Source: Cancer Resource Room

What is Kidney Cancer (Renal Cancer)?
Kidney cancer has several names: renal cancer, renal cell cancer, or renal cell carcinoma. Cancer is a disease caused by a group of abnormal cells that grow and multiply without stopping. As these cells grow and multiply, they form a tumor. The tumor cells crowd out the normal cells. When normal cells get crowded out, there are fewer healthy cells left to do the job of that organ. Also, tumor cells can travel through the blood and lymph to other parts of the body and form more tumors. These are called metastases.

There are two kidneys, one on each side of the backbone, just above the waist. Cancer of the kidney can start in one or both of the kidneys. Kidneys have several important jobs:

• filter all the blood of the body many hundreds of times a day
• maintain the balance of water and vital salts needed by the body
• produce some important hormones related to water balance, blood-cell production, and calcium levels
• help control blood pressure

Kidneys are so important in keeping these processes in balance that there is a lot more kidney tissue than is absolutely necessary. This is an advantage if part of a kidney is injured or diseased. Kidney cancer comes from abnormal kidney cells that grow, double, and crowd out normal kidney tissue. As a tumor in the kidney grows and damages the normal kidney tissue, the rest of the kidney keeps working. We do not get sick if just part of a kidney is not working. But it also means that the damage can go unnoticed for a long time. The healthy kidney tissue continues doing the filtering and maintaining good health until the disease is discovered, often by chance.

How is kidney (renal cell) cancer found?
Renal cell is the most common form of cancer found in the kidney. Fewer than 10% of patients with renal cell cancer have symptoms of diseased kidneys. Renal cell cancer is most often found by chance. It is usually found while doing tests for routine health or to diagnose some problem in a patient’s abdomen. It could be found by a simple urine test that shows a microscopic amount of blood (blood in urine is called hematuria). Or in a CT scan of the abdomen that shows a lump growing in or on a kidney.

However, renal cell cancers are not always found by chance. Health problems that can be associated with kidney cancer include:

• blood in the urine
• anemia
• fever
• weight loss (without dieting)
• a high level of calcium in the blood
• persistent low back ache

What tests are used to diagnose renal cell cancer?
CT scanning of the abdomen is most often used to diagnose renal cell cancer. A CT scan shows the kidneys in many cross-sectional pictures. It can show both solid masses and hollow cysts. CT scans also show the lymph nodes in the area around the kidneys, and the veins leaving the kidneys. These veins can become clogged with cancer cells.

Ultrasound is helpful in showing whether the mass is hollow (cystic) or solid. Hollow or cystic masses are rarely caused by cancer. Solid masses are more likely to be cancer than noncancer. So if the CT scan shows a mass, but cannot determine if it is cystic or solid, an ultrasound is done. MRI is used to show the possible spread of tumor outside the kidneys, especially in a vein called the inferior vena cava (the largest vein returning blood from the body to the heart).
If a mass on a CT scan, ultrasound, or MRI looks like cancer, other tests will be needed to determine if the cancer has spread to other parts of the body. A chest X-Ray examines the lungs for any sign that the cancer has spread from the kidneys. A bone scan shows the entire skeleton, looking for metastases from kidney cancer. There is no blood test specifically for cancer of the kidneys. But blood counts and tests of substances made by the kidneys can show that cancer may be present.

A diagnosis of kidney cancer is nearly certain when there is blood in the urine and a solid mass in the kidney is shown by one of the imaging studies. These results are enough to plan an operation to remove some or all of the diseased kidney (usually all) to confirm the diagnosis. This operation is also the first step in treating the cancer. After the kidney is removed, a pathologist studies the cancerous tissue under a microscope. The cells of the cancer tissue have a particular appearance. The way the cells look allows the pathologist to make the diagnosis of kidney cancer. They can also see how different the cancer cells are from normal kidney cells. These pieces of information help the oncologist (cancer doctor) decide whether or not further treatment is necessary. Other treatments (after removal of the diseased kidney) include chemotherapy and radiation. The choice of treatment will depend upon the “stage” of a person’s disease.

What is the “stage” of kidney cancer?
Stage describes:

• how large the tumor is
• whether it has spread to tissues, blood vessels, or lymph nodes around the area of the kidney
• whether it has spread to many lymph nodes and to other parts of the body such as the lungs, bones, or brain.
  In general, the stages are grouped as follows:

Stage I: tumor is no more than 7 cm (about 3 inches) in size and no spread of disease is found.

Stage II: tumor is larger than 7cm but has not spread beyond the kidney.

Stage III: any tumor that has extended to one lymph node near the kidney, to veins leaving the kidney, or to the fat that surrounds and protects the kidney.

Stage IV: any tumor that has spread through the tissue around the kidney, to several lymph nodes, or to other organs.

When kidney cancer spreads to other organs (lungs, bones, brain) it is still kidney cancer, but it has started growing in a different location. It does not mean that the person now has more than one type of cancer. What changes is how treatment is planned.

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