Kidney cancer

The main cancer that can affect the kidney (90%) is renal adenocarcinoma, also called renal cell carcinoma or hypernephroma. Usually affect twice as many men as women, especially in patients between the ages of 40 and 60.

Others less common tumors that can affect the kidney They can be both malignant, such as rhabdomyosarcoma, fibrosarcoma, or renal metastases, or benign, such as cortical adenomas, angiolipomas, or oncocytomas.

How is it produced?

Renal cell carcinoma has several risk factors, such as tobacco smoke or toxic agents such as cadmium or asbestos. Likewise, it has been associated with two inherited pathologies, familial papillary renal cell carcinoma and Von Hippel-Lindau syndrome, as well as other phakomatoses less frequently.

In multiple cases, chromosome 3 alterations. On the other hand, a higher incidence of renal cell cancer has been observed in patients with polycystic kidney disease, with cystic disease secondary to chronic disease, and in kidneys with anatomical malformations.

The renal tumor usually originates at the level of the renal cortex and grows until invade perirenal fat and local nodes. From there it can generate metastases, mainly at the level of the lung, liver, bones or brain.

Symptoms

The classic presentation of the renal tumor is the presence of a mass at the level of one of the flanks accompanied by pain and hematuria. When all these symptoms occur, it is usually an already advanced disease. 30% of patients present metastases at the time of diagnosis, although in many cases they are diagnosed incidentally at the time of diagnosis. perform an abdominal ultrasound for other reasons in asymptomatic patients.

The hematuria is the most common alteration (It occurs in 60% of the cases). Also, a dull ache, weight loss, a feeling of occupation in the flank, fever, night sweats or high blood pressure may appear.

In rare cases, the tumor can produce hormonal secretion, such as parathyroid hormone, prostaglandins, prolactin, renin, gonadotropins or corticosteroids, which will give different manifestations depending on the hormone produced.

In advanced stages the tumor can occupy the renal vein, which if it is on the left side can cause appearance of an ipsilateral varicocele of sudden origin.

Diagnosis

The diagnosis of renal cell cancer should be suspected in patients who present symptoms compatible with it (feeling of occupation in the flank, hematuria, pain). A correct exploration It will allow us to see if there is a palpable mass at the level of one of the flanks or if there is a left varicocele.

The ultrasound is the initial imaging test, as it will allow to see if it is a simple cyst or a solid mass. If there are doubts and it cannot be classified as a clear simple cyst, a computerized axial tomography (CT) should be performed, which will allow us to see if it is a solid mass or not. Likewise, the CT scan will provide information on the involvement of the renal vein, the vena cava and the adjacent lymph nodes and organs. In any case, to assess the involvement of the adjacent vessels, it is provided with better information.

If the presence of metastases, the extension study will be based on a chest x-ray, a liver function study and, if suspected, a bone scan.

Sometimes, especially to plan surgery, a selective renal arteriography can be performed.

In the blood test, several disorders, such as anemia, hypercalcemia, or polyglobulia. One fifth of patients may present with liver enzyme abnormalities without liver metastases: this is known as Stauffer syndrome.

Treatment

Before a renal cell carcinoma With no lymph node involvement or distant metastases, the treatment option of choice is radical nephrectomy, including the adrenal gland. If possible, it will be performed by laparoscopy, which allows a faster postoperative recovery.

On special occasions, such as the bilateral involvement (extremely rare) or in single-kidney patients, a partial nephrectomy will be considered. Likewise, in the case of single, small tumors (less than 4 cm in diameter) and well located without involvement of the perirenal fat, some authors suggest the possibility of a partial nephrectomy, although there is a risk of local recurrence.

The Regional lymphadenectomy does not improve survival and it is only practiced to carry out the staging.

In the case of patients with disseminated disease, no intervention will be made and by palliative measures such as chemotherapy, radiation therapy, or immunotherapy. However, in the case of single, well-localized metastases, surgical removal of the metastasis may be considered. It should be noted that renal adenocarcinoma can lead to metastases and local recurrences (if partial nephrectomy has been performed) late, up to more than 10 years after nephrectomy.

Precautionary measures

There are few preventive measures to avoid renal cell carcinoma except quit smoking and try not to expose yourself to tobacco and other toxins such as the aforementioned cadmium or asbestos. In case of suffering diseases that may predispose to suffering it, such as certain phakomatosis, a periodic control should be done by means of an ultrasound.