Alternative names: Renal Cell Cancer, Renal Adenocarcinoma
Renal Cell Carcinoma (RCC) involves cancerous cells developing in the lining of a kidney's tubules and growing into a mass (tumor). In most cases, a single tumor develops, although more than one tumor can develop within one or both kidneys.
In the United States, kidney cancer accounts for approximately 3% of all adult cancers. According to the American Cancer Society at the time of writing, about 32,000 new cases are diagnosed and about 12,000 people die from the disease annually. Kidney cancer occurs most often in people between the ages of 50 and 70, and affects men almost twice as often as women.
Wilms' tumor accounts for about 6% of childhood cancers and is the most common type of kidney cancer in children. Incidence of Wilms' tumor is higher in girls younger than the age of 5 and in African Americans.
There are several risk factors associated with RCC:
Genetics. People with a family history of kidney cancer are at increased risk for RCC. It is suspected that inherited genetic mutations may be the cause, perhaps triggered by damage to the DNA that forms genes; cigarette smoke, for example, is known to contain chemicals that can damage the genes of kidney cells.
Other genetic mutations may cause two rare forms of kidney cancer. Von Hippel-Lindau syndrome is a disease that causes multiple tumors of the brain, spine, eyes, adrenal glands, pancreas, inner ear, testicles, and kidneys. Tuberous sclerosis is a disease characterized by small tumors of the blood vessels, which result in numerous bumps on the skin, mental retardation, seizures, cysts in the kidneys, liver, and pancreas and RCC.
The primary symptoms of RCC include the following:
Early diagnosis of kidney cancer is important. If a physician suspects RCC, a series of examinations, procedures and laboratory tests are performed to confirm the diagnosis. A thorough physical examination is performed to assess the patient's health and obtain information about symptoms and a medical history is taken to determine if there are risk factors for RCC. One or more imaging tests may be performed to obtain pictures of the kidney(s) and locate abnormalities. Some imaging tests require the injection of a special "tracer" material (dye or low-level radioactive isotope) into the patient's bloodstream. These tests include:
Laboratory tests may also be performed, including:
Blood tests to detect
Factors that are considered include the patient's age and overall health and the extent to which the cancer has spread. For example, a patient with one healthy, functioning kidney and one afflicted with an aggressive Stage 2 RCC is a more likely candidate for radical surgery than a patient with only one kidney and a less aggressive Stage 1 cancer.
Two or more forms of treatment may be used in combination, such as surgery to remove a primary tumor followed by radiation treatment or chemotherapy to kill cancer cells that may remain in the body.
As with most types of cancer, the earlier the tumor is discovered, the better a patient's chances for survival. Tumors discovered at an early stage often respond well to treatment. Survival rates in such cases are high. Tumors that have grown large or spread (metastasized) through the bloodstream or lymphatic system to other parts of the body are more difficult to treat and present an increased risk for mortality.
Renal cell cancer is unpredictable. It is the second most common tumor to undergo spontaneous regression following removal of the primary lesion; this occurs about 0.5% of the time. Another unusual characteristic of RCC is the variability in the growth of the primary tumor.
Once metastasis occurs, prognosis depends on the extent of the spread and the interval between appearance of metastases and the removal of the kidney.
Overall, the 5-year survival rate for RCC (all stages combined) is about 40-45%.
Close to 50% of all bladder and kidney cancer deaths in men are caused by smoking. Among women, 37% of bladder and 12% of kidney cancer deaths are directly attributable to smoking. The risk of developing these cancers is two to three times greater for both male and female smokers than that of the nonsmoking population. Cigarette smoke can interact with chemicals (especially aromatic amines) in the work place to produce bladder and kidney cancer. Workers exposed to organic chemicals in the dye, rubber, leather and paint industries that also smoke have a greater bladder cancer rate than would be predicted from either smoking or chemicals alone.
Radiation therapy alone has a relatively low success rate in treating RCC, and often produces unpleasant side-effects. It is used often as follow-up (adjuvant) treatment to destroy cancer cells that remain in the body after a radical or partial nephrectomy. It also may be used as palliative therapy to lessen pain or bleeding in patients with inoperable or widespread metastatic RCC. In such cases, there is no expectation of cure; the object is simply to ease the dying patient's discomfort.
Several surgical options are available to the patient and physician; which is most appropriate depends on the patient's condition and the cancer's stage. The most common form of surgery for RCC, radical nephrectomy involves removal of the entire kidney, often along with the attached adrenal gland, surrounding fatty tissues and nearby lymph nodes (regional lymphadenectomy), depending upon how far the cancer has spread.
It may be possible to remove only the cancerous tissue and part of the kidney if the tumor is small and confined to the very top or bottom of the kidney. A partial nephrectomy may be the procedure of choice for patients with RCC in both kidneys and for those who have only one functioning kidney. In additional to the standard risks of surgery, possible failure of the remaining kidney is something that should be considered.
Studies linking coffee consumption with cancer are conflicting and inconclusive at this point, but there is a suggestion of a higher incidence of cancers of the pancreas, ovaries, bladder, and kidneys in coffee drinkers.
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