U.S. Health Watch

Copyright 2006 Radoslaw Pilarski

Kidney cancer is a malignant tumour developed from the kidney cells. Malignant kidney tumours account for 2-5% 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, mutagens or environmental factors are taken into consideration. It is usually diagnosed in people over the age of 45, however, recently, the reduction of the age limit of people who are diagnosed with kidney cancer have been observed, which is affected by the growth of influence of the environmental carcinogenic factors, as well as the spread and constant improvement of diagnosing possibilities. Cancers constitute 85% of kidney tumours. There are many types of kidney cancer. The most common type is a renal cell cancer. Kidney cancer is very dangerous mainly due to the fact that its symptoms occur in a late stage. It can cause the late detection of the tumour change – often in an advanced developing stage. Kidney cancer often develops in a tricky way without causing any disturbing symptoms. Early detection and correct diagnosis of the ill person require performing some or all the types of examination mentioned below. Diagnostic tests which allow to make a diagnosis include: urine test, blood test (morphology, concentration of urea’s creatinine), and imaging tests: ultrasound scan of the abdomen, computed tomography scan, alternatively urography (x-ray examination of the ureters after injecting intravenous dye), renal arteriography (the blood vessels examination using dye). Magnetic resonance imaging is sometimes used. A kidney biopsy, that is removing cells from the tumour and examining under a microscope whether the tumour contains the tumour cells is not usually performed. Currently, over 80% of kidney cancers are detected incidentally, usually due to an ultrasound scan performed as a standard procedure or due to other ailments. Therefore, advanced cancers of kidney parenchyma rarely occur (they constitute >15%).

Kidney cancer treatment

Surgery is a standard treatment for kidney cancer. It’s aim is to surgically remove the tumour, usually along with the kidney and lymph nodes containing the tumour, and, if possible, surgically remove single metastases if they occur. A chance of cure (6-year survival rate without the presence of metastases is considered a recovery criterion) depends on the stage of the disease (the tumour’s size, infiltration of the surrounding tissues, metastases to other organs), and accounts for up to 75%. However, in highly advanced stages, it is much lower. The presence of impossible to remove metastases worsens prognosis to a large extent. Used in the treatment of other cancers – chemotherapy and radiotherapy – are not very effective in treating kidney cancer. Better effects are achieved by using immuno or chemoimmunotherapy. However, they are effective only in some patients.

Chemoimmunotherapy consists in administering recombinant cytokine together with chemotherapeutic agent (so called the Hanover schedule). The attempts of using tumour infiltrating leukocytes or vaccines from the tumour cells are also made. The effectiveness of these methods in treating advanced forms of kidney cancer is estimated at dozen or so per cent, however, they are still under clinical research.

Side effects that can occur when using some of the chemoimmunotherapy trials.

The side effects mentioned below don’t include all the possible complications. Chemoimmunotherapy should be performed in medical centres experienced in conducting such treatment.

Side effects list:

Capillary leak syndrom

Hypotony occuring due to the capillary leak syndrom and appearing within few hours after treatment’s beginning can recede spontaneously. Some patients can require careful intravenous administration of fluids and albumins, and, in persistent cases, small doses of dopamine. When administering fluids intravenously, it is important to remember that the risk of lungs swelling is higher in patients with capillary leak syndrom when filling the vascular tissue. Before performing chemoimmunotherapy, all serum exudations should be cured (especially those concerning organs important to living, e.g. liquid in pericardium), because due to the capillary leak syndrome they can intensify when administering a drug.

Kidneys’ functional activity

In all patients, it is important to monitor parameters of the ionic and acid-alkaline balance due to the possibility of occurring renal failure with oliguria.

Respiratory system

During treatment it is important to monitor the functional activity of the respiratory system, especially in patients who in physical examination are diagnosed with the increase in respiration frequency or auscultation changes over lung fields. In some patients, in case of respiratory failure, it can be necessary to use forced respiration for some time.

Central nervous system

Side effects from the central nervous system (anxiety, confusion, depression), though reversible, can remain for several days after discontinuing treatment. Chemoimmunotherapy can intensify the symptoms related to the undiagnosed focuses of metastases in the central nervous system. If drowsiness occurs, the treatment should be discontinued. Further drug administration can lead to coma.

Digestive system

In case of gastric-intenstine symptoms, antiemetic or antidiarrhoeal drugs are administered if necessary.

Skin

In patients who are diagnosed with skin carcinomas with pruritus, administering antihistamine drugs brings relief.

Autoimmunological diseases

It is common knowledge that some of the administered drugs can intensify the coexisting immunological disease and complications threatening life (in some patients with Crohn’s disease treatment caused exacerbation of the disease requiring surgical intervention), however, not in all patients who suffered from such complications immunological disorders had previously been diagnosed. Therefore, it is recommended to strictly monitor treated patients, taking into consideration irregularities in the thyroid’s function and other possible immunological disorders.

Infection risk

Using chemoimmunotherapy can cause higher susceptibility to bacterial infections. That is why, before administering drugs, all the infection focuses should be cured, and patients with catheters placed to the central veins should be prophylactically administered with antibiotics.

Pregnancy and breast-feeding

It is recommended for chemoimmunotherapy not to be used in persons of reproductive age who do not use the approved contraceptive methods, in pregnant or breast-feeding women.

Driving and operating machines

Chemoimmunotherapy can cause side effects that reduce the ability to drive or operate mechanical devices. It is not recommended to drive during the treatment till the side effects of the drug completely recede.

You should inform your doctor about each case of occurring or suspecting the occurrence of the side effects.

The qualification of symptoms, assessment of the level of their intensification and method of proceeding depend on their decision.

Directly after the surgery, the patient receives intensive nursing and medical care.

The main problem is the possibility of extended effect of drugs taken under anaesthetic, and in consequences, of respiratory disorders, heart’s and arterial pressure’s functions. Therefore, in patients after surgeries these parameters are monitored. During the postoperative period, the body temperature and the amount of excreted urine are also measured.

Patients who were operated under general anaesthetic are usually administered with oxygen. Drips providing water and electrolytes are also administered, especially to the patients who cannot yet receive food and fluids orally. In the next days after the surgery, the patient can gradually pass on to oral feeding. The moment in which the patient can receive food and fluids must be consulted with a doctor.

Convalescence

Together with the patient’s complete awakening after the general anaesthetic the patient starts feeling pain in the postoperative wound. The moment of the pain occurrence should be reported to a nurse. The first dose of the painkiller is administered after reporting the pain occurrence by the patient, the next doses – in precise intervals dependant on the used drug..

During the postoperative period, nausea and vomiting sometimes occur. The occurrence of nausea and vomiting depend on the type of surgery, type of anaesthetic, sex and patient’s predispositions. The appearance of nausea and vomiting should be reported to the nurse. In some cases, the occurrence of vomiting can cause choking on the food, which is very dangerous.

During the convalescence after the surgery, the patient should sit and stand up as soon as possible. It is essential to avoid the potential complications caused by the respiratory system, as well as the risk of developing vein thromboses. If there are no surgical contraindications, the patient should sit on the second day after the surgery. In some patients, breathing exercises are additionally applied. In recumbent patients, there is a high risk of developing thromboses in veins. Especially in people with varicose veins. Such patients, before sitting or standing attempts, should move their legs in the recumbent position as much as they can in order to improve blood circulation.

After about 7 days from the surgery, the stitches are removed from the postoperative wound. The time of removing the stitches depends on the doctor’s assessment of the wound healing process.

In some people after surgeries, so called keloids (i.e.lesions developing in the scar area) may be formed. After several weeks (5-9) from the surgery, when the skin is accurately healed, the ointment preventing the formation of unsightly changes may be used.

After discharging from the hospital, the patient should call for the histopathological examination results. Usually, such results are available after 2-4 weeks from discharging from the hospital.

All patients after surgeries receive scheduled dates of check-ups in hospital clinics.

Usually after removing the tumour with the kidney, the diet with smaller amount of protein (reducing meat, cured meat, and cheese consumption) and drinking higher amount of fluids are advised. The range of physical activity depends on the patient’s efficiency.

Kidney cancer symptoms

The most important symptoms include:

– Blood in the urine

– Low back pain

– Perceptible lump in the abdomen

It’s essential to pay attention to the following symptoms:

– Loss of appetite and weight loss

– Subfebrile temperature or persistent fever

– Spermatic cord varices in men

– Sudden drop of urine amount

– Frequent infections of the urethras

– Sudden appearance of arterial hypertension