Kidney Cancer Treatment & Diagnosis in Singapore
What are Kidney Cancer Treatments in Singapore?
Presenting treatments for both localised cancer and metastatic kidney cancer
There are different types of treatment for patients with kidney cancer. Kidney cancer treatment usually begins with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney, additional treatments may be recommended.
The best approach may depend on several factors, including the patient’s general health, and the type or stage of kidney cancer, such as whether the cancer has spread to other parts of the body.
Sometimes the doctor may recommend close monitoring of the tumour with regular diagnostic tests and clinic appointments. Active surveillance is a form of treatment for localised kidney cancer in which the doctor actively monitors the tumour. Active surveillance is effective in older adults and people who have a small renal tumour and another serious medical condition, such as heart disease, chronic kidney disease, or severe lung disease. It may also be recommended if surgery is not the best option for the patient, and if the patient has a tumour in their kidney which is smaller than four (4) centimeters. Sometimes, a biopsy is done before deciding to watch the tumour to see if the lump is really cancer.
Surgery is usually the main and common treatment for most kidney cancer patients and may help cure the cancer itself. Surgery in kidney cancer treatment is the removal of the tumour and some surrounding healthy tissue during an operation.
If the cancer has not spread beyond the kidneys, surgery to remove the tumour may be the only treatment needed. Surgery to remove the tumour may involve removing part, or all of the kidney, as well as possible surrounding tissue and lymph nodes.
The different types of surgery used for kidney cancer include the following procedures:
- Radical Nephrectomy: Surgery to remove the tumour, the entire kidney, and surrounding tissue is called a radical nephrectomy. In this operation, the surgeon may make the incision in several places, with the most common site being the belly (or the middle of the abdomen), under the ribs on the same side of the tumour, or in the back at the position of the kidney.
If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection is performed. During a lymph node dissection, the lymph nodes affected by the cancer are removed. If the cancer has spread to the adrenal gland or nearby blood vessels, the surgeon may remove the adrenal gland during a procedure called an adrenalectomy, as well as parts of the blood vessels.
A radical nephrectomy is usually recommended to treat a large tumour when there is not much healthy tissue remaining. Sometimes the renal tumour will grow directly inside the renal vein and enter the vena cava; the large vein that empties into the heart. If this happens, complex cardiovascular surgical techniques may be required.
- Partial Nephrectomy: A partial nephrectomy is the surgical removal of the tumour. This type of surgery preserves kidney function and lowers the risk of developing chronic kidney disease after surgery. As with a radical nephrectomy, the surgeon can make the incision in several places, depending on factors like the location of the tumour.
Partial nephrectomy is the most common treatment for patients with early-stage kidney cancer, often done to remove single small tumours that are less than four (4) centimeters or remove large tumours up to seven (7) centimeters across the kidney. One of the benefits of partial nephrectomy is that the patient gets to keep more kidney function. However, this particular surgery may not be an option if the tumour is in the middle of the kidney, large, if there are more than one tumour in the same kidney, or if the tumour has spread to the surrounding lymph nodes or organs.
- Laparoscopic and Robotic Surgery (minimally invasive surgery): In a laparoscopic surgery, the surgeon makes several small cuts in the abdomen, rather than the one larger cut used during a traditional surgical procedure. The surgeon then inserts telescoping equipment into these small keyhole incisions to completely remove the kidney or perform a partial nephrectomy. Sometimes, the surgeon may use robotic instruments to perform the operation. This surgery may take longer but may be less painful.
Radiation therapy is the use of high-energy rays to destroy cancer cells. A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Radiation therapy is not effective as a primary treatment for kidney cancer. It is very rarely used alone to treat kidney cancer because of the damage it causes to the healthy kidney. For most patient with kidney cancer, radiation therapy is more often used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain, or when a patient has only one kidney. Other treatments are tried first before introducing radiation therapy as part of the patient’s treatment plan.
External beam therapy (EBRT) which focuses radiation on the cancer from a source outside the body is usually used to treat kidney cancer. A Stereotactic Body Radiation Therapy (SBRT) is used to treat a single area of cancer spread.
Chemotherapy is not a standard treatment for kidney patient as the cancer cells do not usually respond to well to chemotherapy.
Immunotherapy, also called biologic therapy, is designed to boost the body’s natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.
- Interleukin-2 (IL-2, Proleukin):IL-2 is a type of immunotherapy that has been used to treat advanced stage kidney cancer. It is a cytokine, which is a protein produced by white blood cells. It is important in the immune system function, including the destruction of tumour cells.
- PD-1 Inhibitors: Another form of immunotherapy treatment is PD-1 inhibitor. Pembrolizumab (Keytruda) and Nivolumab (Opdivo) are drugs that targets PD-1, a checkpoint protein on immune system cells called T cells,that normally helps keep these cells from attacking normal cells in the body. By blocking PD-1, this drug boosts the immune response against kidney cancer cells. It has shown promising results in shrinking or slowing down the growth of kidney cancer tumours.
Pembrolizumab may be given for one (1) year after surgery for patients who have a higher risk of the cancer coming back. It may also be given to patients who have surgery to remove the main tumour along with surgery to remove any organs or lymph nodes of the cancer spread. Pembrolizumab is usually given with targeted drugs Axtinib or Lenvatinib as the first treatment for patients with advanced stage kidney cancer.
For patients with an intermediate or poor risked advanced stage kidney cancer who have not received any form of treatment, nivolumab can be given with ipilimumab (a CTLA-4 inhibitor) for four (4 doses) followed by nivolumab alone. This combination has been shown to help people live longer (see CTLA-4 inhibitors below). Nivolumab can be used for patients whose advanced kidney cancer starts growing again after targeted drug treatments. Studies have shown this helps patients live longer.
Pembrolizumab is given as an intravenous (IV) infusion every three (3) or six (6) weeks, while Nivolumab is given as an intravenous (IV) infusion every two (2), three (3) or four (4) weeks.
- PD-L1 Inhibitors: Immunomodulators such as Avelumab (Bavencio) is a checkpoint inhibitor that targets the PD-1/PD-L1 pathway. This is commonly used for patients with advanced kidney cancer, including as a first line of therapy in combination with chemotherapy.
Blocking the PD-L1 protein can help boost the immune response against cancer cells. This can often shrink some tumours or slow their growth. It is given every two (2) weeks as an IV infusion.
- CTLA-4 Inhibitors: This is another drug that boosts the immune response, but it has a different target. It blocks CTLA-4, another protein on T cells that normally helps keep them in check. For patients with intermediate or poor risk advanced kidney cancer who have not received any treatment, ipilimumab can be given with nivolumab (a PD-1 inhibitor) for four (4) doses followed by nivolumab alone.
Ipilimumab is given as an intravenous (IV) infusion, usually once every three (3) weeks for four (4) treatments.
Targeted drug therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. Targeted dug therapy is commonly used to treat advanced kidney cancers. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
As not all tumours have the same targets, research studies continue to find out more about specific molecular targets and new treatments directed at them.
Targeted drug therapies for kidney cancer are described below.
- Anti-angiogenesis Therapy: This type of treatment focuses on stopping angiogenesis, which is the process of making new blood vessels. Most clear cell kidney cancers have mutations of the VHL gene, which causes the cancer to make too much of a certain protein, known as vascular endothelial growth factor (VEGF). VEGF controls the formation of new blood vessels and can be blocked with certain drugs. Because a tumour needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to under nourish the tumour. There are two ways to block VEGF, with small molecule inhibitors of the VEGF receptors (VEGFR) or with antibodies directed against these receptors.
The different drugs used in anti-angiogenesis therapy:
- Sunitinib (Sutent): This drug acts by blocking both angiogenesis and growth-stimulating proteins in the cancer cell itself. It does by blocking several tyrosine kinases that are important for cell growth and survival. This drug is taken as a pill daily, typically for four (4) weeks on and two (2) weeks off. Sunitinib may be used in people with advanced kidney cancer, as well as in people with a high risk of the cancer returning after surgery to help lower the risk of the cancer coming back. This is also known as adjuvant therapy.
- Sorafenib (Nexavar): Similar to sunitinib, the sorafenib drug blocks several tyrosine kinases. Sorafenib attacks both blood vessel growth and other cells that helps cancer cells grow. Sorafenib is commonly taken as a pill twice a day.
- Pozapanib (Votrient): Pazopanib is a drug that blocks several tyrosine kinases involved in cancer cell growth and the formation of new blood vessels in the tumour. It is taken as a pill once a day.
- Cabozantinib (Cabometyx): Cabozantinib is a drug that blocks several tyrosine kinases, including some that help form new blood vessels. It may be used as a first treatment for patients with intermediate or poor risked advanced kidney cancer, or in patients with advanced kidney cancer that has already tried other targeted drug therapy and/or after immunotherapy. Depending on the type and stage of the kidney cancer, this drug is taken as a pill once a day and has shown results to help patients live longer.
- Lenvatinib (Lenvima): Lenvatinib is a kinase inhibitor drug that helps block tumours from forming new blood vessels, as well as targeting some of the proteins in cancer cells that normally help them grow. It can also be used with the immunotherapy drug pembrolizumab as a first treatment in people with advanced kidney cancer. Lenvatinib is taken as capsules once a day.
- Bevacizumab (Avastin): Bevacizumab is an IV drug that works by slowing the growth of new blood vessels. It may help patients with kidney cancer when used with interferon-alfa immunotherapy.
- Axitinib (Inlyta): Axitinib is a drug that inhibits several tyrosine kinases involved in the formation of new blood vessels. It can be used by itself after at least one other treatment has been tried, or it can be used with certain immunotherapy drugs, like pembrolizumab or avelumab, as the first treatment for people with advanced kidney cancer. Axitinib is taken as a pill twice a day.
- Tivozanib (Fotivda): Tivozanib is a drug that blocks several tyrosine kinases involved in cancer cell growth and the formation of new blood vessels in the tumour. This drug is typically used in patients with advanced kidney cancer after someone has already tried two or more other systemic drugs such as chemotherapy, targeted therapy, or immunotherapy. This drug is taken as a pill daily, typically for three (3) weeks on and one (1) week off.
- Belzutifan (Welireg): Belzutifan is commonly used in patients with von Hippel-Lindau (VHL) disease who have kidney cancer and do not require surgery right away. Belzutifan is a type of drug known as a HIF inhibitor. It blocks a protein called hypoxia-inducible factor 2 alpha (HIF-2a), which is involved in both cancer cell growth and the formation of new blood vessels in tumours. This drug is taken as pills, typically once a day.
- mTOR Inhibitors: mTOR inhibitors or Mammalian target of rapamycin inhibitors is another form of targeted drug therapy treatment used in kidney cancer. Everolimus (Afinitor) and Temsirolimus (Torisel) are drugs that target a certain protein that helps kidney cancer cells grow, called mTOR. Studies show that these drugs slow kidney cancer growth. Temsirolimus is given as an intravenous (IV) infusion, typically once a week while Everolimus is taken as a pill once a day.
In patients who are too sick to undergo surgery or opt out of surgery treatment, ablation can sometimes be used to destroy the kidney tumour. This approach is usually considered for small kidney cancers (less than four (4) cm across.
- Cryotherapy (Cryoablation): Cryotherapy is used to treat small, early-stage kidney cancers less than four (4) centimeters across. In some patient, it can cure the cancer without a kidney being removed. Cryotherapy uses extreme cold to destroy the tumour. A hollow probe (needle) is inserted into the tumor either through the skin (percutaneously) or during laparoscopy. Cold gases are passed through the probe, creating an ice ball at its tip that destroys the tumour. To ensure the tumour is destroyed without too much damage to nearby tissues, the doctor carefully watches images of the tumour during the procedure with ultrasound, CT or MRI scans, or measures the tissue temperature.
- Radiofrequency Ablation (RFA): Radiofrequency ablation (RFA) is a treatment that use image guidance (ultrasound or CT scan) to place a needle through the skin into a kidney tumour. In RFA, high-frequency electrical currents are passed through an electrode in the needle, creating a small region of heat. The heat helps destroy the cancer cells.
Are There Any Side Effects of Kidney Cancer Treatment?
Surgery, like all cancer treatments, has benefits, risks, and side effects. After surgery, it is common to have some pain from the surgery’s effect on the body. Most patients will have at least some pain after the operation, which can usually be helped with pain medication, if needed.
The amount and location of the pain varies depending on your surgery. Factors that can affect the pain you experience include:
- Location of the surgery
- Size of incision, or surgical cut
- Amount of tissue removed
- If you had pain before surgery
Fatigue is also common after surgery. Many people are very tired after major surgery, especially when it involves the abdomen in the case of kidney cancer. Fatigue usually goes away gradually two to four weeks after surgery.
The possible side effects of radiation therapy depend on where the radiation is targeted. The common side effects include:
- Skin irritation (in areas of radiation, ranging from redness, blisters, and peeling)
- Hair loss
- Lower blood cell counts
- Increase risks of infections
- Mouth and gum sores/difficulty swallowing/dry mouth
- A type of swelling called lymphedema
The side effects of chemotherapy commonly include the following:
- Nausea and vomiting
- Loss of appetite
- Hair loss
- Skin and nail changes
- Numbness and tingling
- Low white blood counts, low red blood counts and low platelet counts
- Risks of infections
- Risk of infertility
The side effects of targeted therapy may include:
- Nausea and vomiting
- Swelling of hands and feet
- Rash and other skin changes
- Vision problems
Depending on the targeted drugs used, the common side effects may include:
- Low or High blood pressure
- Increased blood sugar level or cholesterol
- Nausea and vomiting
- Poor appetite and weight loss
- Voice changes
- Skin rash/Mouth sores
- Swelling in the arms and legs (fluid build-up)
Major complications are uncommon in ablation therapy; however, the side effects may include bleeding and damage to the kidneys or other nearby organs.
What Do I Need to Do If I have Kidney Cancer?
Kidney cancer begins when healthy cells in one or both kidneys change and grow out of control, forming a mass called a renal cortical tumour. A tumour can be malignant, indolent, or benign. A malignant tumour is cancerous, meaning it can grow and spread to other parts of the body. An indolent tumour is also cancerous, but this type of tumour rarely spreads to other parts of the body. A benign tumour means the tumour can grow but will not spread.
If you suspect that you or your loved one have kidney cancer, it is advisable to get the support you need. Early detection and diagnosis of kidney cancer is key to treating the disease.
Regardless of what stage your kidney cancer may be, you should schedule an appointment to see an oncologist specialising in kidney cancer as soon as possible. With the speed of developments in kidney cancer diagnosis and treatment, novel emerging treatment options could be explored by your medical oncologist.
Our cancer specialists at OncoCare specialise in treating late stage and advanced stages of kidney cancer, as well as earlier stages of the disease.
Who are the Kidney Cancer Specialists in Singapore?
Senior Consultant, Medical Oncologist
MBBS (Delhi) – American Board Certified (Int Med) – American Board Certified (Hematology)
American Board Certified (Med Oncology)
Before joining OncoCare Cancer Centre at Mount Elizabeth Hospital, Singapore, Dr Akhil Chopra was a Senior Consultant in Medical Oncology at Johns Hopkins Singapore, Tan Tock Seng Hospital and Adjunct Associate Professor at Lee Kong Chian School of Medicine.
Dr Chopra has experience treating multiple cancer types including breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers; as well as Sarcomas and chronic leukaemia’s/multiple myeloma. Besides his clinical and research work, he has been involved in teaching medical students from the Lee Kong Chian School of Medicine as well as medical residents and students from Johns Hopkins University, Baltimore in USA.
- Graduated from Delhi in 2001
- American Board Certified, Internal Medicine
- American Board Certified, Medical Oncology
- American Board Certified, Hematology
- Fellowship Training at Hahnemann University Hospital/Drexel University College of Medicine in Philadelphia, USA
Cancer Specialities: breast cancer, lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and bladder, gynaecological cancers such as ovarian and uterine/cervical cancers
MBBS (Singapore) – M.Med (Singapore) – MRCP (United Kingdom) – FAMS (Medical Oncology)
Dr Tay Miah Hiang, Senior Consultant Medical Oncologist at OncoCare Cancer Centre, was previously consultant at the National Cancer Centre Singapore’s Department of Medical Oncology, and Chairperson of Patient Education & Patient Survivorship programmes. Dr Tay also served on the board of Singapore Children’s Cancer Foundation from 2006 till 2015, and was Chairperson of this foundation from 2011 to 2013, and now serving as advisor. He is an elected member of Singapore Medical Council (SMC) since 2017 till date.
Dr Tay is passionate in contributing to Continuous Medical Education in the region, giving lectures in cancer management to cancer specialists, general practitioners, medical students and patients. He has won numerous awards for his service excellence and humanity contribution to disaster inflicted regions as such as post-Afghanistan war and Sri Lanka after Tsunami.
He has been actively involved in clinical and translational research for many years, in genitourinary (testicular, kidney, bladder, prostate), lung and other cancers. His research work is well published in hormone-refractory prostate cancer involved chemotherapy agents such as docetaxel and carboplatin. Acknowledged as a senior cancer specialist and an authority in prostate cancer in Singapore, he had also published on the use of ketoconazole and as part of a multi-centre clinical trial, the use of abiraterone acetate in metastatic castration-resistant prostate cancer progressing after chemotherapy.
As a pioneer in kidney cancer oncology, he had used sunitinib (Sutent), refametinib in kidney cancer patients when the drugs were coming into clinical practice in Singapore. Recognised as an authority in prostate cancer in Singapore, he had helped developed guidelines for the treatment of prostate cancer in Singapore in 2013 and the management of kidney cancer in Asia at the Asian Oncology Summit 2012.
His significant research work has been published in both local and international journals including Urology, Cancer, and Annals of Oncology. He also wrote chapters in several internationally recognised cancer specialty books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
Dr Tay is lauded for his experience in treating prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian and uterine/cervical cancers, gastrointestinal & hepatobiliary cancers, lung cancer, brain tumour. He does not see patients with lymphoma, leukemia and breast cancer.
- Graduated from the National University of Singapore in 1992.
- Obtained Master of Medicine (Internal Medicine) and Membership of the Royal College of Physicians (United Kingdom) in 1999.
- Awarded the Ministry of Health Manpower Development Programme (HMDP) Scholarship to train at Dana Farber Cancer Institute, (Teaching Affiliates of Harvard Medical School), Boston USA 2003.
- Completed the Cancer Medicine and Hematology course at Harvard Medical School, Boston, MA, USA 2003.
- He was the Chairperson of Cancer Education for National Cancer Centre and Dr Tay was also previously the Chairperson and management committee member of Children’s Cancer Foundation. He is an elected member of Singapore Medical Council since 2017.
- In clinical patient care, he was awarded for his professional and genuine care with National Excellent Service Gold Award (EXSA*) in 2006 and Star Award in 2007.
- He has been actively involved in clinical and translational research for many years, in prostate, kidney, lung and other cancers. These have involved international trials of chemotherapy drugs currently in active use and newer targeted therapy. He was principal investigator for more than 10 clinical trials for cancer drug development.
- Research work by Dr Tay has been published in both local and international journals including Urology, Cancer, Annals of Oncology. He also wrote chapters in several international books such as Comprehensive Textbook of Genitourinary Oncology (3rd Edition), American Cancer Society’s Complete Guide to Prostate Cancer 2006, and Textbook on Urologic Oncology 2004.
- With respect to public service, Dr Tay has given talks both locally and overseas. These include the 13th and 15th Malaysian Urological Symposium on management of prostate cancer and renal cell cancer and Urological Conferences held in Singapore in 2004-2007
- With teaching appointments as Clinical Teacher, Faculty of Medicine, National University of Singapore and had been one of the lecturer for the First Singapore Medical Oncology Review Course (2007) involving surgeons, medical oncologists, radiation oncologists and physicians.
- Accredited for Palliative Medicine.
- Clinical interest in lung cancer, cancers of stomach, colon, rectum, liver, prostate, kidney, testicular and the bladder, gynaecological cancers such as ovarian and uterine/cervical cancers, and brain tumour.
- (*) National Excellent Service Award (EXSA) is a national award managed by SPRING Singapore and nine industry lead associations in Singapore. This award recognises the best of the best individuals who have delivered outstanding service in their respective industries. It seeks to develop models for service staff to emulate, create service champions and enhance professionalism in service delivery.
What is Kidney Cancer?
Definition of Kidney Cancer
Kidney cancer is cancer that begins in the kidneys. Your kidneys are two bean-shaped organs, each about the size of your fist. They’re located behind your abdominal organs, with one kidney on each side of your spine.
In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can also occur.
The incidence of kidney cancer seems to be increasing. One reason for this may be the fact that imaging techniques such as computerized tomography (CT) scans are being used more often. These tests often lead to the discovery of more kidney cancers. Kidney cancer is often discovered at an early stage, when the cancer is small and confined to the kidney.
In Singapore, kidney cancer is among the top ten (10) most common cancer affecting men in Singapore. It accounts for one (1) to two (2) percent of all cancers, or approximately 2.4 and 1.3 of every 100,000 men and woman respectively. It is mainly discovered in patients over the age of fifty (50), with nearly two-thirds of them being over sixty-five (65).
Kidney cancer is the fourteenth (14) most common cancer worldwide.
What are the Signs and Symptoms of Kidney Cancer?
The most common symptoms of Kidney Cancer are:
- Blood in the urine
- A mass in the abdomen
- A pain in the side that does not go away
- Loss of appetite or weight loss for no known reason
- Anaemia (low blood count
Screening for Kidney Cancer
Screening is used to look for cancer before you have any symptoms or signs.
Routine screening tests to detect early kidney cancer are not available. Doctors may recommend that patients with a high risk of the disease have imaging tests to look inside the body. For patients with a family history of kidney cancer, CT scans or renal ultrasounds are sometimes used to search for early-stage kidney cancer.
How Kidney Cancer is Diagnosed
Tests to diagnose Kidney Cancer include:
- Urinalysis: Urine is checked in the lab to see if there are blood or cancer cells in it.
- Blood Chemistry Tests:These tests show how well the kidneys are working.
- Complete Blood Count (CBC):This test measures the number of blood cells in the blood, like white blood cells, red blood cells, and platelets. Patients with kidney cancer often have low red blood cell counts. (This is called anemia).
- Chest X-Ray:X-rays may be done to see if the cancer has spread to the patient’s lungs.
- CT Scan: This is also called a “CAT scan.” It uses a special kind of x-ray that takes detailed pictures of the patient’s insides including kidney to see if there is any abnormal growth
- MRI Scan: This testuses radio waves and strong magnets instead of x-rays to make pictures that look at the soft tissue parts of the patient’s body. This test may be used to see the characteristics of the kidney tumor and to see if it has spread outside the kidney
- Ultrasound:Uses sound waves to make pictures of the inside of the patient’s body. This test can help show whether a kidney mass is solid or filled with fluid. Kidney cancers are more likely to be solid. If a kidney biopsy is needed, ultrasound can be used to guide a needle into the lump to take out some cells for testing.
- Kidney Biopsy: In a biopsy, the doctor takes out a small piece of tissue to check it for cancer cells. For most cancers, a biopsy is the only way to tell for sure if the patient has cancer. But a biopsy is not always needed as X-rays or scans are sometimes enough.
What are the Causes and Risk Factors of Kidney Cancer?
The following factors may raise a person’s risk of developing kidney cancer:
- Smoking:Smoking tobacco doubles the risk of developing kidney cancer. It is believed to cause about 30% of kidney cancers in men and about 25% in women.
- Gender: Men are two times more likely to develop kidney cancer than women.
- Age:Kidney cancer is typically found in adults and is usually diagnosed between the ages of 50 and 70.
- Nutrition and weight:Research have often shown a link between kidney cancer and obesity.
- High blood pressure: Men with high blood pressure (hypertension) may be more likely to develop kidney cancer.
- Chronic kidney disease:People who have decreased kidney function but do not yet need dialysis may be at higher risk for the development of kidney cancer.
- Long-term dialysis: People who have been on dialysis for a long time may develop cancerous cysts in their kidneys. These growths are usually found early and can often be removed before the cancer spreads.
- Family history of kidney cancer:People who have a strong family history of kidney cancer may have an increased risk of developing the disease.
What are the Types of Kidney Cancer?
The type of kidney cancer a patient has tells what type of cell it started in. These are the several types of kidney cancer:
- Renal Cell Carcinoma: Renal cell carcinoma is the most common type of adult kidney cancer, making up about 85% of diagnoses. This type of cancer develops in the proximal renal tubules that make up the kidney’s filtration system. There are thousands of these tiny filtration units in each kidney. These can be further divided into clear cell and non-clear cell carcinomas.
- Sarcoma: Sarcoma of the kidney is rare. This type of cancer develops in the soft tissue of the kidney; the thin layer of connective tissue surrounding the kidney, called the capsule; or surrounding fat. Sarcoma of the kidney is usually treated with surgery. However, sarcoma commonly comes back in the kidney area or spreads to other parts of the body.
- Lymphoma: Lymphoma can enlarge both kidneys and is associated with enlarged lymph nodes, called lymphadenopathy, in other parts of the body, including the neck, chest, and abdominal cavity. In rare cases, kidney lymphoma can appear as a lone tumour mass in the kidney and may include enlarged regional lymph nodes.
What are the Stages of Kidney Cancer?
Staging is a way of describing where the cancer is located, or if it has spread and whether it is affecting other parts of the body. The tests and scans used to diagnose the patient’s cancer will give some information about:
- the type of cell the cancer started in and where it began
- how abnormal the cells look under the microscope (the grade)
- the size of the cancer and whether it has spread (the stage)
The tumour is seven (7) centimeters or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
The tumour is larger than seven (7) centimeters and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
Either of these conditions are grouped under Stage 3:
- A tumour of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body.
- The tumour has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body.
Either of these conditions are grouped under Stage 4:
- The tumour has spread to areas beyond Gerota’s fascia (a fibrous envelope of tissue that surrounds the kidney) and extends into the adrenal gland on the same side of the body as the tumour, possibly to lymph nodes, but not to other parts of the body.
- The tumour has spread to any other organ, such as the lungs, bones, or the brain
One tool that doctors use to describe the stage is the TNM system. Results from diagnostic tests and scans are used to answer these questions:
- Tumour (T): How large is the primary tumour? Where is it located?
- Node (N): Has the tumour spread into the lymph nodes? If yes, where and how many?
- Metastasis (M): Has the cancer spread to other parts of the body? If yes, where and how much?
The results are combined to determine the stage of cancer of each patient and to plan the best treatment.
Here are more details on each part of the TNM system for kidney cancer.
The “T” plus a letter or number (0 to 4) is used to describe the size and location of the tumour.
TX: The primary tumour cannot be evaluated.
T0 (T plus zero): No evidence of a primary tumour.
T1: The tumour is found only in the kidney and is seven (7) centimeters or smaller at its largest area. There has been much discussion among doctors about whether this classification should only include a tumour that is five (5) cm or smaller.
- T1a:The tumour is found only in the kidney and is four (4) centimeters or smaller at its largest area.
- T1b:The tumour is found only in the kidney and is between four (4) centimeters and seven (7) centimeters at its largest area.
T2: The tumour is found only in the kidney and is larger than seven (7) centimeters at its largest area.
- T2a:The tumour is only in the kidney and is more than seven (7) centimeters but not more than ten (10) centimeters at its largest area.
- T2b:The tumour is only in the kidney and is more than ten (10) centimeters at its largest area.
T3: The tumour has grown into major veins within the kidney or perinephric tissue, which is the connective, fatty tissue around the kidneys. However, it has not grown into the adrenal gland on the same side of the body as the tumour. The adrenal glands are located on top of each kidney and produce hormones and adrenaline to help control heart rate, blood pressure, and other bodily functions. In addition, the tumour has not spread beyond Gerota’s fascia, an envelope of tissue that surrounds the kidney.
- T3a:The tumour has spread to the large vein leading out of the kidney, called the renal vein, or the branches of the renal vein; the fat surrounding and/or inside the kidney; or the pelvis and calyces of the kidney, which collect urine before sending it to the bladder. The tumour has not grown beyond Gerota’s fascia.
- T3b:The tumour has grown into the large vein that drains into the heart, called the inferior vena cava, below the diaphragm. The diaphragm is the muscle under the lungs that helps breathing.
- T3c:The tumour has spread to the vena cava above the diaphragm and into the right atrium of the heart or to the walls of the vena cava.
T4: The tumour has spread to areas beyond Gerota’s fascia and extends into the adrenal gland on the same side of the body as the tumour.
The “N” in the TNM staging system stands for lymph nodes. These small, bean-shaped organs help fight infection. Lymph nodes near the kidneys are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be evaluated.
N0 (N plus zero): The cancer has not spread to the regional lymph nodes.
N1: The cancer has spread to regional lymph nodes.
The “M” in the TNM system describes whether the cancer has spread to other parts of the body, called distant metastasis. Common areas where kidney cancer may spread include the bones, liver, lungs, brain, and distant lymph nodes.
M0 (M plus zero): The disease has not metastasized.
M1: The cancer has spread to other parts of the body beyond the kidney area.