KIDNEY CANCER TREATMENT INFORMATION
Where are the Kidneys Located?
People normally have 2 kidneys which are located below the ribcage at the level of the 2nd and 3rd lumbar vertebrae, in the "small of the back" region. The fight kidney is usually a little lower than the left one, since the right one is pushed down by the liver. The kidneys are "bean shaped" (hence "kidney bean") and the urine produced by each kidney is collected in a hollow area within the kidney called the "renal pelvis".
From the renal pelvis, the urine drains through the "ureters" which are tubes vach conduct the urine into the bladder. These structures are called the "collecting system" of the kidney. Each kidney is fed blood by a "renal artery"' and drained off by a "renal vein". The renal arteries come off the the "aorta", which arises from the heart and supplies the whole lower body with blood. The renal veins drain into Inferior vena cava, which then returns the blood to the heart.
There are small glands on the top of each kidney called the "adrenal gland". Each kidney and adrenal gland is surrounded by fat, called the "perinephric fat". The fat is then surrounded by a tough fibrous membrane, called "Gerotals Facia". This is important since the behavior of kidney cancers can often be gauged by whether they have invaded the perinephric fat or Gerota's Facia. Furthermore, like all major organs the kidneys have surrounding "lymph nodes", which are small bean-sized glands that filter the blood as part of the immune system. The outcome of kidney cancer also depends on whether these lymph nodes have been invaded by the disease, as will be seen.
What Do the Kidneys Do?
Obviously, the main function of the kidneys is to detoxify the blood; the toxins are diluted with water and then excreted out as "urine". Urine gets is name from "urea", which is a form of ammonia caused by the body's breakdown of protien; urea gives urine its characteristic smell. If this urea was not urinated out (such as will happen when the kidneys fail) it will build up in the bloodstream, causing "uremia". The symptoms of uremia are worsening fatigue which eventually lapses into a coma and causes death. Thus the excretion of urine is necessary for life.
While kidney failure used to always be fatal, machines than artificially do the kidneys work (called "dialysis filters") can now prolong life from many years in patients with kidney failure- but is is not as good as a real kidney. Dialysis takes a lot of time, is very expensive, and is prone to problems of infection and chemical imbalances in the blood. Some patients will get transplanted kidneys, (called "renal transplant") which eliminates the need for dialysis, if the transplanted kidney "takes" and is not rejected. Therefore, kidney failure today is often a treatable condition.
Besides for making urine, the kidneys control much of the chemical balance of the blood, and the amount of water it contains. Specifically, the kidneys monitor and control the acidity or "acid-base" (pH) balance of the blood. If the blood is too acidic, the kidney makes bicarbonate to restore the bloods pH balance. If the blood is to alkaline, then the kidney excretes bicarbonate into the urine to restore the balance. The kidney also filters out drugs into the urine, and senses the blood pressure to adjust the amount of water being urinated out. The adrenal glands on top of the kidney make hormones contolling sugar and fat metabolism. You can see that the kidney is a complex organ!
What is Kidney Cancer?
Normally, in an adult kidney cells divide rarely, to replace those lost to old age and injury, The division and growth of these cells is under tight control by the genes inside the cells. Kidney cancer starts when control of this division is lost, and so a cell starts to divide "out of control". Kidney cancer starts in just one cell. A change occurs in the genes of this cell which screws up its controls that prevent haphazard division, and it starts dividing like crazy, forming a tumor. A tumor simply means a swelling and is not necessarily cancerous. When the cells in the tumor just grow in their local area, and do not spread elsewhere, then the tumor is benign. However, when the tumor's cells have the ability to spread elsewhere in the body, this is a malignant (cancerous) tumor. A malignant tumor can metastasize (spread) to any area of the body, cause symptoms there, and eventually kill the patient.
Staging
After all of these tests are performed, the stage of the cancer is known. The staging of a cancer basically describes how much it has grown before the diagnosis has been made, documenting the extent of disease. This is often extremely important in terms of what treatment is offered to each individual patient. Before the staging systems are introduced, we will first describe some of the ways that cancers may grow and spread.
Cancers cause problems because they spread and can disrupt the functioning of normal organs. One way kidney cancer can spread is by local extension to invade through the normal structures. This initially includes the kidney, hence causing hematuria, a mass, and abdominal pain. If more growth occurs, cancer can grow to involve the main vein that leaves the kidney (the renal vein), the large vein that returns blood from the bottom half of the body to the heart (the inferior vena cava), or into other organs-most commonly the adrenal glands which sit atop the kidneys.
Kidney cancer can also spread by accessing the lymphatic system. The lymphatic circulation is a complete circulation system in the body (somewhat like the blood circulatory system) that drains into various lymph nodes. When cancer cells access this lymphatic circulation, they can travel to lymph nodes and start new sites of cancer. This is called lymphatic spread. Kidney cancer can spread, at times, into the lymph nodes surrounding the kidney, called the perirenal lymph nodes.
Kidney cancers can also spread through the bloodstream. Cancer cells gain access to distant organs via the bloodstream and cause distant metastases. Cancers of the kidney generally spread locally into the fat surrounding the kidney, the adrenal glands, or the veins prior to spreading via the lymphatic system or the bloodstream. However, tumors, especially larger tumors, can access the bloodstream and spread to the lungs and bones, most commonly. Kidney tumors have also been known to spread to the testis and ovaries through the testicular or ovarian veins that are in close proximity to the kidney.
The staging system used today in kidney cancer is designed to describe the extent of disease within the area of the kidney, in the surrounding lymph nodes, and distantly. The staging system most commonly used today to describe kidney tumors is the "TNM system", as described by the American Joint Committee on Cancer. The TNM systems are used to describe many types of cancers. They have three components: T-describing the extent of the "primary" tumor (the tumor in the kidney itself); N-describing the spread to the lymph nodes; M-describing the spread to other organs (i.e.-metastases).
The "T" stage is as follows:
For kidney (cortex) tumors:
* T1-tumor size of 7 cm or less and confined to the kidney
* T2-tumor size more than 7 cm, but still confined to the kidney
* T3a-tumor invading into the adrenal gland or just outside of the kidney
* T3b-tumor invading into the renal vein or inferior vena cava, but contained below the diaphragm
* T3c- tumor invading into the renal vein or inferior vena cava, and extending above the diaphragm
* T4-tumor invades outside of these areas
For medullary tumors:
* T1-tumor contained within the collecting system
* T2-tumor invades into the muscular layer of the wall of the collecting system
* T3-tumor invades into the fat surrounding the collecting system
* T4-tumor invades into other organs
The "N" stage is as follows for any subsite:
* N0-no spread to lymph nodes
* N1-tumor spread to a single lymph node
* N2-tumor spread to multiple lymph nodes or for collecting system tumors, lymph node spread that is between 2 and 5 cm
* N3-for collecting system tumors only, those lymph nodes that are >5 cm
The "M" stage is as follows:
* M0-no tumor spread to other organs
* M1-tumor spread to other organs
The overall stage is based on a combination of these T, N, and M parameters:
For kidney cortex tumors
* Stage I: T1N0M0
* Stage II: T2N0M0
* Stage III:
o T1-2N1M0
o T3N0-1M0
* Stage IV: and T4, any N2 or M1
For collecting system tumors
* Stage I: T1N0M0
* Stage II: T2N0M0
* Stage III: T3N0M0
* Stage IV: any T4, any N1-3, any M1
How Common is Kidney Cancer?
Each year in the U.S.A. there are 32,500 new cases of kidney cancer leading to 12,000 deaths from the disease. It represents about 2% of all new cancers and cancer related deaths. The average age at diagnosis is 60 years old, and men get kidney cancers twice as commonly as women. The number of cases diagnosed has risen slightly as better imaging techniques detect them more accurately. Sometimes the cancer is missed altogether, and only found incidently when an autopsy is done. About 1% of elderly patients will have some kidney cancer found at autopsy for some other condition, but the cancer never caused them problems in their lifetime. When a tumor is found in the kidney on an imaging scan (such as a CT scan), it has about a 60% chance of being cancerous. The remainder are benign tumors which may cause local symptoms, but will very seldom prove fatal.
Cancer from other areas of the body, particularly lung, can spread to the kidney or adrenal gland. Therefore, finding a cancer in the kidney does not prove that it originated there. About 25% of patients with lung cancer will have eventual spread of it to the adrenal glands overlying the kidneys. Likewise, kidney cancer can spread to other organs, and the kidney may not be recognized as the site where the cancer began.
What Causes or Increases the Risk for Kidney Cancer?
Like any cancer, the exact reason why one person gets kidney cancer and another does not is unknown. However, several factors have been noted which increase the risk for getting it.
The kidney is the blood chemistry and urine producing organ necessary for life. It detoxifies the blood. Besides maintaining the body's water level, it regulates the blood pressure. You can see that the kidney is essential for the maintaining the bodies basic chemical functions. The kidneys are very resilient, but when they fail they can lead to rapid demise of the patient. It has been said, "as go the kidneys, so goes the patient."
It is critical to get proper diagnosis and treatment for a kidney cancer problem, this can literally make the difference between life and death. Understanding your options with kidney cancer will give you the peace of mind knowing that you have done everything possible for a successful outcome for yourself or a loved one.
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