Diagnosis

Can Kidney Cancer Be Found Early?

Many kidney cancers are found fairly early, while they are still limited to the kidney, but others are found at a more advanced stage. There are a few reasons for this:

These cancers can sometimes grow quite large without causing any pain or other problems.
Because the kidneys are deep inside the body, small kidney tumors cannot be seen or felt during a physical exam.
There are no recommended screening tests for kidney cancer in people who are not at increased risk. This is because no test has been shown to lower the overall risk of dying from kidney cancer.

For people at average risk of kidney cancer

Some tests can find some kidney cancers early, but none of these is recommended to screen for kidney cancer in people at average risk.

A routine urine test (urinalysis), which is sometimes part of a complete medical checkup, may find small amounts of blood in the urine of some people with early kidney cancer. But many things other than kidney cancer cause blood in the urine, including urinary tract infections, bladder infections, bladder cancer, and benign (non-cancerous) kidney conditions such as kidney stones. Sometimes people with kidney cancer do not have blood in their urine until the cancer is quite large and might have spread to other parts of the body.

Imaging tests such as computed tomography (CT) scans and magnetic resonance imaging (MRI) scans can often find small kidney cancers. Ultrasound is less expensive and can also detect some early kidney cancers. One problem with these tests is that they can’t always tell benign tumors from small renal cell carcinomas.

Often, kidney cancers are found by accident (incidental) during imaging tests for some other illness or symptom. These cancers usually are not causing pain or other symptoms when they are found. The survival rate for these kidney cancers is very high because they are usually found at a very early stage.

For people at increased risk of kidney cancer

People who have certain genetic conditions such as von Hippel-Lindau disease have a higher risk of kidney cancer. Doctors often recommend that these people get regular imaging tests such as CT, MRI, or ultrasound scans at younger ages, to look for kidney tumors. Kidney cancers that are found early with these tests can often be cured.

It is important to tell your doctor if any of your family members (blood relatives) has or had kidney cancer, especially at a younger age, or if they have been diagnosed with an inherited condition linked to this cancer, such as von Hippel-Lindau disease. Your doctor may recommend that you consider genetic counseling and testing to see if you have the condition. Some doctors also recommend that people with kidney diseases treated by long-term dialysis or those who have had radiation to their kidneys in the past have regular tests to look for kidney cancer.

Imaging tests to look for kidney cancer

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests are done for several reasons, such as:

To look at suspicious areas that might be cancer
To learn how far cancer might have spread
To help determine if treatment is working
To look for possible signs of cancer coming back after treatment

Unlike most other cancers, doctors can often diagnose kidney cancer with fair certainty based on imaging tests without doing a biopsy (removing a sample of the tumor). Some patients, however, may need a biopsy.

CT
MRI
USG
ANGIOGRAPHY
PET / BONE SCAN

Kidney biopsy

Unlike with most other types of cancer, biopsies are sometimes not needed to diagnose kidney tumors. In certain cases, imaging tests can provide enough information for a surgeon to decide if an operation is needed. The diagnosis is then confirmed when part of the kidney that was removed is looked at in the lab.

In cases where the doctors think kidney cancer might have spread to other sites, they may take a biopsy of the metastatic site instead of the kidney.

Treatment

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The type of treatment(s) your doctor recommends will depend on the stage of cancer and on your overall health.

Stages I, II, or III

These cancers are usually removed with surgery when possible. There are two common approaches:

Partial nephrectomy (removing part of the kidney). This is often the treatment of choice in tumors up to 7 cm (a little less than 3 inches) if it can be done.
Radical nephrectomy (removing the entire kidney).

The lymph nodes near the kidney may be removed as well, especially if they are enlarged. This is done either with laparoscopy or robotic methods.

Hyperlink to robotic section

If cancer has grown into nearby veins (as with some stage III cancers), your surgeon may need to cut open these veins to remove all of cancer. This may require putting you on the bypass (a heart-lung machine) so that the heart can be stopped for a short time to remove cancer from the large vein leading to the heart.

Stage IV

Stage IV kidney cancer means cancer has grown outside of the kidney or has spread to other parts of the body such as distant lymph nodes or other organs.

Treatment of stage IV kidney cancer depends on how extensive the cancer is and on the person’s general health.

In rare cases where the main tumor appears to be removable and cancer has only spread to one other area (such as to one or a few spots in the lungs), surgery to remove both the kidney and the metastasis (the outside area of cancer spread) may be an option if a person is in good enough health. In certain cases, removing the area of spread can help people live longer. Radiation, instead of surgery, might also be an option to treat the area of cancer spread.

If the main tumor is still there, and cancer has spread extensively elsewhere, removing the tumor in the kidney is not recommended in most cases, as it had been in the past. This is based on recent information that shows the removal of the kidney, in this case, does not help people live longer. The first treatment choice would be systemic therapy, which might consist of two immunotherapy drugs, a targeted therapy drug with an immunotherapy drug, or a targeted therapy drug alone. It’s not clear if anyone of these therapies or any particular sequence is better than another, although the combinations of ipilimumab along with nivolumab and axitinib with pembrolizumab appears to be most helpful for people with advanced kidney cancer.

For some people, palliative treatments such as RT may be the best option. A special form of radiation therapy called stereotactic radiosurgery can be very effective in treating brain metastases. Surgery or radiation therapy can also be used to help reduce pain or other symptoms of metastases in some other places, such as the bones.

Chemotherapy

As in any other cancer, the treatment depends on the stage of the disease, the overall fitness of the patient including the presence of other medical illnesses and the tolerance during the treatment.

Renal cancers are broadly divided into clear cell carcinoma and non-clear cell carcinoma The treatment depends on this histological division as the response differs. Clear cell renal cell carcinoma has a good response to targeted therapy except in cases they have high-risk features like sarcomatoid histology.

The mainstay of advanced renal cancer is a systemic therapy. The usual drugs are targeted therapy, immunotherapy and very rarely chemotherapy. The target of drug action is mostly the Vascular Endothelial Growth factor receptor which is involved in Angiogenesis. Antiangiogenic agents include oral drugs like Sunitinib, Pazopanib, Axitinib, etc and intravenous agents like Bevacizumab are commonly used in advanced renal cancers. The medications are continued till there is disease progression. The usual side effects include hypertension, proteinuria, skin discoloration, hypothyroidism, etc.

In recent times, the role of immunotherapy in renal cell carcinoma has been established well. The current treatment of choice in the first line for renal cell carcinoma is Immunotherapy with anti-VEGF therapy. Immunotherapy acts to stimulate the human immunity against the tumour cells resulting in cell kill without the usual side effects of cytotoxic chemotherapy. They are given as 2 weekly or 3 weekly intravenous injections and tolerated well. The treatment is planned to be continued till disease control is maintained. The combinations of ipilimumab along with nivolumab and axitinib with pembrolizumab are approved as first-line therapy. They are also used as second-line after progression on first-line anti-angiogenesis agents.

In rare cases where the main tumour appears to be removable and cancer has only spread to one other area (such as to one or a few spots in the lungs), surgery to remove both the kidney and the metastasis (the outside area of cancer spread) may be an option if a person is in good enough health. In certain cases, removing the area of spread can help people live longer. Radiation, instead of surgery, might also be an option to treat the area of cancer spread.

The first treatment choice would be systemic therapy, which might consist of two immunotherapy drugs, a targeted therapy drug with an immunotherapy drug, or a targeted therapy drug alone. It’s not clear if any one of these therapies or any particular sequence is better than another, although the combinations of ipilimumab along with nivolumab and axitinib with pembrolizumab appears to be most helpful for people with advanced kidney cancer.

For some people, palliative treatments such as RT may be the best option. A special form of radiation therapy called stereotactic radiosurgery can be very effective in treating brain metastases. Surgery or radiation therapy can also be used to help reduce pain or other symptoms of metastases in some other places, such as the bones.

Road to recovery and aftercare (Diet and Nutrition)

Sticking to healthy habits is very important to lead a healthy life. Eating a balanced diet, getting good sleep, moderate drinking habits, no smoking, regular exercise, hygiene and cleanliness, etc are signs of healthy habits. It is important to follow all these habits to avoid major health consequences.

Living with kidney cancer makes life difficult and reduces appetite, so it is very important to watch one's daily eating habits. The diet during the treatment for kidney cancer should help the body cope up with treatments and stress. Here is the list of food items that can benefit the body during treatments of cancer.

Whole Grains and Starches - Food products which are high in iron, vitamin B and fiber such as whole wheat pasta, whole bread and wild rice increases energy levels in the body. Few whole grain products contain a good source of Potassium and Phosphorus in them. This helps in the functionality of the kidney. However, these food products need to be limited to a certain amount as they might increase the stress on the kidney's work process. Always consult an expert before consuming these products.

Fruits and Vegetables - Including fresh fruits and vegetables in your daily diet helps build a strong immune system. Fruits and vegetables are known for containing soluble fibers which help in maintaining healthy blood sugar and cholesterol levels. They also contain a high source of essential minerals and vitamins in them.

Proteins - Proteins are vital nutrients required to develop and maintain muscle mass in the body and need to be part of one's daily diet. Those suffering from kidney problems need to control the intake of proteins as they increase the stress on the kidneys' functionality. People diagnosed with kidney cancer should limit their protein intake to fewer portions as the waste produced from the food gets piled up in the bloodstream and causes severe problems.

Avoid food with high salt content - High intake of salt leads to high blood pressure which is caused due to imbalance in body fluid levels. This imbalance increases stress levels on the kidney and leads to kidney damage. Avoid food that contains high sodium such as canned food, deli meats, fast food and salty snacks. Instead, try replacing salt with spices and herbs to enhance the flavors and taste of food.

Avoid Food High in Phosphorus - Phosphorus is abundant in food items such as nuts, seeds, beans and processed bran cereals. It is an important nutrient that helps in maintaining bone strength. However, excessive intake of phosphorus while one has kidney cancer increases stress on the kidney. Phosphorus piles up in the bloodstream and reacts severely to cause symptoms such as joint pain and itchiness.

Avoid Overhydration - Drinking 8 to 10 glasses of water every day is healthy and ideal for everyone. Overhydrating yourself by drinking too much water can cause unnecessary stress to kidneys. It is important to monitor the amount of water consumed every day to avoid complications. It is recommended that kidney patients drink less water when compared to others as their kidneys are already under stress.

Diet During Treatment - Appetite is greatly reduced in patients diagnosed with cancer. It is important to eat a balanced diet with all nutrients that can help in quick recovery. Most often, cancer patients feel nauseous and lose interest in eating as their palettes have failed to identify the taste. These shouldn't be a reason to stop healthy eating habits. Here are a few tips that can help with eating better during cancer treatment.

Eat small portions of food in small intervals. This will maintain energy levels at all times.
Do not wait to be hungry. Have meals on time.
Cancer treatments weaken the immune system. Always rinse all fruits and vegetables before cooking or eating raw.
Stay cautious while eating outside. Avoid street food.
Ensure meat products are cooked well before eating.
Do not eat raw foods like shellfish, sushi and vegetable sprouts.
Do not drink unpasteurized juice or milk. Remember to boil milk before drinking.

Eating healthy food is the key to wellbeing. It is important to watch what you eat and avoid edibles that do not suit the body. Consult a dietician and nutrition to suggest foods that suit your body.

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