Kidney Cancer
Other Renal Parenchymal Tumors
Tumors that arise in other organs may metastasize (spread) to the kidney. These are most commonly lung, breast and intestinal cancers. Lymphomas and leukemia can also affect the kidney. Biopsy may be indicated in these cases to differentiate these tumors from a primary renal carcinoma. Treatments of these tumors follow recommendations for treatment of the primary lesion.
Transitional Cell Carcinoma
Transitional cell carcinoma arises from the hollow part of the kidney. They are classified as either low grade (slow growing) or high grade (fast growing). There is a correlation of developing these tumors with cigarette smoking and aniline dyes. Taking large quantities of the pain medication phenacetin over a long period of time can also be associated with developing transitional cell carcinoma.
Symptoms
Patients usually present with blood in the urine (either microscopic or visual). If the tumor or blood clots block urine flow, flank pain can develop.
Treatment
Treatment is tailored for each situation. In some instances, the tumor alone can be removed. In other cases the entire kidney and ureter may need to be removed. In addition, chemotherapy may be indicated if there is spread of tumor.
Local Excision:
For low-grade small tumors, removal of the tumor may be sufficient for cure. This may be accomplished with an ureteroscope. This is a telescope that is placed through the water channel and passed to the tumor where it can be grabbed or cut with a laser or electricity. For some tumors a small hole needs to be placed in the back (<1/3 inch) and a telescope passed through the skin to allow tumor removal. Sometimes a tube is left in place to allow medicine to be dripped into the kidney weekly for up to six weeks to minimize the chance of recurrence.
Nephroureterectomy:
Nephroureterectomy is removal of the entire ureter and kidney. This can be done laparoscopically and is usually recommended for high grade and large tumors. Lymph nodes may also be removed during this surgery, but it is not necessary to remove the adrenal gland.
Follow up
Patients with a history of upper tract tumors have at least a 20% chance of developing a subsequent bladder tumor. As such, cystoscopy is recommended usually at 3-4 month intervals over the first 2 years following surgery and then increasing to every 6 months until 5 years following surgery when it becomes yearly. Periodic blood work, CXR and CT scans are also obtained at intervals depending upon the extent of the initial tumor. In patients who have had only the tumor removed, periodic x-ray studies as well as ureteroscopy is needed.
