Renal Cell Carcinomas: All You Need to Know

by admin | May 5, 2022 10:52 am

Renal cell carcinomas refer to the tumors involving the kidney.

Incidental Detection

• The prevalence of renal cell carcinomas is on the rise and they are often detected by incidental means.
• This means that when the patient is being investigated for some other condition with scans and other diagnostic tests, renal cell carcinoma is detected. This is called incidental detection.
• The presence of a tumor in the kidney does not necessarily mean renal cell carcinoma for all patients.

Symptoms of Renal Cell Carcinomas

Other than the above-mentioned incidental detection of the carcinoma, patients can also present with the following symptoms.

• Blood in urine also called hematuria
• Flank pain or side back pain
• Loss of appetite/weight

When the tumor has spread to other parts like the lungs or bones, patients may report the following:

• Excessive cough
• Blood in sputum or blood in phlegm
• Bone pain

In advanced stages, when there is a blockage in the vein system, the following are reported:

• With male patients, varicocele is reported which is a condition in which the scrotum veins are swollen.
• Feet swelling is also reported.

Risk Factors

• People who smoke are at an increased risk of developing renal cell carcinomas. The number of years for which they have been smoking along with the number of cigarettes they smoke per day have a huge role to play.

Even if a person stops smoking, the risk factor will not come down to zero and they will always be more at risk compared to a person who has never smoked.

• Having chronic hypertension[1] (long-term increased BP levels)is another risk factor.
• Obesity[2] with increased BMI also plays a role.
• Certain syndromes increase the risk of renal cell carcinomas. Some such syndromes are Von Hippel Lindau syndrome, familial papillary RCC, familial hereditary RCC, etc.

Investigations

The patient will be asked to get some blood tests done along with urine test and CT scan.

• The blood test will check for kidney function, liver function, ESR, CBC, creatinine value, calcium in the blood, etc.
• Urine test will be done based on the individual patient’s presentation.
• Ultrasound scan will not be enough and a CT scan is often necessary to define the character of the tumor.
• The CT scan will involve the use of a contrast dye and the scan will be done before and after the dye is administered to check how the tumor reacts to the dye.
• The CT scan is a tri-phasic scan i.e., it will be done in 3 phases – the arterial phase, the nephrogenic phase and the excretory phase.
• An MRI will be done if the blood test shows the creatinine value to be high.

Purpose of Scans

• The scans are not only done to differentiate between a benign and malignant tumor but also to help determine the location and size of the tumor and to decide on the kind of surgery to be carried out (whether the kidney can be conserved).
• Another important reason for getting the scan is to determine the number of blood vessels affected by the tumor. More the number of blood vessels involved, more complicated the surgery becomes.
• Scan also helps to identify the presence of a clot in the inferior vena cava – this is very important as the staging of the tumor depends on it.

Treatment

The most important treatment modality for these tumors is surgery. Surgery can be of two types:

• Radical Surgery – Here, the whole of the involved kidney is removed.
• Conserving Surgery – Here, the non-tumorous part of the kidney is retained. The surgery is called partial nephrectomy and can be done laparoscopically. The tumorous part will be sent to the laboratory for further analysis. This will help in identifying the type of tumor and will also be useful for future management.
• After surgery, patient will have to come for regular follow-ups.
• In case of patients who present after the tumor has spread to nearby parts, immunotherapy will be advised.
• Cytoreductive nephrectomy will be advised for patients whose organs have also been affected. Here, the doctor will try to remove (as much as possible) the areas affected by cancer.

Some of the other treatment modalities are discussed briefly below:

• Radiation therapy[4] makes use of high energy waves to destroy cancer cells. The doctor will consider many factors like tumor size, location, health condition of the patient, etc. to decide on the kind of radiation therapy that will benefit the patient the most.
• Chemotherapy[5] given either in the form of tablets or as an IV can also be used to kill the cancer cells.
• Immunotherapy is another form of treatment which basically boosts the body’s immune system in its fight against cancer.
• In targeted therapy, drugs are given to kill the cancer cells alone, leaving the normal cells unharmed.

Recovery from renal carcinoma is dependent on how early the carcinoma is detected. A complete recovery is possible for patients who present in the early stages.

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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