Kidney cancer is the third most common of the genitourinary system and represents approximately 3% of malignant diseases in adults. Kidney cancer is also known as hypernephroma or renal adenocarcinoma. The most frequent is clear cell kidney cancer, accounting for 85% of diagnosed tumours.
Kidney cancer usually affects individuals between 50 and 70 years of age, being twice as frequent in men than in women.
According to urologist in Dwarka, approximately 54% of the kidney tumours diagnosed today are confined to the kidney, 20% are locally advanced (affecting regional ganglia close to the kidney) and 25% already have metastases of the disease, mainly to the lungs, liver and bones.
Some risk factors for kidney cancer are known, including:
- Family history of the disease.
- Von Hippel-Lindau disease and dialysis.
6% to 10% of patients have flank pain, blood in the urine and a palpable abdominal mass. However, the most frequent form of diagnosis is incidental findings in routine examinations such as ultrasound of the abdomen.
The definitive diagnosis of the disease is made by ultrasound and computed tomography of the abdomen.
Tomography, in addition to making the diagnosis of the disease, is very useful in its staging (checking the extension to other organs) and in planning the most appropriate therapy, says the best urologist in Dwarka.
Chest radiography is used to assess the involvement of the lungs, and in some cases, it can be used for a more detailed assessment.
Nuclear magnetic resonance is rarely used in the evaluation of these tumours and is only performed in very specific situations.
Preoperative renal biopsy is usually not performed, and is only necessary in exceptional situations, in order to differentiate between malignant and benign lesions, which would not require treatment, explains urologist in Janakpuri.
The most important prognostic factors in kidney cancer, which assist in therapeutic planning and disease follow-up, are:
- Clinical internship.
- Histological graduation (Fuhrman degree).
- Histological type.
- Clinical status of the patient (“performance status”).
In order to be able to make adequate therapeutic planning, the performance status is fundamental for the type of procedure as well as it will be able to determine the response to the kidney cancer treatment. The other prognostic factors all refer to the volume of tumour existing at the time of diagnosis and the aggressiveness that certain tumours exhibit, explains the best urologist in Janakpuri.
Surgery is the only definitive curative kidney cancer treatment. Radical nephrectomy, ie the removal of the kidney en bloc with its linings, adrenal gland (only in large tumours or in the upper pole of the kidney) and regional lymph nodes in the traditional treatment for kidney tumours.
However, with the evolution of diagnostic methods and the increasingly early findings of small renal masses, radical nephrectomy, in most cases, is no longer indicated, and partial nephrectomy should be chosen. This type of treatment consists of removing the tumour with a small safety margin, thus preserving the rest of the renal parenchyma, explains urologist in Uttam Nagar.
The oncological results of partial surgery are similar to that of radical nephrectomy for selected cases of tumours smaller than 4 centimetres, less aggressive, and can even be applied to larger tumours as long as they are in a favourable anatomical situation.
Laparoscopic radical nephrectomy is a new method that can be applied in kidney cancer treatment, offering the same cure rates as open surgery. Among the advantages is the fact that it is a less invasive method, with less morbidity and shorter hospital stay, in addition to the aesthetic advantage (small holes instead of the large scar from open surgery).
It is possible to use laparoscopic surgery to perform partial nephrectomy, however in very selected cases, and with complication rates even higher than those of open surgery.
It is also worth mentioning the treatment methods for kidney cancer that lead to tumour destruction through freezing (cryotherapy) or heat (radiofrequency) and the minimally invasive methods using needles, indicated in special situations, says the best urologist in West Delhi.
In patients with advanced disease, with distant metastases, there are forms of systemic treatment with immunotherapy (interferon or interleukin) or with the use of drugs that inhibit angiogenesis. These drugs, associated or not with surgical treatment, can lead to disease control and regression.
According to a urologist in Delhi, the kidney tumour responds very poorly to chemotherapy treatments and radiation therapy. The only modalities that have proven objective responses are immunotherapy with interferon or interleukin with modest responses and high toxicity. More recently, angiogenesis inhibiting drugs have appeared, which have shown very promising response rates, being the main therapeutic option in patients with metastatic disease.