, as well as surgical methods.

What is Kidney Cancer?

The kidneys, located in the upper back of the abdomen, are two organs in the body, protected by the back muscles and rib bones, and producing urine by filtering foreign substances from the blood. The growth of malignant tumors in the kidneys, whose task is to clean the water and minerals such as excess salt in the body, is called kidney cancer.

What are the Types of Kidney Cancer?

Kidney cancer, also known medically as renal cell carcinoma, is a general definition. The most common type of kidney cancer is renal cell cancer. The type of kidney cancer, also known as renal cell carcinoma (RCC), accounts for an average of 90% of all cases. In this type, although a single tumor formation is generally observed in one kidney, in some cases more than one tumor in one kidney or tumor in both kidneys can be observed. This type is divided into two subgroups.

Clear cell carcinoma

This subtype, named after the transparent and clear appearance of cancerous cells, is generally diagnosed in Stage I and Stage II. In the following periods, it can metastasize to nearby organs such as the lung and liver. Clear cell carcinoma accounts for the vast majority of renal cell carcinoma cases.

Papillary Renal Cell Carcinoma

Papillary renal cell carcinoma, which is generally diagnosed in Stage I and Stage II, is more common in patients with renal failure or renal cyst, rather than genetic predisposition or hereditary diseases. Thanks to the ease of diagnosis in the early stage, the survival rate in total cases is approximately 90%. In this sense, the success rate of the treatment is quite high.

Besides these types, there are also rare subtypes of renal cell carcinoma. Among these rare types, the most common chromophobe renal cell carcinoma has a much higher success rate than papillary and clear cell carcinoma. There are also subtypes such as multilocular cystic renal cell cancer, transitional epithelial cell cancer, duct carcinoma in adults and renal cell carcinoma seen in less than 1% in children, such as renal sarcoma and nephroblastoma.

What are Kidney Cancer Risk Factors?

Although the exact cause of kidney cancer is not known, the risk factors are as follows:

hereditary factors,

excess weight (obesity),

high blood pressure (hypertension),

smoking,

exposure to chemicals,

being a male of advanced age,

genetic diseases,

renal insufficiency,

exposure to excessive radiation.


Advanced age greatly increases the likelihood of developing kidney cancer. Studies show that this disease mostly occurs in individuals over the age of 50-60. At the same time, the disease is twice as common in men than in women. The use of cigarettes and other tobacco products also significantly increases the risk of developing this disease.

Those with inherited diseases such as Tuberous Sclerosis Complex, Birt Hogg Dube (BHD) and Von Hippel-Lindau and those with a family history of kidney cancer are also at higher risk. However, industrial workers such as petroleum, steel and textiles exposed to chemicals such as cadmium and asbestos are also likely to develop kidney cancer.

Individuals who are exposed to intense radiation both during treatments and for a different reason and kidney failure patients who undergo regular dialysis are also in the risk group. At the same time, patients with hypertension are three times more likely to develop kidney cancer than healthy individuals.

What are the Symptoms of Kidney Cancer?

Common symptoms of kidney cancer are as follows:

odark red or brown blood in the urine (hematuria),

ofeeling tired and sluggish,

oloss of appetite and weight loss,

oswelling in the lumbar region,

opalpable swelling or mass in the abdomen,

osudden and unexplained low back pain,

oanemia,

ohigh fever of unknown cause.

Hematuria is one of the early and common symptoms of kidney cancer. Although these symptoms can be seen in other conditions such as kidney stones or urinary tract infections, it is important to consider all symptoms for early diagnosis.

Pain in the lumbar region, in particular, indicates that kidney cancer is at an advanced level. For treatment to be successful, it is essential that the cancer is diagnosed before advanced symptoms such as pain. For this reason, it is absolutely necessary to consult a physician in case of stomach and lower back pain and digestive system complaints, especially blood in the urine. Most kidney cancer diagnoses are made by chance with the tests performed based on these symptoms.

In some cases where kidney cancer has advanced without symptoms and metastasized, different symptoms are seen. Depending on the regions where cancerous cells spread, symptoms such as shortness of breath, pain in the bones, loss of consciousness and headache may occur. In this case, metastases to areas such as the lung, bones, and brain are suspected.

Kidney Cancer Stages

After identifying the lesion that indicates kidney cancer, the stage of the cancer is determined by CT and other imaging methods, and a treatment plan is made according to the spread of cancerous cells.

Stage I

At this stage, the size of the tumor, which is found only in the kidney, is less than 7 cm. Generally, the growth rate of the tumor is slow at this stage, when no symptoms are observed in patients.

Stage II

The tumor, which is generally found in the kidney, can also be seen in the tissues around the kidney in some cases. Tumors are larger than 7 cm in size.

Stage III

At this stage, when cancerous cells begin to spread out of the kidney and into the lymph nodes, the dimensions of the tumor are not clear. Symptoms such as pain and fever can be seen in patients at this stage.

Stage IV

At this stage of metastasis, cancerous cells have spread to tissues other than the kidney and many lymph nodes, as well as to areas such as the liver, lungs, and bones. The tumor spreading to areas of the body other than the kidney may cause severe discomfort in patients.

How is Kidney Cancer Diagnosed?

In the diagnosis of kidney cancer, first of all, the medical history of the patients is learned and a physical examination is performed. During the physical examination, the doctor checks for a palpable mass, usually in the abdomen and around the kidney.

After the physical examination, blood test, urinalysis and imaging methods are used. Urinalysis is important as occult blood can be seen in the urine of some patients.

Imaging methods are especially effective in the diagnosis of very small tumors. In most patients who use imaging methods for a different reason, kidney cancer can be diagnosed incidentally and at an early stage. In this sense, regular health check-up is extremely important for early diagnosis.

Imaging methods used in the diagnosis of kidney cancer are ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI). In some cases, in addition to images taken with contrast material, specialist doctors may also order angiography, bone scan, positron emission tomography (PET), intravenous pyelography (IVP), and chest X-ray.

Thanks to these methods, information such as the size, shape, location of the tumor and whether it has metastasized is obtained.

Kidney Cancer Treatment Methods

The treatment plan in kidney cancer is made according to the stage of the cancer, the spread of the tumor, its size and the general health status of the patients. In general, the preferred method is surgery. Surgical methods aimed at removing the tumor may not be applicable because the patients' health condition may not be good enough. In this case, alternative methods such as drug therapy are used.

Surgical Methods

Today, the surgical method is applied with different techniques. The goal of treatment is to either completely or partially remove the tumor. Although the surgery can be performed openly, the closed (laparoscopy) method is generally preferred.

Partial necrectomy is generally performed in the early stage when the tumor size is small. Although partial necrectomy is preferred for tumors smaller than 4 cm, in some cases and according to the experience of specialist physicians, it can be applied to remove tumors up to 7 cm in size. In this method, only the tumor or the part with the tumor is removed.

In radical nephrectomy, the entire kidney, tissues around the kidney, lymph nodes and adrenal glands are removed.

Cryoablation or ablation method, on the other hand, is one of the new methods preferred in cases where other surgical methods lead to limited kidney functions and surgery is risky, especially in elderly individuals. It is performed by making a small incision and then freezing the tumor very quickly through that incision. The ablation method, which is generally very effective on tumors smaller than 4 cm, is only applied to certain patient groups.

In these cases, where cancerous cells are limited to the kidney, any other method is generally not used except for surgical methods. Non-surgical techniques are used in metastases or in very small tumors that do not require surgery. Although surgery is an option for cancer cells that have spread to the lung, liver and bone tissues, chemotherapy, radiotherapy and immunotherapy can also be applied together with surgical intervention.

Kidney Cancer Surgery Risks

As with all surgical operations, kidney cancer surgeries have some risks. These risks can be listed as follows:

renal insufficiency,

damage to surrounding internal organs, tissues, and blood vessels,

urinary tract damage,

air accumulation in the chest cavity,

Non-Surgical Methods

The main treatment method for kidney cancer is surgery. Because, although non-surgical methods, especially radiotherapy, are effective in other types of cancer, they are not very effective in the treatment of kidney cancer. However, these methods are also used, especially in patients with metastases.

Immunotherapy, also known as biological therapy, is a method aimed at strengthening the immune system of patients. It is aimed to destroy cancerous cells by strengthening the healthy cells in the kidney with external intervention. This method provides successful results, especially in 20% of patients in whom cancerous cells spread. With this method, further spread of cancerous cells can be prevented.

Chemotherapy, which is a drug treatment, has a limited effect on kidney cancer like radiotherapy. It is generally applied when there is no response from immunotherapy. Chemotherapy is one of the preferred methods, especially in advanced stage patients where cancer cells metastasize to a large area outside the kidney.

What are the Ways to Prevent Kidney Cancer?

Although it is impossible to interfere with genetic factors, individuals can reduce their risk of kidney cancer by changing environmental factors and lifestyles. The measures you can take with this goal are as follows:

avoiding cigarettes and other tobacco products,

being at a healthy weight for age and height,

doing regular exercise,

eating a balanced and regular diet,

sleeping regularly, and

taking supplements under the supervision of a doctor.


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