Kidney cancer

Kidney cancer is what medical practitioners call malignant tumors that occur in the kidneys. There are different types of kidney cancer. The most common is the renal cell carcinoma, which starts with certain cells in the kidney tissue. This article only deals with renal cell carcinoma.

Kidney cancer usually only occurs in one kidney; cancer in both kidneys is rare.

Doctors usually discover kidney cancer “by accident”, i.e. when they examine the abdomen for other medical reasons. The disease is then usually in its early stage and patients do not have any symptoms. Only when the disease advances can symptoms appear.

The following symptoms may indicate kidney cancer:

• bloody urine
• pain in the side of the back
• high blood pressure that has recently appeared
• swollen legs
• non-specific symptoms such as persistent high temperature, fatigue, and loss of weight

Some symptoms, such as swollen legs, high temperature, or loss of weight do not only occur with kidney cancer, but with other, benign conditions. If the symptoms persist over several weeks, a visit to the doctor is recommended. The doctor can start narrowing down what is causing the symptoms and, if necessary, initiate further diagnostic steps by specialists.

In terms of the causes of, and risk factors for, kidney cancer, the research differentiates between controllable and non-controllable factors. Doctors recommend avoiding controllable risk factors, such as smoking and obesity. If a person has high blood pressure, a good blood pressure level can reduce the risk of kidney cancer.

Non-controllable risk factors include a family predisposition, for example. Indicators of an inherited risk of disease may be:

• The age of the patient is 45 or below.
• Patients have tumors in both kidneys.
• Family members have or have had a kidney tumor.

People with indicators of an inherited predisposition should be given the opportunity of genetic counseling by a doctor. Various changes in the genetic makeup are known to be able to cause kidney cancer. They can be revealed by genetic testing. Anyone affected who has inherited this type of change can be offered tests to detect the cancer as early as possible.

However, there is no statutory nationwide screening program for kidney cancer in Germany.

When there is a suspicion of renal cell carcinoma, a range of diagnostic methods which complement one another are available to doctors.

To start with, there is always the basic diagnosis, which consists of the following elements:

• taking the patient’s case history, asking about pre-existing conditions, symptoms and family history
• physical examination
• determining blood values
• imaging methods such as ultrasound, computed tomography (CT), and magnetic resonance tomography (MRT)
• possibly taking tissue samples and conducting a histological examination

General Practitioners can take the first steps of a basic diagnosis themselves. Specialists such as urologists and radiologists are responsible for subsequent steps. Specialist outpatient clinics also have trained staff and the medical equipment required.

Tissue samples (biopsies) from the kidney tumor are not needed with all patients. If the diagnosis is relatively safe and the doctors plan to remove the tumor, some patients do not need to have a biopsy beforehand. However, if surgery does not seem to make sense, the urologist must take samples and confirm the kidney cancer by studying the tissue.

Would you like to know more about the various test methods? The website of the Cancer Information Service of the German Cancer Research Center has background information on the various diagnostic methods and how they work (in German).

Doctors treat kidney cancer in different ways, depending on the stage of the tumor. With renal cell carcinoma, a distinction is drawn between three stages:

• localized (early): the cancer is only growing in the kidney.
• localized advanced: the cancer cells are growing beyond the kidney, but they remain within the protective capsule (Gerota’s fascia).
• metastatic: the cancer cells are spreading through the Gerota’s fascia, for example to the adjacent kidney, or to other organs.

Treatment of early and localized advanced kidney cancer

If the cancer is growing inside the kidney or its protective capsule, doctors can usually remove the entire tumor with surgery. They generally try to preserve the kidney in such cases. This operation is the main therapy used to cure patients. However, a long-term cure is not always possible: with some patients the kidney cancer returns, for example in the kidney area or as metastases. There are then other therapy methods.

If surgery is not possible, for example for reasons of age, doctors can destroy the cancer tissue locally. Heat or cold can be deployed to destroy cancer tissue locally. Specialists refer to this method as ablation: however it is only an option for small kidney tumors, i.e. if they are no bigger than 4 cm.

Treatment of metastatic kidney cancer

If the renal cell carcinoma has spread, a cure is not usually possible. Then drugs that act on the body as a whole can keep the disease in check and alleviate symptoms. With these systemic therapies the doctors often combine various agents with one another. These include the following therapy methods:

• So-called targeted therapies: drugs are used to attack particular features of cancer cells. Healthy cells have little or none of these features.
• Immunotherapy: drugs stimulate certain of the body’s own defense cells to fight the cancer cells themselves.
• Supportive treatment methods: these include ways of alleviating adverse symptoms and improving the general quality of life.

Would you like to know more about the different treatment options for kidney cancer? The website of the Cancer Information Service of the German Cancer Research Center has more information on therapy for renal cell carcinoma (in German).

Cancer treatment can be both mentally and physically exhausting. Medical rehabilitation (rehab) after cancer therapy aims to help patients regain their strength. It also aims to help them deal with the consequences of the disease and treatment in the best possible way.

Rehab for kidney cancer patients is specialized, i.e. the program includes specialized urological care. In general, urological rehab is based around the person’s medical history, the specific therapy and the limitations that exist.

A urological rehab program after kidney cancer therapy may include:

• exercise therapy, possibly targeted physiotherapy to prevent abdominal weaknesses after the kidney surgery
• lifestyle advice, for example for the best possible maintenance of the kidney function
• nutritional advice and recommendations on drinking behavior
• options for learning relaxation techniques
• psychological support

What’s next? Aftercare, and kidney cancer checkups

Kidney cancer aftercare is intended to detect any recurrence at an early stage as well as any delayed effects of the treatment. Once treatment has been completed, patients are examined regularly, initially at short intervals, then at longer ones. The doctors ask about symptoms and examine the body, blood pressure and blood values. They also offer imaging procedures.

However, if patients have any problems they can also visit their doctor more often. If the cancer cannot be cured, regular follow-up checks will help to detect adverse symptoms at an early stage. The aim is to maintain the patient’s quality of life for as long as possible.

Many kidney cancer patients want to take an active part in contributing to their recovery. There are a number of ways they can do this. What can help them to cope better with the disease and the consequences of treatment depends on the individual situation:

• Exercise can help overcome fatigue and weakness. Patients should adjust this to suit their own capabilities.
• A healthy balanced diet, or nutritional therapy, can prevent or treat malnourishment.
• Psycho-oncological counseling can help to overcome worries and fears.

If it is no longer possible to cure the cancer and it is becoming more advanced, good medical and nursing care are very important. Adverse symptoms such as pain and breathlessness can be alleviated. And psychosocial support can help maintain quality of life for as long as possible.

Doctors with different specializations work closely together to treat kidney cancer. Hospitals that are particularly experienced in treating patients with kidney cancer can get certification to prove this. The German Cancer Society (DKG) regularly checks their compliance with certain professional requirements.

You can find the addresses of the certified centers on the OncoMAP website.

The urological university hospitals in Germany are listed on the Urologenportal (urologists’ portal) website, which is jointly operated by the German Society of Urology and the Association of German Urologists (in German).

Do you have further questions about dealing with the condition in everyday life and additional support options? The website of the Cancer Information Service of the German Cancer Research Center provides a wide range of information (in German).

You can also contact the Cancer Information Service directly on freephone 0800 - 420 30 40 or by e-mail at krebsinformationsdienst@dkfz.