Conditions Treated / Kidney Cancer
Kidney Cancer
Cancer of Kidney
According to the American Cancer Society, an estimated 51,190 people in the United States will be diagnosed with kidney cancer (31,590 men and 19,600 women) and about 12,890 people (8,080 men and 4,810 women) will die from this disease. As with all cancers, early diagnosis of kidney cancer dramatically improves the chance for survival. Although the prognosis is relatively poor for kidney cancer that is advanced (metastasized), promising new treatments are improving the outlook for patients.
Types
There are several types of kidney cancer. In renal cell carcinoma (RCC), which makes up approximately 85 percent of all cases, the tumor develops in the lining of the small tubes within the kidneys, where the blood is filtered and the urine produced. Less common is transitional cell carcinoma, which develops in the tissues that connect the kidneys to the bladder. Wilms’ tumor, a type of kidney cancer affecting children, accounts for approximately 6 percent of pediatric cancers.
Certain factors are associated with increased susceptibility to kidney cancer. Smokers are at a much higher risk – it’s estimated that as many as one in four kidney cancers are caused by smoking. Other risk factors include age (RCC is most common in adults 50-70), sex (men are diagnosed at twice the rate of women), a high-fat diet, obesity, high blood pressure, long-term dialysis treatment, exposure to certain chemicals in the workplace (including asbestos and cadmium), and a family history of kidney cancer (certain hereditary conditions such as Von Hippel-Lindau syndrome have been implicated).
Symptoms
The first symptoms of kidney cancer can include blood in the urine, fever, persistent fatigue, unexplained weight loss, and back pain just below the ribs or on the side. Unfortunately, by the time these symptoms are felt, the disease has usually progressed beyond the early stage. In addition to a medical history and physical exam, diagnostic tests include blood and urine studies; imaging tests including ultrasound and computerized tomography (CT) or magnetic resonance imaging (MRI); a cystoscopy to provide a view of the bladder, urethra and kidneys; and a biopsy. If cancer is found, these tests also help to determine the cancer’s stage – whether it is confined to the kidney, has spread to surrounding tissue or a nearby lymph node, or has moved to distant parts of the body.
Surgery and Treatment Options
Treatment options for kidney cancer after a diagnosis have expanded dramatically. When the kidney cancer is in the early stage, surgery can remove the affected kidney (radical nephrectomy), or may spare the kidney while removing the tumor. Such surgery can also be performed laparoscopically – a minimally invasive approach associated with less pain and more rapid recovery than the open surgery. For smaller tumors located at the outer edge of the kidney, laparoscopy can also be used to perform cryotherapy – freezing the tumor, under ultrasound guidance, to kill the cancer cells while preserving the normal tissue.
For advanced kidney cancer, surgery may be followed by immunotherapy – administering interleukin-2 or interferon to stimulate an immune response against the tumor. In addition, new targeted therapies (drugs that, unlike the more toxic chemotherapy, aim specifically at killing cancer cells without harming normal cells) represent a major advance with the potential to revolutionize the treatment of advanced kidney cancer. Since 2005, three targeted therapies have been approved by the U.S. Food and Drug Administration for treating advanced kidney cancer: Sunitinib (Sutent), and Sorafenib (Nexavar), and Temsirolimus (Torisel), and a fourth, Avastin, approved for treating colorectal and lung cancers, is also being tested for kidney cancer. There are numerous advantages to these newer therapies. They can be easily administered orally in the form of a pill. These treatments are generally well tolerated and produce fewer side effects than traditional therapies. Although these therapies have only been FDA approved for the treatment of metastatic kidney cancer; there are several clinical trials investigating their use as a treatment for high risk patients (patients who are identified as being at a higher risk of developing recurrent kidney disease) as well as in combination with immunotherapy.
For kidney cancer patients in whom surgery alone or in combination with one of the established medication regimens is not curative, enrolling in a clinical trial can offer hope by providing access to cutting-edge treatments. One closely watched clinical trial involves a genetic vaccine for kidney cancer patients, developed at UCLA and being tested through the National Cancer Institute’s Rapid Access to Intervention Development program. The goal of this novel tumor vaccine is to stimulate a patient's immune system to attack one's own kidney tumor. The treatment is based on the use of a patient's own immune cells that have been genetically engineered to express carbonic anhydrase IX (CA IX), a novel RCC-associated protein that is expressed in almost all RCC tumors but not in normal kidney tissue. Based on nearly 10 years of work, this treatment will soon be ready for patients on an experimental protocol being performed only at UCLA.
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