Renal cell carcinoma is a malignant tumor that arises from the tubular cells of the kidneys. The majority of all renal tumors are renal cell carcinomas.
What is renal cell carcinoma?
Around three percent of all malignant tumors in adults are kidney carcinomas. Nine out of every 100,000 inhabitants develop renal cell carcinoma every year. Most people become ill between the ages of 40 and 70. Renal cell carcinoma, also known as Grawitz tumor, originates in the tubular cells of the kidney. See etaizhou for What does Scaphoid Fracture Mean.
Depending on the starting tissue, cytogenetic findings and histological picture, different renal cell carcinomas can be distinguished. Classic renal cell carcinoma is the most common. It is also known as clear cell carcinoma. Other forms of renal cell carcinoma are chromophilic or papillary carcinoma and chromophobic carcinoma. Ductus Bellini carcinoma develops rather rarely. It is also known as collecting duct carcinoma.
The exact etiology of renal cell carcinoma is still unclear. It is known that men are much more likely to get the disease than women. Patients suffering from Hippel-Lindau syndrome become ill more frequently. Hippel-Lindau syndrome is an autosomal dominant inherited disorder associated with facial and central nervous system vascular malformations.
Risk factors for renal cell carcinoma are old age, chronic renal insufficiency, smoking, exposure to lead, cadmium exposure, long-term therapy with painkillers, congenital tuberous sclerosis and contact with trichloretes.
Symptoms, Ailments & Signs
Renal cell carcinoma usually only causes symptoms when the tumor is already quite large. There are usually no early symptoms. The tumor cells initially grow centrally in the parenchyma and are therefore not connected to the tubular system of the kidney.
A renal cell carcinoma in the early stages is therefore often only an incidental finding during an ultrasound examination of the abdominal organs. Almost 70 percent of all kidney tumors are found by chance during imaging studies such as sonography, computed tomography or magnetic resonance imaging. A characteristic and threatening late symptom of renal cell carcinoma is blood in the urine. This so-called hematuria occurs suddenly and is painless.
Other symptoms of renal cell carcinoma are rather unspecific. The tumor can cause pain in the flank. Particularly pronounced tumors can be felt in the flank area. In the context of cancer, so-called B symptoms can occur. These include weight loss, increased susceptibility to infections, night sweats and fever. Those affected are no longer as productive as they used to be.
Anemia may occur with fatigue, hair loss, difficulty breathing on exertion and severe paleness. If the tumor grows into the left renal vein or compresses the left renal vein, men can develop a varicose vein in their testicles. This is also known as a varicocele.
A paraneoplastic syndrome rarely develops in renal cell carcinoma. The paraneoplastic syndrome is the name given to the accompanying symptoms of cancer that are not caused by the tumour. In renal cell carcinoma, the paraneoplastic syndrome can be caused by tumor cells that produce hormones such as renin, erythropoietin, ACTH or parathyroid hormone.
Possible symptoms of such a paraneoplastic syndrome include hypertension, hyperthermia, and cachexia. There is a possibility that Cushing’s syndrome will develop as a result of the increased ACTH value. Those affected have a full moon face, gain weight, have a so-called bull’s neck and suffer from muscle and heart weakness.
Diagnosis & course of disease
Clinical examination with palpation, auscultation and percussion only reveals large and advanced kidney tumors. Hematuria is indicated by a pink coloration of the urine. A urine stick can be used to detect erythrocytes in the urine. The laboratory may show anemia caused by the large blood loss through the kidneys.
However, an ultrasound examination must be carried out to confirm the diagnosis. Ultrasonography is used to diagnose suspicious masses in the kidney. The conspicuous areas are then punctured. The tissue material obtained is examined histologically by a pathologist. Most renal cell carcinomas have a lipid-rich and glycogen-rich cytoplasm.
In order to be able to assess the growth of the tumor, the so-called staging, a computed tomography of the abdomen is carried out. The CT can also be used to determine the operability of the cancerous tumor. Chest x-rays, skeletal scintigraphy, and brain MRI can detect distant metastases.
However, X-rays only show metastases that are larger than one centimeter in diameter. The 5-year survival rate for patients with renal cell carcinoma is around 50 percent.
Renal cell carcinoma can lead to severe complications, which is typical for tumors. In a large number of patients, progressive metastasis occurs in other organs. Because malignant kidney tumors tend to spread through the lymph and blood vessels in the body and form secondary tumors. In particular, lungs, liver, brain and skin can be affected by other tumors.
Bone metastasis is also within the typical spectrum. As a result, life-threatening complications can arise in renal cell carcinoma, such as clots (embolism), blocked blood vessels or pneumonia. The probability of metastasis to other organs increases significantly if the renal cell carcinoma is not treated or only treated very late. Not least because of this, early detection plays an important role.
In the course of the medically indicated treatment, complications can also arise that are attributable to the substances ingested. It occasionally happens that the anti-angiogenic antibody bevacizumab leads to thromboembolic events and perforations in the gastrointestinal tract.
When should you go to the doctor?
Symptoms of renal cell carcinoma are often silent in the early stages of the disease. If the disease progresses, individual symptoms can become noticeable. A doctor should be consulted if you lose weight for no reason or if your flank pain becomes more severe.
Fever that lasts for a long time should always be checked out by a doctor. A significant and prolonged reduction in performance can be the symptom of a serious illness. In such a case, a doctor should be contacted. Blood in the urine is also a reason to see a doctor. Seeing a doctor early can have a positive effect on the prognosis. If you are unsure, you should make an appointment with a doctor as soon as possible.
Treatment & Therapy
Surgical removal is the gold standard in the treatment of non-metastatic renal cell carcinoma. Tumors no larger than seven centimeters are usually removed without damaging the kidney. For larger tumors, the entire kidney must be surgically removed along with the adrenal gland, ureter, renal capsule, and surrounding fatty tissue.
If the tumor has grown into the renal vein or even into the inferior vena cava, these tumor plugs must also be removed. A heart-lung machine may be required. New surgical procedures such as laparoscopic radical nephrectomy or minimally invasive procedures such as radiofrequency interstitial tumor ablation (RITA) are currently being researched and tested.
Drug therapies are used for metastatic and locally inoperable renal cell carcinomas. Drug therapies are usually palliative for renal cell carcinoma, and a cure is usually no longer possible. Classic cytostatics such as antimetabolites, alkylating agents, anthracyclines and mitotic inhibitors are ineffective in renal cell carcinoma.
Renal cell carcinoma is therefore considered to be chemotherapy-resistant. Cancer immunotherapies are used instead of chemotherapy. Oral tyrosine kinase inhibitors, bevacizumab and mTOR inhibitors are also used.
Outlook & Forecast
The prognosis for renal cell carcinoma depends largely on the time of detection and the stage of the cancer. Metastatic renal cancer generally has a less favorable prognosis than pure, isolated renal cell carcinoma.
Easily operable renal cell carcinomas that grow in one piece on the surface of the kidney have a particularly good prognosis. If these are surgically removed in time, a recovery can be assumed. Papillary and chromophobic types are also more often limited to the kidney (i.e. do not spread) and have a good prognosis.
The more lymph nodes are affected, the worse the prognosis. In the case of metastases, it is generally unfavorable. While a local tumor that has not spread still has an average five-year survival rate of 90 percent, it is only around 60 to 70 percent if the lymph nodes are involved. In the case of distant metastases, for example in the brain or lungs, it is only 15 percent.
It should be noted that early detection is still the best influence on a favorable prognosis in renal cell carcinoma. Especially people with risk factors (genetic diseases, kidney failure, etc.) benefit from check-ups. If a carcinoma finally occurs in the kidney, it can usually be treated quickly.
Since the exact origin of renal cell carcinomas has not yet been clarified, prevention is difficult. Risk factors such as long-term use of painkillers or smoking should be avoided.
A follow-up check or follow-up care is urgently required after every cancer therapy. This is because many tumors grow back over time. There is also the risk of metastasis growth, which regularly leads to a reduction in life expectancy.
Follow-up care is usually agreed before the end of the initial therapy. Doctor and patient determine the location and the rhythm. Quarterly follow-up care is usual in the first year. The distance between appointments then widens. From the fifth year of freedom from symptoms, an annual presentation is sufficient.
This type of follow-up care is aimed at closely monitoring the patient to prevent complications from arising in the first place and to enable diagnosis at an early stage. The latter brings with it the best chance of recovery. Follow-up care includes a detailed interview and physical examination.
A blood test is usually also carried out. Imaging procedures such as a CT or MRI are used as needed. Follow-up care can also take on a palliative character. Then there is no longer a chance of healing the renal cell carcinoma. Doctors try to enable the patient to lead a symptom-free life. Medication and assistance in everyday life form an important foundation for this.
You can do that yourself
Pure self-help measures that have a medical or even therapeutic effect on renal cell carcinoma do not exist. There are no home remedies, exercises or other measures that those affected can reasonably take. Rather, the experimental use of non-prescribed drugs and substances is not recommended. However, pain management measures can be taken if necessary. It is important that the drugs used do not put a strain on the kidneys.
It can help the patient if he informs himself very extensively about renal cell carcinoma. This type of cancer is very well researched and information is readily available. Knowing about your own illness makes the treatment and your own condition more understandable and can accordingly help to overcome fears. It also gives patients more security when talking to doctors if they are well informed themselves.
Since renal cell carcinoma also affects the healthy parts of the kidneys, it is also advisable to make the diet gentle on the kidneys. This means a significant reduction in the amount of salt consumed and an increase in the amount of water you drink. The amount of salt should be around five grams or less per day, and the amount you drink should be increased to around 2.5 to 3 liters. The proportion of meat in the diet can also be reduced to further relieve the kidneys.