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Kidney Cancer

Kidney Cancer – Symptoms, Diagnosis & Treatment | SingHealth

Kidney Cancer - What is it for

What is kidney cancer?

kidney cancer conditions & treatments | SingHealth

Kidney cancer or renal cell cancer, occurs when cells in the kidneys develop abnormally and become cancerous. The kidneys are organs located on either side of the spine, they clear toxins produced by the body by forming urine that drains into the bladder and is then passed out of the body. 

How prevalent is kidney cancer?

Kidney cancer commonly affects the elderly, with most being diagnosed over the age of 65. It also affects more men than women. In Singapore, kidney cancer is the 7th most common cancer among men. 

Is there a link between kidney cancer and kidney disease?

A link has been discovered between kidney cancer and kidney disease, where individuals with chronic kidney disease have been found to have an increased risk of developing kidney cancer after long-term haemodialysis. This is probably due to the increased risk of developing kidney cysts for individuals on long-term kidney dialysis, which increases the risk of kidney cancer.

Kidney Cancer - Symptoms

What are the symptoms of kidney cancer?

There are usually no signs or symptoms in the early stages of kidney cancer. The disease is often diagnosed during an ultrasound or CT scan when patients are being investigated for other health complaints. The majority of kidney cancer cases diagnosed this way are at an early stage. However, about one-third of kidney cancers are discovered at an advanced stage. 

Symptoms may include: 
  • Blood in the urine 
  • A mass in the abdomen 
  • Persistent pain in the lower back or side (just under your ribs), that does not go away 
  • Loss of appetite 
  • Sudden, unexplained weight loss 
  • Anaemia (low blood count) 

When should you see a doctor?

The symptoms mentioned above should not be ignored, although they can be caused by a number of other reasons. You should make an appointment with your doctor if you experience any signs or symptoms that worry you.

Kidney Cancer - How to prevent?

How is kidney cancer prevented?

There is no known way to prevent kidney cancer, but the following factors may reduce risk: 
  • Quit smoking. If you've never smoked, don't start
  • Maintain a healthy lifestyle – have a nutritious diet, regular exercise and maintain a healthy weight 
  • Control high blood pressure

Kidney Cancer - Causes and Risk Factors

What are the risk factors for kidney cancer?

While there are no clear identifiable causes for kidney cancer, there are certain risk factors including: 
  • Smoking - smokers have approximately double the risk of non-smokers 
  • Obesity 
  • High blood pressure (hypertension) 
  • End-stage kidney disease that requires dialysis 
  • Chronic intake of mild painkillers, such as paracetamol, and nonsteroidal anti-inflammatory drugs (NSAID) such as ibuprofen and aspirin 
  • Family history of kidney cancer 
  • Some hereditary conditions – individuals with hereditary conditions such as von Hippel-Lindau (VHL) syndrome, tuberous sclerosis, and Birt-Hogg-Dube syndrome, have an increased risk of kidney cancer 
  • Exposure or contact with certain chemicals – e.g. aniline dye and heavy metals

Kidney Cancer - Diagnosis

How is kidney cancer diagnosed?

Tests and procedures used to diagnose kidney cancer include: 

Ultrasound or Computed Tomography (CT) scan

- Ultrasound or CT scan is taken to give detailed images of the kidney to show the size, characteristics and extent of spread of the kidney tumour. 

Magnetic Resonance Imaging (MRI) scan

- MRI scans use strong magnetic fields and radio waves to produce a detailed image of the kidneys and look for any spread of the cancer cells. 

Biopsy

- During a biopsy, samples of kidney tumour tissue are removed and examined under the microscope in the laboratory to confirm the presence of cancer. 

Positron Emission Tomography (PET) scan

- A detailed body scan that can help to investigate kidney cancer cases to see if the cancer has spread or evaluate how well it is responding to treatment. 

Cystoscopy

- Cystoscopy is a test used to examine the inside of the bladder that is usually used for patients who have a kidney tumour and blood in the urine. During the test, a cystoscope which is an instrument that contains a lens and light system is used to help the doctor to examine the inside of the urethra, prostate and bladder to identify any tumours. 

How is staging for kidney cancer done?

After a patient is diagnosed with kidney cancer, a series of tests are performed to stage the cancer and determine the size, aggressiveness and growth of the cancer. This helps doctors determine the best treatment plan for the patient. These may include blood and urine tests, imaging tests (e.g CT scans and MRIs) and procedures such as a biopsy. 

Stages of kidney cancer: 
  • Stage I – the kidney tumour is less than 7cm and has not spread 
  • Stage II – the kidney tumour is larger than 7cm and has not spread 
  • Stage III – the tumour has spread to surrounding tissue, nearby lymph nodes or blood vessels 
  • Stage IV – the cancer has spread to lymph nodes and other organs in the body

Kidney Cancer - Treatments

How is kidney cancer treated?

Treatment for kidney cancer depends on several factors including the patient’s age, medical conditions, significant illnesses, test results, aggressiveness of the cancer and spread of disease. 

Kidney cancer treatment usually begins with surgery to remove the cancer if it is diagnosed in its early stages. If the cancer has spread beyond the kidney (advanced stage), additional treatments may be recommended. 

An individual with kidney cancer should be assessed by a multi-disciplinary team of specialists to determine which modality of treatment is best for them. Such multi-disciplinary care is available at SingHealth healthcare institutions. It is important to discuss all the possible treatment choices, including what to expect and possible side effects, to help you make an informed decision. 

Treatment options for early-stage kidney cancer 

Surgery

Surgery is the standard treatment option for those with kidney tumours who are fit for surgery. Depending on the kidney tumour characteristics and patient suitability, kidney surgery may be performed using conventional open surgery, laparoscopic (keyhole surgery) or robot-assisted techniques. 

There are two main types of surgery for kidney cancer: 
  • Partial nephrectomy - the tumour is removed with a margin of normal tissue, preserving the rest of the unaffected kidney. Partial nephrectomy is performed when the tumour is small or if the patient has impaired kidney function or a single kidney left. 
  • Radical nephrectomy - the whole kidney including the tumour is removed. Depending on the spread of the cancer, sometimes the adrenal gland, tissue around the kidney and lymph nodes in the area are removed. This procedure is performed when the tumour is large and very close to the blood vessels or ureter. The remaining kidney is usually able to perform the work of both kidneys. 

It is possible for an individual to lead a normal, active life with only one good kidney. Most people with one kidney removed do not end up with kidney failure that requires dialysis. Your treating doctor will advise you on the risks of impaired kidney function after surgery, which depends on the presence of other factors such as diabetes, high blood pressure and advanced age. 

Targeted ablation therapy

Targeted ablation therapy is a minimally invasive ablative procedure that uses thermal energy or ice (cryotherapy) to destroy tumour cells. This is usually performed with image guidance such as CT to identify the tumour cells. 

Active surveillance 

Patients with a very small kidney tumour may be monitored closely with regular kidney scans to assess the growth rate or changes in the tumour appearance. 

Targeted ablation and active surveillance for early-stage kidney cancer are more suited for elderly patients with multiple medical problems, who are not fit for surgery. 

Treatment options for advanced kidney cancer 

Radiation therapy

Radiation therapy or radiotherapy uses high-energy beams to kill cancer cells. It is also sometimes used to relieve pain when kidney cancer has spread to the bone. 

Systemic therapy

For some patients who present late with kidney cancer that has spread to other parts of the body, surgery to remove the kidney in combination with systemic therapy has shown to be effective. 

Systemic treatment for this group of patients includes: 

  • Targeted therapy – the use of drugs that target specific parts of the cancer cells. This is often the first line of treatment for patients with advanced kidney cancer. 
  • Immunotherapy – Immunotherapy uses the body’s own disease-fighting immune system to fight cancer. This is done by extracting immune cells from the body, ‘training’ them in the laboratory to identify and fight kidney cancer cells, then injecting the immune cells back into the body to fight the cancer. 

If a patient is not fit for surgery, immunotherapy or targeted therapy may be given to control the disease (with or without surgery), depending on the patient’s response to treatment. 

Arterial embolisation

Arterial embolisation is a procedure where a special material is injected through a catheter to clog the main renal blood vessel. This deprives the cancer tumour of oxygen-carrying blood and other substances it needs to grow, and therefore causes the tumour to shrink. Arterial embolisation may be used before surgery or in some cases may be used to provide pain relief when it is not possible to surgically remove the tumour. 

Palliative treatment

Palliative treatment is a specialised type of medical care that can help patients with advanced stage disease by providing pain relief and helping with other symptoms they may experience. This is done when the cancer is advanced, and it is not possible to completely remove the cancer. The goal of palliative treatment is to improve the quality of life of the patient and their family. Palliative treatment for kidney cancer may include surgery or other treatments that can help relieve symptoms from the cancer such as pain or bleeding.

Kidney Cancer - Preparing for surgery

Kidney Cancer - Post-surgery care

What can you expect after kidney cancer surgery?

After surgery, you will be given regular outpatient appointments to see your team of doctors. During these appointments, you may have blood tests and scans to check if the cancer recurs. 

It is important to follow your doctor's advice, keep to your clinic visits and do the recommended scans and tests, so that timely treatment can be administered if the cancer recurs, or other problems occur.
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