Our kidneys are remarkable organs which filter waste and excess fluids from our bloodstream to keep our body healthy. Hence, maintaining good kidney health is crucial for maintaining our overall well-being. Any abnormalities or diseases affecting these vital organs can have serious consequences.

Kidney Tumours – An Overview

Kidney tumours are abnormal growths that develop in the kidneys. These tumours can be benign (non-cancerous) or malignant (cancerous). Understanding the types of kidney tumours is essential to determine the appropriate diagnosis and treatment plan.

Types of Kidney Tumours

Kidney tumours can be of various types, the most common being:

Renal Cell Carcinoma (RCC)

Renal cell carcinoma, often abbreviated as RCC, is the most prevalent type of kidney cancer. It originates in the lining of the renal tubules, the small tubes within the kidney that filter waste from the blood to form urine. RCC accounts for about 85% of all kidney cancer cases.

Transitional Cell Carcinoma (TCC)

Transitional cell carcinoma, also known as urothelial carcinoma, affects the lining of the renal pelvis, ureter, or urinary bladder. While it primarily starts in the bladder, it can sometimes extend into the renal pelvis or ureter, causing kidney tumours.

Wilms Tumour

Wilms tumour primarily affects children and is one of the most common kidney tumours in paediatric patients. It typically occurs in children aged 3 to 4 years but can sometimes be found in older children or adults. Wilms tumours originate in the kidney’s embryonic cells and can grow quite large.

Oncocytoma

Oncocytoma is a benign tumour that usually doesn’t cause symptoms and doesn’t spread to other parts of the body. While it is non-cancerous, it may require treatment if it becomes too large or causes discomfort.

Angiomyolipoma

Angiomyolipoma is another benign kidney tumour composed of blood vessels, smooth muscle cells, and fat. It is usually harmless but can cause complications if it grows large enough or starts to bleed.

Risk Factors for Kidney Tumours

Understanding the risk factors associated with kidney tumours can help you take preventive measures and seek early detection. Common risk factors include:

• Age: The risk of kidney tumours increases with age, with most cases occurring in people over 45.
• Gender: Men are more likely to develop kidney tumours than women.
• Smoking: Tobacco use is a significant risk factor for kidney cancer.
• Obesity: Excess body weight, particularly in the abdominal area, increases the risk.
• Hypertension: High blood pressure is a known risk factor for kidney tumours.
• Family History: A family history of kidney diseases or kidney cancer can increase one’s risk.
• Certain Genetic Conditions: Conditions like von Hippel-Lindau disease and hereditary papillary renal cell carcinoma can raise the risk significantly.

Common Symptoms Associated with Kidney Tumours

Kidney tumours, whether benign or malignant, can exhibit various symptoms. However, it is important to note that early-stage kidney tumours often do not cause noticeable symptoms, which is why regular check-ups and screenings are important, especially for individuals with risk factors. Here are some common symptoms associated with kidney tumours:

Diagnosing Kidney Tumours

Early diagnosis of kidney tumours is crucial for effective treatment. Various diagnostic tools and procedures help healthcare professionals determine the presence, type, and extent of kidney tumours. Let us take a look at them.

Medical History and Physical Examination

A thorough medical history review and physical examination are often the initial steps in diagnosing kidney tumours. The healthcare provider will enquire about symptoms, risk factors, and family history while conducting a physical examination to check for any abnormalities or signs of tumours.

Imaging Tests

Imaging tests are instrumental in visualising the kidneys and detecting tumours. Common imaging modalities used for kidney tumour diagnosis include:

• Ultrasound – Ultrasound uses high-frequency sound waves to create images of the kidneys. It is a non-invasive and safe imaging technique, making it a common choice for initial screening.

• Computed Tomography (CT) Scan – CT scans provide detailed cross-sectional images of the kidneys, allowing for a more accurate assessment of the tumour’s size, location, and characteristics.

• Magnetic Resonance Imaging (MRI) – MRI uses powerful magnets and radio waves to create detailed images of the kidneys. It is especially useful for evaluating the extent of tumour invasion into surrounding tissues.

Biopsy

In some cases, a biopsy may be necessary to confirm whether a kidney tumour is cancerous. A biopsy involves the removal of a small tissue sample from the tumour, which is then examined under a microscope by a pathologist.

Blood and Urine Tests

Blood and urine tests can help assess kidney function and detect any abnormalities. Elevated levels of certain substances in the blood or urine, such as erythropoietin or parathyroid hormone, may be indicative of kidney tumours.

Kidney Tumour Prognosis

Several factors influence the prognosis of kidney tumours, including:

• Tumour Type: Different types of kidney tumours have varying prognoses. For example, renal cell carcinoma tends to have a better prognosis than other types.
• Stage: The stage of the tumour at diagnosis plays a significant role. Early-stage tumours are generally associated with better outcomes.
• Tumour Grade: The grade of the tumour indicates how abnormal the cancer cells appear under a microscope. Higher-grade tumours may have a worse prognosis.
• Patient’s Age and Health: A patient’s overall health and age can impact their ability to tolerate treatment and recover.
• Response to Treatment: The effectiveness of treatment and how well the tumour responds also affects prognosis.

Treatment Options for Kidney Tumours

The choice of treatment for kidney tumours depends on several factors, including the type of tumour, its size, stage, and the patient’s overall health. Here, we explore various treatment options for kidney tumours.

Active Surveillance

In cases of small, low-risk kidney tumours, active surveillance may be a viable option. This approach involves closely monitoring the tumour’s growth with regular imaging tests, such as CT scans or MRIs. Surgery or other treatments are considered if the tumour shows signs of growth or progression.

Surgery

Surgical intervention is the primary treatment for many kidney tumours. The type of surgery performed depends on the tumour’s size and location. Common surgical procedures include:

• Partial Nephrectomy – In a partial nephrectomy, only the tumour and a small portion of healthy tissue around it are removed, preserving as much of the healthy kidney as possible. This approach is often used for smaller tumours or when preserving kidney function is essential.
• Radical Nephrectomy – A radical nephrectomy involves the removal of the entire affected kidney. This procedure is typically performed for larger tumours or when the cancer has spread beyond the kidney.
• Laparoscopic or Robotic Surgery – Minimally invasive techniques, such as laparoscopic or robotic-assisted surgery, may be used for some kidney tumour removals. These approaches involve smaller incisions and generally result in faster recovery times.

Ablation

Ablation procedures are used to destroy kidney tumours without surgical removal. They may be considered for smaller tumours or for individuals who are not good candidates for surgery. Common ablation methods include:

• Radiofrequency Ablation (RFA) – Radiofrequency Ablation (RFA) is a minimally invasive treatment for tumours that uses high-frequency radio waves to destroy cancer cells while preserving healthy tissue. It is particularly helpful for patients with small tumours or those who are unfit for surgery. RFA involves inserting a needle into the tumour and delivering radiofrequency energy to cause cell death.
• Cryoablation – Cryoablation is a minimally invasive procedure used to treat small kidney tumours. It involves the use of extreme cold temperatures to destroy cancer cells in the kidney. During the procedure, a thin probe is inserted through a small incision near the tumour, guided by imaging techniques such as ultrasound or CT scan. The probe emits extremely cold gases or liquids that freeze and kill the cancer cells.

Targeted Therapy

Targeted therapy is a type of systemic treatment that uses drugs to target specific molecules or pathways involved in cancer growth. It is often used for advanced kidney cancer. Common targeted therapy drugs include sunitinib, pazopanib, and axitinib.

Immunotherapy

Immunotherapy helps the body’s immune system recognise and attack cancer cells. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, have shown promise in treating advanced kidney cancer.

Radiation Therapy

Radiation therapy uses high-energy X-rays or other radiation sources to kill cancer cells. It is not typically a primary treatment for kidney tumours but may be used to relieve symptoms or shrink tumours in specific cases.

Living with Kidney Tumours

A diagnosis of kidney tumours can be life-changing, and it often brings a host of physical, emotional, and practical challenges. Let us discuss some coping mechanisms that can help a patient or a caregiver deal with this diagnosis.

Coping Strategies

• Seek Support: Joining a support group or talking to a mental health professional can help navigate the emotional challenges of a tumour diagnosis.
• Healthy Lifestyle: Maintaining a healthy lifestyle, including regular exercise and a balanced diet, can contribute to overall well-being during treatment.
• Communication: Open and honest communication with healthcare providers is vital. Patients should feel comfortable discussing their concerns and treatment options.

Follow-up Care

Regular follow-up appointments with healthcare providers are essential to monitor the progress of treatment and check for any signs of recurrence. Patients should adhere to their recommended follow-up schedule and report any new symptoms or concerns promptly.

Lifestyle Adjustments

Kidney tumours and their treatments may necessitate lifestyle adjustments, including dietary changes and modifications to physical activity. Patients should work closely with their healthcare team to develop a personalised plan that suits their needs.

Sources:

• https://my.clevelandclinic.org/health/diseases/kidney-tumor
• https://www.hopkinsmedicine.org/health/conditions-and-diseases/kidney-renal-cancer-introduction
• https://www.healthline.com/health/kidney-cancer/kidney-cancer-prognosis-stage
• https://www.healthline.com/health/kidney-cancer/kidney-cancer-survival-rates-by-age
• https://www.cancer.org/cancer/types/kidney-cancer/after-treatment/follow-up.html