kidney cancer

kidney cancer

Epidemiology. Tumors of the kidney in adults are found relatively infrequently, accounting for 2-3% of all neoplasms. The predominant age of patients is 55-60 years. Men suffer from kidney cancer 2 times The etiology of kidney tumors is not well understood. The appearance of atypical cells is promoted by chemical pollution of the environment, smoking, the use of hormonal products and cytostatics, radiation, virus carriers, nitrosamines and aromatic amines. In Hüppel-Lindau disease and polycystic kidney disease, a high incidence of kidney cancer has been noted. Genetic Aspects

• • There are several inherited forms of renal cell adenocarcinomas (see Appendix 2. Inherited disorders: normalized phenotypes)
  • Associations of individual forms with some HLA haplotypes were noted (Bw44, Dr8, W17)
  • Various chromosomal rearrangements have been registered
  • There are associations with tumors of other localizations (pheochromocytoma – Lindau’s disease, multiple hamartomas – Cowden’s disease).

Pathological anatomy. Most kidney tumors are clear cell carcinomas (adenocarcinomas). The following histological variants of renal cell carcinoma are distinguished

• • clear cell alveolar
  • Granular (dark cell)
  • Spindle cell (polymorphic cell, sarcomatoid, aggressive carcinosarcomas)
  • Glandular (adenocarcinoma).

TNM classification (see also Tumor, staging)

• • T0 – no evidence of a primary tumor
  • T, – the kidney is not palpable, the tumor is established on the basis of urography or angiography data
  • T, – the kidney is palpable, but easily displaced
  • T3 – the kidney is palpable, its turnover is limited
  • T, – an enlarged, completely immovable kidney is palpated.

Clinical classification of kidney cancer by stages

• • Stage I – tumor up to 2.5 cm, limited to the kidney
  • Stage II – tumor more than 2.5 cm; invasion no further than the perirenal tissue
  • Stage III – Tumor within Gerdt’s capsule, affecting regional lymph nodes, renal vein, or inferior vena cava
  • Stage IV – the tumor spreads beyond the Gerdt’s capsule; there are distant metastases.

clinical picture. Kidney tumor is asymptomatic for a long time

• • The classic triad – palpable tumor, gross hematuria, pain in the lower back or abdomen – is recorded in the late stages of kidney cancer and is observed only in 5% of cases. It is much more common to note 1 or 2 of

these symptoms

• • Hematuria is the most common finding, observed in 70% of patients, and in 45-50% of patients, hematuria is the first symptom of the disease, blood in the urine appears suddenly, without warning or pain.
  • Pain is noted in 60-70% of cases
  • An increase in body temperature can sometimes be the only symptom of a kidney tumor. Patients with fever of unknown origin should undergo a detailed urological examination.
  • Weight loss (in 30%)
  • Malaise, night sweats and anemia (15-30% of cases)
  • Paraneoplastic syndromes: hypercalcemia, polycythemia and arterial hypertension. Metastasis. Cancer tumors of the kidney are characterized by pronounced vascularization and rapid metastasis to the lungs, bones, liver, brain and other areas.
  • Lymphogenically, tumors metastasize to the paracaval, para-aortic lymph nodes and to the lymph nodes of the hilum of the kidney.
  • Most metastasis occurs hematogenously. In terms of metastases, the lungs are in first place, followed by the liver, bones, and brain.

Diagnostics

• • General urine test: detect hematuria
  • Cytological examination of urine is valuable in the diagnosis of tumors of the ureter and renal pelvis. Examine urine samples taken either after urination, or obtained during catheterization, or scrapings from the wall of the urinary tract taken during cystoscopy
  • Excretory urography is more accurate: reveals cup filling defect or amputation symptom
  • In the future, it is necessary to establish the origin of the filling defect. It is necessary to differentiate uroepithelial tumor from X-ray negative stones. A filling defect can result in blood clots and necrotic renal papillae.
  • Approximately 30% of the diseased kidney is not visualized on the urogram (radiologically silent kidney). A radiologically silent kidney may be a sign of tense hydronephrosis, which is easily confirmed by ultrasound or CT.
  • Retrograde ureteropyelography: reveal damage to the filling of the renal calyces; risky for infection
  • Ultrasound: detect the presence of tumor tissue (infiltrate that does not form a shadow). In addition, under the control of ultrasound, it is possible to perform targeted puncture biopsy of the tumor with the collection of material for cytological examination.
  • CT can differentiate very dense urate stones from tumors. The density of the tumor shadow does not change after intravenous administration of a contrast agent.
  • Ureteroscopy is an endoscopic procedure that allows examination and targeted biopsy of the affected area in the ureter.
  • Angiography of the kidney reveals tumor vascularization
  • Avascular tumors of the kidney – adenoma, adenocarcinoma
  • Hypervascular tumors – clear cell, polymorphic cell, dark cell
  • Determine the deformed configuration of the tumor, the depot of the contrast agent
  • Displacement of vessels by the tumor, arteriovenous fistulas, as well as arteries that additionally supply blood to adjacent tissues are detected.

Treatment. Radical nephrectomy with removal of lymph nodes is the treatment of choice for stage I, II, and III renal cell carcinoma.

• • Surgical access during operations – lumbotomy or laparotomy.
  • Nephrectomy is indicated in all cases where the tumor is technically resected and the other kidney is intact.
  • When lymph node involvement is minimal, complete removal of the kidney with affected lymph nodes is likely.
  • With a widespread lesion of the lymph nodes, surgical treatment is not radical
  • A renal vein affected by a tumor or containing a tumor thrombus must be removed
  • In some cases, selective renal artery embolization is recommended to stop life-threatening hematuria, followed by surgery.
  • In stage IV, only palliative surgery or symptomatic therapy is performed. Hormones and chemotherapy do not work. Immunotherapy (a-interferon) has some effect in 13-20% of patients with metastases to the lungs or soft tissues.
  • Solitary distant metastases are not a contraindication to nephrectomy.
  • The immobility of the tumor on palpation does not always indicate the improbability of its removal.

Forecast

• • I stage. 5-year survival – 67%, 10-year -49%
  • II stage. 5-year survival – 59%, 10-year – 34%
  • III stage. 5-year survival – 30%, 10-year – 19%
  • IV stage. 5-year survival – 7%, 10-year – 2%.

Synonyms

• • kidney cancer
  • Hypernephroma
  • Hypernephroid Carcinoma See also Tumors of the renal pelvis and ureter; tumor, radiation therapy; Tumor, markers; Tumor, methods of treatment; Tumor, ICD stage. C64 Malignant neoplasm of kidney