Definition

Renal cell cancer, also known as renal cell carcinoma, originates from the tubular layer, which is the smallest passage in the kidney responsible for filtering and cleaning the blood. These tubules play a crucial role in filtering waste substances and forming urine. Afterward, urine travels from both kidneys through long tubes called ureters into the bladder, which is stored until expelled from the body through the urethra. It's important to note that cancer originating from the ureter or renal pelvis, which collects and channels urine to the ureter, differs from renal cell carcinoma.

Renal cell carcinoma constitutes 90% of all kidney malignancies, with the highest incidence rates observed in Western countries.

Causes

Experts have not yet determined the exact cause of renal cell carcinoma. However, most kidney cancers develop due to abnormalities in the genes or DNA of the kidney.

Risk factor

Risk factors for renal cell carcinoma include:

• Smoking: Smoking doubles the risk of renal cell carcinoma.
• Long-term use of pain relievers: Abuse of pain-relieving drugs over the long term.
• Obesity, especially in women.
• High blood pressure.
• Family history of renal cell carcinoma.
• Male gender: The male-to-female ratio is 1.5:1.
• Certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma.

Having risk factors does not guarantee that you will get cancer, nor does it guarantee the opposite.

Symptoms

Symptoms and signs of renal cell carcinoma can also be found in other conditions. In the early stages, symptoms may not be present. Symptoms typically appear as the tumor grows, including:

• Blood in the urine
• A lump in the abdomen
• Persistent pain in the back or side of the body
• Loss of appetite
• Unexplained weight loss
• Anemia (low red blood cell count)

Diagnosis

Renal cell carcinoma is diagnosed through examinations of the abdomen and kidneys. The examinations and procedures that may be performed include:

• Physical examination and medical history: The doctor will conduct a physical examination to assess overall health, including looking for signs of this cancer, such as lumps or other abnormal signs.
• Ultrasound: This procedure uses high-energy sound waves to create echoes from organs inside the body, forming images of body tissues.
• Blood chemistry tests: This procedure involves taking a blood sample to examine the levels of certain substances released by organs and body tissues. Abnormal levels of substances (higher or lower) can indicate the presence of disease.
• Urine tests: These tests check the color and content of urine, such as sugar, protein, red blood cells, and white blood cells.
• CT scan: This procedure provides detailed images of the inside of the body, such as the abdomen and pelvis, which can be viewed from various angles. Contrast agents may also be injected into a vein or swallowed to help organs or tissues appear more clearly.
• MRI: This procedure uses magnets, radio waves, and a computer to produce detailed images of areas inside the body.
• Biopsy: A thin needle is inserted into the tumor to draw a tissue sample. The sample is then examined under a microscope by a pathologist to check for signs of cancer.

After renal cell carcinoma is diagnosed, the doctor will conduct additional tests to determine whether the cancer cells have spread within the kidney or to other parts of the body. This is done to determine the stage of the disease, which is crucial for planning therapy. The tests and procedures used include:

• CT scan or MRI of various areas such as the chest or brain.
• Chest X-ray.
• Bone scan: This procedure checks for rapidly dividing cells, such as cancer cells, in the bones. A very small amount of radioactive material is injected into a vein and flows through the bloodstream. This material accumulates in the bones with cancer and is detected by the scanner.

Management

There are several types of treatment for renal cell cancer that differ from each other. The choice of therapy depends on the stage, age, and general health condition. The five standard types of therapy used are:

• Surgery: Surgery to remove part or all of the kidney is often used to treat renal cell carcinoma.
• Radiation therapy: This therapy uses high-energy X-rays or other types of radiation to kill cancer cells or prevent them from growing. External beam radiation therapy uses a machine outside the body to deliver radiation to the area of the body with cancer. External beam radiation therapy is also used for palliative therapy aimed at improving symptoms and quality of life rather than curing the disease.
• Chemotherapy: Chemotherapy is a cancer therapy that uses drugs to stop the growth of cancer cells, either by killing them or by stopping their division. Chemotherapy can be given by mouth or injected into a vein or muscle, where the drugs enter the bloodstream and can access cancer cells throughout the body.
• Immunotherapy: Immunotherapy uses the patient's immune system to fight cancer. Substances produced by the body or made in the laboratory enhance, direct, and restore the body's natural defenses against cancer. This cancer therapy is one type of biological therapy.
• Targeted therapy uses drugs or other substances that can identify and attack specific cancer cells. Targeted therapy usually causes less damage to normal cells than chemotherapy or radiation therapy.

Complications

Complications of renal cell carcinoma include:

• Metastasis: Cancer spreads to other parts of the body. Tumors in metastasis are the same type of cancer as the original tumor. For example, if renal cell carcinoma spreads to the bones, the cancer cells in the bones are still renal cell carcinoma cells. The condition is called metastatic renal cell carcinoma, not bone cancer. Cancer cells can break away from the original site and spread through local invasion, the lymphatic system, or the bloodstream.
• Impairment of kidney function, which can be fatal if dialysis (blood cleansing) or surgery is not performed.
• Recurrence of renal cell carcinoma several years after initial therapy.

In addition to complications from cancer, complications can also arise from cancer therapy.

Prevention

While there's no proven way to prevent kidney cancer, you can reduce your risk by:

• Quitting smoking
• Controlling blood pressure
• Maintaining a healthy weight
• Following a diet high in fruits and vegetables and low in fat

When to see a doctor?

If you're experiencing symptoms of renal cell carcinoma, it's important to consult with a doctor

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