Kidney Cancer

Running head: KIDNEY CANCER

Kidney Cancer
Leslie Wiley
The Robert B. Miller College

BSRN 420
Faith Vruggink/Theresa Dawson
February 17, 2010

Kidney Cancer

Kidney Cancer
Receiving a diagnosis of a disease can be scary, especially when the diagnosis is
cancer. Those unfortunate enough to hear the word cancer are stopped in their tracks,
gripped with fear. One day a patient is thought to be healthy and the next death becomes
imminent. Physical issues need to be addressed as well as emotional issues. This is a
look into kidney cancer and what healthcare workers will be up against in helping a
patient fight this debilitating disease.
The kidneys are located on either side of the back and are about the size of a fist.
The lima bean shaped organs work to regulate red blood cell production, control blood
pressure, and filter out waste in the blood. The excretory system, or the urinary system,
maintains fluid volume and regulates the pH balance in the body creating homeostasis.
The amount of water excreted in the urine is regulated by the urinary system. The
secretion of erythropoietin within the urinary system helps with red blood cell
production. The enzyme, Renin, is also secreted to help maintain a normal blood
pressure. If all other organs that help with excretion fail, the urinary system will not be
able to compensate adequately causing problems for the patient, such as pH levels.
(National Cancer Institute, no date).
Cancer starts in the cells. Cells should regenerate as new cells are needed. When
the old cells die the new cells replace them. When cancer forms, the old cells do not die
when they should but new cells are still being formed. These extra cells will form a
mass, also known as a tumor. Some tumors will be benign or noncancerous. A malignant
tumor is cancerous and may be life threatening. These tumors may be removed surgically
but there is a chance that a malignant tumor will grow back. The cells from malignant

Kidney Cancer

tumors can spread to other areas of the body and damage those tissues or organs. The
lymphatic system can also be affected when cancer cells break away from the tumor and
enter the bloodstream. This is how cancer spreads, also known as metastasis. Kidney
cancer may spread to the lymphatic system, the lungs, bones, or liver. It may also spread
from one kidney to the other. As cancer spreads, the same kind of abnormal cells invade
other parts of the body. (National Cancer Institute, March 30, 2004).
There are several types of kidney cancer. The most common type in adults is
renal cell cancer, otherwise known as renal adenocarcinoma or hypernephroma. For
children, the most common type of kidney cancer is Wilmstumor. This type of cancer is
very different from adult kidney cancer and requires different treatment. Transitional cell
carcinoma is another type of cancer that affects the renal pelvis. This is similar to bladder
cancer. Physicians will treat this particular type of cancer just like bladder cancer.
(National Cancer Institute, March 30, 2004).
Kidney cancer is not a contagious disease that we can catch from someone.
However, there are contributing risk factors. Kidney cancer develops most of the
time in people over the age of forty. Cigar and cigarette smoking may increase the
risk of cancer. Cigarette smokers are twice as likely to develop kidney cancer than a
nonsmoker. Patients who are obese, have high blood pressure, and are on long-term
dialysis have an increased risk of developing cancer. Certain occupations that
expose people to asbestos or cadmium may be at risk. Gender also plays a role.
Males are more likely to be diagnosed than females. (National Cancer Institute,
March 30, 2004).

Kidney Cancer

Prevention is the key to helping stay cancer free. To decrease the risk of
kidney cancer smoking needs to stop. This will not only prevent the chances of
getting kidney cancer but other cancers and diseases as well. To ensure that enough
nutrients are obtained one should eat more fruits and vegetables. Replacing snacks
with fruits and vegetables will also help to maintain a healthy weight. This is
another way to prevent cancer. If weight is a problem other methods are available
to help with that, such as diet and exercise. High blood pressure needs to be
controlled. There are other ways to lower blood pressure than taking medications,
such as lifestyle change, exercise, and diet. All of these are ways to prevent disease
and cancer. In todays world, we come in contact with many chemicals. Exposure
to these chemicals needs to be reduced or avoided all together. If they cannot be
avoided then special precautions such as wearing a mask and heavy gloves needs to
be adhered to. (Mayo Clinic, 1998-2010).
Common symptoms for kidney cancer are blood in the urine, pain in the side that doesnt
go away, a mass in the side or the abdomen, weight loss, fever, and a general feeling of
tiredness or poor health. These symptoms may also mean another disease; therefore,
further testing should be done. A urine test is done to check for blood. Blood tests will
be performed such as a creatinine. A creatinine level should be 0.6-1.2 mg/dL. If this is
elevated then the kidneys are not working properly. A physician may inject dye into a
vein in the arm, known as an intravenous pyelogram, and the dye will travel through the
body and collect in the kidneys. X-rays are then taken to show the dye moving through

Kidney Cancer

the kidneys to the ureters and bladder. This test will show if there is a problem or a
tumor. A CT scan will also show a tumor. This may also be done with contrast dye. A
tumor will also show up using an ultrasound of the kidneys. This test is done using sound
waves that bounce off of the kidneys. A biopsy may need to be done to get a definitive
diagnosis. This happens by removing a piece of tissue through a thin needle guided by
ultrasound or x-ray. A pathologist then assesses the tissue for the presence of cancer
cells. Surgery is the last step in diagnosing. Based on results from CT scans, ultrasound,
and x-rays, the surgeon will remove part or the entire kidney. The pathologist must make
a final diagnosis. (http://www.cancer.gov/cancertopics/wyntk/kidney/page3).
Treatment for kidney cancer will vary by individual. Factors to take into
consideration include general health, the kind of cancer the patient has, and if the
cancer has spread. Patient preference is a large factor also. Some may not want the
quality of life that comes with a huge surgery and chemotherapy. Surgical options
include a radical nephrectomy. This involves removing the kidney, a border of
healthy tissue, and the removal of lymph nodes. If the tumor has grown into the
adrenal gland then that too will be removed. This procedure may be performed as
an open procedure or a laparoscopic procedure, which is done with a video camera
and tiny surgical tools. The preferred surgical procedure is the nephron-sparing
surgery. This is also called a partial nephrectomy. Instead of removing the entire
kidney, only a part of the kidney is removed as well as a small margin of healthy
tissue surrounding the kidney. Also performed open or laparoscopically, this
method should be used if the kidney cancer is small or the patient only has one

Kidney Cancer

kidney. Retaining as much kidney tissue as possible may reduce later complications
such as kidney disease (Mayo Clinic, 1998-2010).
If surgery is not possible for the patient other treatments are available.
Embolization is where special material is injected into the main blood vessel leading
to the kidney. This will block the tumor from getting oxygen and other nutrients.
Cryoablation is used to freeze cancer cells. A needle is inserted through the skin and
into the tumor using x-ray. Gas inside the needle freezes the cancer cells. Another
option is radiofrequency ablation. A needle is inserted into the tumor using x-ray
and an electrical current is run through the needle into the cancer cells. This causes
the cells to heat up and burn. These options are used when patients are not surgical
candidates and the tumors are small in size and located in areas that can be reached
with the needles (Mayo Clinic, 1998-2010).
If cancer has spread to other parts of the body a surgeon will perform surgery to
remove as much of the kidney tumor as possible. Then biological therapy or
immunotherapy is tried. This uses the patients immune system to fight the cancer.
These drugs include interferon and interleukin-2, synthetic versions of chemicals
that are made by the human body. Chemotherapy is another option. This may be
used to treat transitional cell carcinoma, cancer of the ureters that sometimes begins
in the kidneys. Chemotherapy is not commonly used to treat renal cell carcinoma.
To treat cancer that has metastasized it depends on the number of distant tumor,
their location, and the patients general health. Surgery may be used for brain
metastasis or radiation for bone metastasis (Mayo Clinic, 1998-2010).

Kidney Cancer

Another option that must be addressed with the patient for treatment is alternative
medicine. These have not been proven to successfully treat kidney cancer, however,
they will help the patient cope with cancer. If a patient is experiencing distress
therapies that may be tried are art therapy, dance or movement therapy, music
therapy, and exercise. To help patients relax meditation and relaxation exercises are
useful. Not only are physical issues a problem that needs to be addressed but the
emotional issues are as well (Mayo Clinic, 1998-2010).
Staging for kidney cancer involves imaging tests such as a CT scan or MRI. This
will give the physician a better idea of the extent of the cancer. Stage one is the early
stage of cancer in which the tumor measures up to 2 inches. The cancer cells will
only be found in the kidney at this point. Stage two is the same as stage one only the
tumor will measure more than 2 inches. In stage three there is numerous
scenarios found. The tumor is only in the kidney, however, the cancer cells have
entered the lymphatic system to one lymph node. Secondly, the tumor has invaded
the adrenal gland or layers of fibrous tissue surrounding the kidney. The cancer
cells have not spread past the fibrous tissues but they will be found in one nearby
lymph node. The third scenario involves one nearby lymph node as well as
spreading from the kidney to a nearby large blood vessel. Stage four cancer is by
far the worst where the tumor has spread beyond the fibrous tissue surrounding the
kidney, cancer cells are present in more than one lymph node, and the cancer has
spread to other places in the body. (National Cancer Institute, March 30, 2004).
Diagnosis of kidney cancer while the cancer is still in the primary site is 58% with a
survival rate of 90.4%. If the cancer has spread to the lymph nodes or just beyond

Kidney Cancer

the primary site the survival rate is 62.3%. This diagnosis happens 18% of the time.
The unfortunate 19% are diagnosed after the cancer cells have spread to other areas
of the body, also known as metastasis. The survival rate for these patients is 10.4%
(Mayo Clinic, 2010). These are very good reasons why screening should take place
for early detection. Research has been done to link certain factors with shorter
survival times if patients with kidney cancer present with the following:

High blood lactate dehydrogenase levels

High blood calcium levels

Anemia

Cancer metastasized to 2 or more distant sites

Less than a year from diagnosis to needing systemic treatment

Low performance status (how well a person can perform daily activities)

If patients show none of these risk factors they are considered good risk.
Intermediate risk is presenting with 1 or 2 of the factors listed above. Patients with
3 or more factors have a very poor prognosis and will generally not benefit from
certain treatments (American Cancer Society, May 14, 2009).
It is important for patients to have support throughout this life-altering period. A
patient will need time to adjust to the fact that they are living with cancer. Support
groups are available whether it is in person, on the phone, or the internet. Families also
need support during this difficult time. There are support groups specifically for this as
well. A patient may worry about keeping jobs, managing side effects, hospital stays, and
medical bills. A social worker can help by assisting with resources such as financial aid,

Kidney Cancer

transportation, home care, and emotional support (National Cancer Institute, March 30,
2004).
The future for cancer treatment is very promising. Physicians all over the world
are conducting clinical trials on a daily basis. Patients may volunteer to take part in
clinical research studies. Currently being studied are new surgical techniques, biological
therapy, chemotherapy, and combinations of these treatments. Stem cell transplantation
is being researched with much controversy. This transplant allows patients to be treated
with high doses of drugs that destroy both cancer cells and normal blood cells in the
marrow. At a later stage, the patient then receives healthy stem cells from a donor in
which new blood cells will develop from the transplanted cells. Cancer vaccines are also
being studied. These would help the immune system fight cancer cells (National Cancer
Institute, March 30, 2004).
Healthcare workers need to be aware of the five stages of grief that a patient and
even a family member will go through. Families need to be supported and informed of
what their loved ones will go through as they deal with kidney cancer. A patient will
have many questions and it is our responsibility to answer them. Take the time to spend
with these patients, as they may not have much time left. We would want the same care if
we were in their shoes.

Kidney Cancer

10

References
American Cancer Society. (May 14, 2009). How is Kidney Cancer Staged. Retrieved
from
http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_kidney_
cancer_staged_22.asp.
Mayo Clinic. (1998-2010). Kidney Cancer. Retrieved from
http://www.mayoclinic.com
/health/kidneycancer/DS00360/DSECTION=prevention.
Mayo Clinic. (2010). Department of Urology: Kidney Cancer. Retrieved from
http://mayoresearch.mayo.edu/urology/kidney_cancer.cfm.
National Cancer Institute. (N.D.) Introduction to the Urinary System. Retrieved from
http://training.seer.cancer.gov/anatomy/urinary/.
National Cancer Institute. (March 30, 2004). Understanding Cancer. Retrieved from
http://www.cancer.gov/cancertopics/wyntk/kidney/page3.

Kidney Cancer

11