Cancer in the Kidney
Kidney cancer is a malignant tumour developed from the kidney cells. Malignant kidney tumours account for 1-2% of malignant cancers in adults. Men are affected twice as often as women. The cause of kidney cancer is unknown, however, some genetic factors and damages of the kidney cell DNA caused by e.g. cigarette smoking or environmental factors are taken into consideration.
Kidney cells that develop a malignant tumor are called kidney cancers. In adults, malignant kidney tumours account for 2-5% of malignant cancers. Men have more cases of kidney cancers two times more than women. Some genetic factors and damages of the kidney cell DNA caused by e.g. cigarette smoking, mutagens or environmental factors are taken into consideration even though the cause of kidney is still unknown.
Usually, people who are diagnosed with kidney cancer are at the age 45 or above but recently the age limit is reduced, as have been observed. The age limit became younger due to the growth of influence of the environmental carcinogenic factors, as well as the spread and constant improvement of diagnosing possibilities. Eighty five percent of kidney tumours are constituted by the cancers. Kidney cancer has many types. Renal cell cancer is the most common type. The fact that its symptoms occur in a late stage makes kidney cancer very dangerous. Late detection of the tumor change often occurs - usually in an advanced developing stage. Without causing any disturbing symptoms, kidney cancer often develops in a tricky way. Some or all the types of examination mentioned below are required to be performed in order to have an early detection and correct diagnosis. Diagnostic tests that able to help making a diagnosis include:
- Urine test
- Blood test (morphology, concentration of urea's creatinine)
- Imaging tests (: ultrasound scan of the abdomen, computed tomography scan)
- Urography (x-ray examination of the ureters after intravenous dye injection )
- Renal arteriography (the blood vessels examination using dye)
Sometimes, magnetic resonance imaging is also used. Removing cells from the tumor and examining under a microscope or known as kidney biopsy, to check whether the tumor contains the tumor cells or not, is not usually performed. Usually, due to an ultrasound scan performed as a standard procedure or due to other ailments, over 80% of kidney cancers are detected incidentally. Thus, there is rare occurrence of advanced cancers of kidney parenchyma (they constitute >15%).
Treatment for kidney cancer
The standard treatment for kidney cancer is surgery. The purpose is to remove the tumor surgically, usually along with tumor-containing kidney and lymph nodes and if single metastases occur, they remove it too. The stage of the disease (the tumor's size, infiltration of the surrounding tissues, metastases to other organs) determine the chance of cure (6-year survival rate without the presence of metastases is considered a recovery criterion) and accounts for up to 75%. It is much lower in highly advance stages though. Mostly, prognosis is worsened by the presence of impossibility to remove metastases. Chemotherapy and radiotherapy are used in the treatment of other cancers but not very effective in treating kidney cancer. Immunotherapy or chemo-immunotherapy achieves better effects. In some patients, however, chemotherapy and radiotherapy are effective.
Chemo-immunotherapy is performed by administering recombinant cytokine along with chemotherapeutic agent which then called the Hanover schedule. Vaccines from the tumor cells or using tumor to infiltrate leukocytes are attempted to make as well. Approximately at dozen or so per cent, these methods are effective in treating advanced forms of kidney cancer. However, clinical research for it is still going on.
Side effects of the chemo-immunotherapy trials
All possible complications are not mentioned on side effects list below. Chemo-immunotherapy should be done in medical centers that are experienced in conducting such treatment.
List of side effects
· Capillary leak syndrom
Due to the capillary leak syndrom and appearing within few hours after treatment's beginning can recede spontaneously, hypotony occurs. Careful intravenous administration of fluids and albumins, and, in persistent cases, small doses of dopamine may be required for some patients. It is important to remember when administering fluids intravenously, that the risk of lungs swelling is higher in patients with capillary leak syndrome when filling the vascular tissue. All serum exudations should be cured (especially those concerning organs important to living, e.g. liquid in pericardium) before performing chemo-immunotherapy because due to the capillary leak syndrome they can intensify when administering a drug.
· Kidney's functional activity
Due to the possibility of occurring renal failure with oliguria, it is important to monitor parameters of the ionic and acid-alkaline balance in all patients.
· Respiratory system
It is important to monitor the functional activity of the respiratory system during treatment particularly in patients who are diagnosed with the increase in respiration frequency or auscultation changes over lung fields in physical examination. It can be necessary to use forced respiration for some time in case of respiratory failures for some patients.
· Central nervous system
Anxiety, confusion, depression are side effects from CNS that can remain for several days after discontinuing treatment, even though reversible. The symptoms related to the undiagnosed focuses of metastases in the central nervous system can be intensified by chemo-immunotherapy. The treatment should be discontinued if drowsiness occurs. It can lead to coma if the drug administration went further.
· Digestive system
Antiemetic or antidiarrhoeal drugs are administered if necessary if there are any gastric-intenstine symptoms.
Administering antihistamine drugs brings relief in patients who are diagnosed with skin carcinomas with pruritus.
· Autoimmunological diseases
Some of the administered drugs can intensify the coexisting immunological disease and complications threatening life, as commonly known. For example there is exacerbation of the disease requiring surgical intervention in some patients with Crohn's disease treatment. Nevertheless, not all patients have been previously diagnosed. Monitor treated patients, taking into consideration irregularities in the thyroid's function and other possible immunological disorders are recommended.
· Risk of infection
Susceptibility to bacterial infections will become higher when using chemo-immunotherapy. Thus, all the infection focuses should be cured before administering drugs and antibiotics should be administered prophylactically to patients with catheters placed to the central veins.
· Pregnancy and breast-feeding
In pregnant or breast-feeding women, chemo-immunotherapy is not recommended to be used.
· Driving and operating machines
The ability to drive or operate mechanical devices will be reduced while using chemo-immunotherapy. Driving is not recommended during the treatment until the side effects of the drug completely recede.
Inform your doctor about each case of occurring or suspecting the occurrence of the side effects. They will decide the qualification of symptoms, assessment of the level of their intensification and method of proceeding.
The patient receives intensive nursing and medical care directly after the surgery.
The possibility of extended effect of drugs taken under anesthetic which in consequences will affect respiratory disorders, heart's and arterial pressure's functions is the main problem. Thus, these parameters are monitored in patients after surgeries. The body temperature and the amount of excreted urine are also measured during the postoperative period.
Usually, patients who were operated under general anaesthetic are administered with oxygen. Particularly to the patients who cannot yet receive food and fluids orally, they also administered drips providing water and electrolytes. The patient can gradually pass on to oral feeding in the next days after the surgery. Patients should consult with a doctor the moment in which they receive food and fluids.
After the general anaesthetic, the patient starts feeling pain in the postoperative wound together with the patient's awakening. The patient should report to a nurse in the event of pain occurrence. After reporting the pain occurrence by the patient, the first dose of the painkiller is administered. In precise intervals, the next doses will be administered depending on the used drug.
Nausea and vomiting sometimes occur during the postoperative period. The type of surgery, type of anesthetic, sex and patient's predispositions determine the occurrence of nausea and vomiting. Patient should report to the nurse about the appearance of nausea and vomiting. The occurrence of vomiting can cause choking on the food in some cases, which is very dangerous.
The patient should sit and stand up as soon as possible during the convalescence after the surgery. Avoiding the potential complications caused by the respiratory system, as well as the risk of developing vein thrombosis is essential. The patient should sit on the second day after the surgery if there are no surgical contraindications. Breathing exercises are additionally applied in some patients. There is a high risk of developing thrombosis in veins in recumbent patients, especially in people with varicose. Before sitting or standing attempts, such patients should move their legs in the recumbent position as much as they can in order to improve blood circulation.
The stitches are removed from the postoperative wound after about 7 days from the surgery. The doctor's assessment of the wound healing process will determine the time of removing the stitches.
Keloids (i.e. lesions developing in the scar area) may be formed in some people after surgeries. When the skin is accurately healed, the ointment preventing the formation of unsightly changes may be used after several weeks (5-9) from the surgery.
The patient should call for the histopathological examination results after discharging from the hospital. Such results are usually available after 2-4 weeks.
Scheduled dates of check-ups in hospital clinics are received by all patients after surgeries.
The diet with smaller amount of protein (reducing meat, cured meat, and cheese consumption) and drinking higher amount of fluids are usually advised after removing the tumor with the kidney. The patient's efficiency will determine the range of physical activity.
Symptoms of kidney cancer
The kidney cancer has the most important symptoms which are low back pain, perceptible lump in the abdomen and blood in the urine.
The following symptoms are important to be noticed:
- Weight loss and loss of appetite
- Persistent fever or sub febrile temperature
- In men, spermatic cord varices
- Urine amount sudden drop
- Urethras frequent infections
- Arterial hypertension sudden appearance
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