Carcinoma of the renal pelvis is a relatively rare tumor disease; just one percent of all tumors that form in the urogenital area affect the renal pelvis. The prognosis depends on the detection of the tumor; Surgical methods are the only way to defeat the tumor.
What is renal pelvic carcinoma?
As already mentioned in the name, renal pelvis carcinoma refers to tumor formation directly in the renal pelvis. Carcinoma of the renal pelvis is a relatively rare tumor; just one percent of all urogenital tumors are formed by carcinoma of the renal pelvis. The tumor forms predominantly in people who have exceeded the age of 60. See definitionexplorer for NCBRS Definitions.
It should be noted that in the context of renal pelvic carcinoma, several types of tumors are possible, which can be distinguished on the basis of histology. 90 percent are so-called papillary eoithelial tumors; 10 percent are [[spinalioma (squamous cell carcinoma)|squamous cell carcinoma.
Causes
As part of various studies, doctors have found that renal pelvic carcinoma can sometimes occur due to work. People who work primarily in mining or chemical plants are affected more frequently than people who are not employed in those sectors. Aromatic amines and nitrosmines are said to promote tumor formation. However, there are also tumor formations which arise due to mutations in the apoptosis gene. Chronic urinary tract infections also promote tumor formation.
Symptoms, Ailments & Signs
Even if hematuria (visible blood in the urine) occurs relatively early, renal pelvic carcinoma can go unnoticed for a long time. The patients also complain about pain again and again, whereby accumulations of blood – clots – are the reason here, since the patient’s urinary tract is blocked.
The pain is described as colicky and sometimes radiates to the back. For this reason, many physicians – at the beginning of the examination – assume urolithiasis. Other symptoms that only appear as the disease progresses later are nausea, weight loss, fever, night sweats and loss of appetite.
Diagnosis & course of disease
Based on the medical history and the patient’s symptoms, the doctor suspects that a tumor may be present. At the beginning, the focus is on whether it is a renal pelvis carcinoma or a ureter or kidney tumor.
By means of an ultrasound examination, there is the possibility that the doctor can detect any changes in the structures. An X-ray also gives information about whether a tumor is present. Occasionally, bone metastases can also be detected on the X-ray. If the suspicion of a renal pelvis carcinoma has been confirmed, further examinations are carried out. These examinations serve to determine the stage or the extent.
Computer tomography can be used to determine whether secondary tumors (metastases) are already present. In order for a targeted therapy to be started, tumor staging must be carried out. The doctor assesses the tumor according to the TNM classification, which is made up of the tumor size (T), the lymph node involvement (N) and the metastases (M):
- T1 N0 M0 = Stage I. There are neither metastases nor involvement of the lymph nodes.
- T2 N0 M0 = Stage IIA. Although the tumor has grown into the surrounding tissue layers, there are no metastases and there is no lymph node involvement.
- T1-2 N1 M0 = Stage IIB. Comparable to Stage IIA; the lymph nodes are already affected.
- T3-4 N1 M0 = Stage III. The tumor has already grown into the organ tissue; the lymph nodes are also affected, but no metastases have formed.
- T3-4 N1 M1 = stage IV. As stage III, but metastases have formed.
The prognosis depends primarily on the stage at which the renal pelvic carcinoma was diagnosed. The chances of recovery are significantly better if the tumor is detected at a very early stage. However, early diagnosis is extremely difficult; mainly because at the beginning of the disease there are no symptoms that suggest that a tumor has formed.
Only in the advanced stage do symptoms appear, which clearly indicate that a carcinoma has formed. For this reason, it is essential that a doctor is consulted as soon as the first symptoms that can indicate a tumor are seen.
Complications
Carcinoma of the renal pelvis is a very serious disease. Unfortunately, in most cases this leads to the death of the patient or to significant disabilities. However, the further course of this disease depends very much on the time of diagnosis and the spread of the tumor, so that a general prognosis cannot be given. Those affected primarily suffer from bloody urine.
Blood in the urine can sometimes lead to a panic attack. Severe pain in the kidneys or flanks can also occur due to renal pelvic carcinoma and also spread to the back. Those affected also suffer from weight loss and fever. A general feeling of illness also occurs with renal pelvic carcinoma and leads to a significantly reduced quality of life for those affected. The patients appear exhausted and also suffer from night sweats.
As a rule, the renal pelvis carcinoma can be removed by surgery. However, those affected are still dependent on chemotherapy or radiation afterwards. This can lead to various side effects. The life expectancy of the patient is significantly reduced by the renal pelvis carcinoma.
When should you go to the doctor?
Blood in the urine, which is not due to menstrual bleeding in sexually mature women, is a cause for concern. A doctor’s visit should take place to clarify the cause. See a doctor if you lose weight, become listless, or lose exercise capacity. If there is fever, nausea, vomiting or general weakness, the person concerned needs help. Sweating or heavy night sweats are signs of an illness.
A doctor’s visit is necessary. Pain, discomfort or a feeling of illness should be clarified by a doctor. Since renal pelvis carcinoma is fatal if left untreated, a doctor’s visit is strongly recommended at the first sign of an irregularity. Prognosis depends on when treatment is initiated. Therefore, participation in regular cancer check-ups is generally recommended in adulthood. In this way, early detection is possible even before symptoms have manifested themselves.
Symptoms such as loss of appetite, back pain or colic should be presented to a doctor. If the person concerned suffers from abnormal urination, a change in the urine or the smell, the observations should be examined further by a doctor. If participation in leisure activities decreases, changes in behavior occur, or if there are mood swings, increased alertness should prevail. These are often the first signs of illness.
Treatment & Therapy
The therapy focuses primarily on the surgical removal of the renal pelvis carcinoma, whereby – since the entire kidney is usually affected – it has to be removed completely. However, not only the kidneys, but also the bladder and the ureter are surgically removed. In individual cases, which means that there is only an extremely small tumor, a partial resection or partial removal of the renal pelvis is sufficient.
Chemotherapy is then prescribed. The goal of chemotherapy is that the patient receives a drug that is supposed to inhibit cell growth. A very thin catheter is inserted directly into the vicinity of the tumour. Radiation therapy is also recommended – but after surgical removal of the renal pelvis carcinoma.
Importantly, radiation therapy only “irradiates” the affected area; In this way, any damage to the surrounding organs can be prevented. If metastases are found, the patient’s entire body must be treated with systemic chemotherapy. The drug is passed directly through the bloodstream. The goal should be to free the affected regions from the daughter tumors.
Outlook & Forecast
The future prospects for patients with renal pelvic carcinoma depend on the stage of the disease when the tumor is discovered and treated. In addition, it must be clarified whether the tumor is malignant or benign. If diagnosed early, the patient has a good chance of recovery. The later the unwanted tissue changes are noticed and the more intensive the growth of the tumor is, the more unfavorable the further course of the disease is.
When making a prognosis, it should be taken into account that carcinoma of the renal pelvis usually occurs in people over the age of 60. In many of those affected, the organism is weakened at an advanced age. In addition, there are often other diseases that can have an impact on further development. The general state of health of the patient is therefore decisive for the further course.
Surgical intervention and tumor treatment are necessary to alleviate the symptoms. The cancer must be completely removed to have any chance of relief. The operation and subsequent therapy are associated with numerous side effects and physical and emotional stress. There is a possibility of secondary diseases.
With a fundamentally healthy immune system and good health, the prospects are significantly improved. If no further complications occur during the surgical procedure, freedom from symptoms is possible.
Prevention
It is important that the renal pelvis carcinoma is prevented in such a way that the patient can have any urinary stones and urinary tract infections treated quickly. If these diseases are not treated, chronic irritation develops, which can also promote tumor formation.
Aftercare
If the renal pelvis carcinoma was successfully treated, follow-up care takes place afterwards. Follow-up treatment in a rehabilitation or health clinic is considered helpful. There, the patient also receives psychological support and valuable insights into a conscious and healthy lifestyle.
One of the most important points of follow-up care is preventing a recurrence of the renal pelvis carcinoma. For this purpose, a check-up is carried out every three months for the first two years after the therapy. The doctor asks about the patient’s condition and performs a physical examination.
The controls include examinations of urine and blood. A sonography (ultrasound examination) is also carried out. A check of the abdominal region can be carried out using computed tomography (CT) or magnetic resonance imaging (MRI). X-rays of the chest are taken to exclude possible metastases in other parts of the body such as the lungs.
From the 3rd year after the end of the renal pelvis carcinoma treatment, the check-ups take place every six months. From the 5th year, only one examination per year is necessary. The examinations are carried out by the family doctor, a urologist or in the clinic where the therapy took place. However, the number of examinations also depends on the course of the disease and the individual state of health. If cancer recurrences, sequelae or accompanying diseases are found, they are treated immediately.
You can do that yourself
After being diagnosed with renal pelvic cancer, those affected need the support of friends and family. Doctors, psychologists and counseling centers are also available with tips to help you cope with everyday life. The most important thing is the return to work. Vocational rehabilitation is successful with the help of various advisory services that the family doctor can provide information about.
Since a renal pelvis carcinoma is usually treated with chemotherapy or radiation therapy, the patients suffer from side effects that affect both the internal organs and their appearance. Problems such as hair loss or scars can be treated with both medical preparations and natural remedies. In the area of sexuality, the sufferers can also turn to a specialist in order to effectively treat typical problems such as erectile dysfunction. Last but not least, dealing with the diagnosis of cancer is also important. Especially in the early days, those affected have many questions and fears. These can be worked through in a self-help group or in a discussion with a psychologist.
All these measures can gradually improve the quality of life. In conjunction with comprehensive medical therapy, the self-help measures mentioned offer the patient the prospect of maintaining a higher standard of living despite the difficult diagnosis.
