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A novel liquid biopsy method can detect kidney cancers with high accuracy, including small, localized tumors which are often curable but for which no early detection method exists, say scientists from Dana-Farber Cancer Institute.
The report in Nature Medicine suggests that if validated in larger trials and applied widely, the noninvasive test could find more early kidney cancers when they havent spread, thus reducing the mortality of the disease. Hopefully we can scale this to a much larger level and detect cancer earlier so we can act earlier, said Toni Choueiri, director of the Lank Center for Genitourinary Oncology at Dana-Farber and a co-senior author of the study.
It is estimated that 73,750 new kidney cancer cases will be diagnosed in 2020, and about 14,830 will die of the disease. About 35 percent of cancers are diagnosed only after they have spread beyond the kidney and are more difficult to treat. Small, early kidney tumors usually cause no symptoms, and increasingly are found incidentally in scans of the abdomen performed for another purpose. However, there is no imaging or other screening test recommended for the general population to look for early kidney cancers. Initially, a test based on the method described in the new report might be used to screen people with a family history of kidney cancer, or who had a previous kidney cancer, said Choueiri. We need to be specific first, before making it totally mainstream, he said.
Blood And Urine Tests For Kidney Cancer
To rule out other potential conditions, your physician will likely order several blood or urine tests. For instance, your physician may check your urine for the presence of albumin, measure the amount of creatinine in your blood and determine your glomerular filtration rate . This can help him or her determine how well your kidneys are working and also indicate whether another, more common condition might be the cause of your symptoms.
How Can I Prevent Kidney Cancer
Because doctors don’t know the causes of kidney cancer, it is not clear how to prevent the disease. However, certain factors are linked to kidney cancer, so you can take certain steps to lower your risk — quit smoking, maintain a healthy weight, manage your blood pressure, and avoid being exposed to harmful chemicals.
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How Can Kidney Cancer Be Detected Early
In many cases, kidney cancer isnt diagnosed until it has reached an advanced stage. This occurs because kidney cancer can grow without causing any noticeable symptoms, and because its often difficult to detect small kidney tumors during a physical examination given the kidneys location within the abdomen.
With this in mind, it would make sense that you would want to know how to detect kidney cancer as early as possible. As of now, the scientific community has not recommended any screening tests for individuals who have an average risk of developing kidney cancer. It should be noted, however, that a urinalysis can sometimes detect trace amounts of blood in the urine, which can be a sign of kidney cancer. Because a urinalysis is often performed as part of a routine physical examination, its important to regularly visit your medical provider for checkups.
Should I Get A Biopsy
A question that we hear all the time. There is a theoretical risk of bleeding or spreading the cancer with a biopsy, but this not why they are not widely used.
Unlike prostate, breast, or colon biopsies it turns out that biopsies of small kidney tumors are not as accurate as we would like.
As many as 20% of the biopsies are “false negatives”- in other words the biopsy says there is no cancer when indeed there is a cancer.
We still use them sometimes but it has to be in the right patient. Recent innovations in how we do the biopsies has allowed us to get more information than ever before. It remains, however, that a biopsy should only be obtained after a discussion with an expert on this disease!
Treatment options for patients with a small kidney tumor including active surveillance, ablation, partial nephrectomy, and total nephrectomy. In the vast majority of patients treatment of a small kidney tumor should result in saving the kidney. A quick decision to remove the kidney may not be the best treatment. Experience is critical in being able to save the kidney. In our section regarding treatment one can find details regarding these options.
At Johns Hopkins our surgeons are experts on all approaches and will help tailor the treatment to the patient. One size does NOT fit all.
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Advanced Or Recurrent Kidney Cancer Treatment
For people with advanced kidney cancer that has spread to other parts of the body, treatment with a drug may be recommended along with surgery, or instead of surgery. Some of these drugs are given to you as a pill that you take by mouth others are given as an injection. Much progress has been made in recent years, and people with advanced kidney cancer are living much longer than ten years ago.
- Medicine is often used for advanced kidney cancer that has spread to other parts of the body or where surgery cannot be done.
- Immunotherapy uses the bodys defense system to stop or slow the growth of cancer cells
- Monoclonal antibodies attack a specific part of cancer cells
- Checkpoint inhibitors help the immune system recognize and attack cancer cells
- Vaccines give an overall boost to the immune system
Diagnosis Of Kidney Cancer
Diagnosis is the process of finding out the cause of a health problem. Diagnosing kidney cancer usually begins with a visit to your family doctor. Your doctor will ask you about any symptoms you have and do a physical exam. Based on this information, your doctor will refer you to a specialist or order tests to check for kidney cancer or other health problems.
The process of diagnosis may seem long and frustrating. Its normal to worry, but try to remember that other health conditions can cause similar symptoms as kidney cancer. Its important for the healthcare team to rule out other reasons for a health problem before making a diagnosis of kidney cancer.
The following tests are usually used to rule out or diagnose kidney cancer. Many of the same tests used to diagnose cancer are used to find out the stage . Your doctor may also order other tests to check your general health and to help plan your treatment.
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What Are The Types Of Kidney Cancer
There are different types of kidney cancer, including:
- Renal cell carcinoma : This is the most common form of kidney cancer in adults and accounts for 85% of all kidney cancers. Renal cell carcinoma usually develops as a single tumor in one kidney, but it can affect both kidneys. The cancer begins in the cells that line your kidneys tubules . The most common type of RCC is clear cell renal cell carcinoma .
- Transitional cell cancer: Transitional cell carcinoma accounts for 6% to 7% of all kidney cancers. This cancer usually begins in the area where your ureter connects to the main part of your kidney. This area is called your renal pelvis. Transitional cell carcinoma can also occur in your ureters or bladder.
- Renal sarcoma: This is the least common form of kidney cancer, accounting for only 1% of kidney cancer cases. It begins in the connective tissues of your kidneys and, if not treated, can spread to nearby organs and bones.
- Wilms tumor: This is the most common type of kidney cancer in children. It accounts for about 5% of kidney cancers.
Coping With The Diagnosis
Being diagnosed with cancer can be very distressing. The news can be difficult to take in and make sense of.
Talking to your friends or family may help, although you might also find it useful to speak to a counsellor, a psychiatrist or other people in a similar situation to you.
Cancer UK has more information and advice on coping with kidney cancer.
Page last reviewed: 03 December 2019 Next review due: 03 December 2022
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What Usually Causes Kidney Cancer
Its not known exactly, but like other cancers, kidney cancer is caused by gene mutations that are either inherited or acquired during life. Some risk factors that have been identified include smoking, obesity, high blood pressure, and workplace exposure to certain chemicals. Family history also plays a role, and certain genetic conditions are associated with a high risk of kidney cancer.
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Diagnosed With Kidney Cancer
We understand the anxiety that a diagnosis of kidney cancer can bring to the patient and their family. The most important thingone can do is to learn about this disease and enlist the help of an experienced team of physicians.
About 1/3 of kidney cancers are diagnosed after the disease has spread to other organs.
The first step is to obtain a “staging” evaluation to determine the extent of cancer. This typically entails obtaining imaging of the chest, abdomen, and pelvis and comprehensive blood work. Bone scans and evaluations of the brain are obtained depending on symptoms and the results of the initial studies.
PET scans are rarely obtained due to their lack of sensitivity for detecting kidney cancer.
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How Is Kidney Cancer Diagnosed
Kidney cancer is usually diagnosed through a multi-step process. Typically, the first step is a clinical evaluation. Your physician will ask about any pain, fatigue, urinary issues and/or weight loss that you have recently started experiencing. He or she may also examine your abdomen for small, hard lumps near your kidneys.
Kidney Tumor With Suspicion Of Spread
You may have been told that the kidney cancer has spread. This could be to lymph nodes, the lungs, liver, bone, or even the vena cava â the largest vein in your body.
About 1/3 of patients find that the cancer has spread even without any symptoms.
For those with symptoms, you may have experienced abdominal or back pain, blood in the urine, bone pain, seizures, or even bad headaches. After a full evaluation of the extent of spread a treatment plan should be formulated.
This can get quite complicated and a multidisciplinary team who specialize in kidney cancer would be best to help with this. It is important that an urologist and medical oncologist collaborate in constructing an optimal plan for your care. This multidisciplinary approach is most important for cancers with a high suspicion of spread! This is because today there are numerous options and combinations for patients with metastatic kidney cancer.
These options can include:
Surgery – In certain settings, removal of the kidney even when the cancer has already spread has been shown to improve survival. This can often be done laparoscopically so the patient can recover rapidly and promptly receive additional therapy.
Immunotherapy – IL-2 can be a good option for some patients and can deliver excellent results for some patients. Interferon-alpha is another option.
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What Are The Treatments For Kidney Cancer
Once you have a diagnosis and know your stage of kidney cancer, you and your doctor can plan treatment. You may want to gather information to help you feel more informed about your decision. Your doctor may refer you to a specialist for treatment. This could include an urologist, a medical or radiation oncologist, or a surgeon. Before beginning treatment, many people find it helpful to get a second opinion about the diagnosis of kidney cancer and the treatment plan.
Kidney cancer is one of the more common cancers to undergo spontaneous regression, in which it may return to an eralier stage. However, the incidence is quite low .
There are several standard types of treatment for kidney cancer. In most cases, surgery is the first step. Even if surgery removes the entire tumor, though, your doctor may suggest an extra treatment to kill any remaining cancer cells that can’t be seen.
Surgery for kidney cancer
These are the main types of surgery for kidney cancer. Which type you have depends on how advanced your cancer is.
You can survive with just a part of one kidney as long as it is still working. If the surgeon removes both kidneys or if both kidneys are not working, you will need a machine to clean your blood or a new kidney . A transplant is possible if your cancer was found only in your kidney and a donated kidney is available.
If surgery can’t remove your kidney cancer, your doctor may suggest another option to help destroy the tumor.
Biologic therapy for kidney cancer
People At Average Risk
Typically, someone at average or low risk of kidney cancer wont undergo screenings. They discover the disease only if they go to a doctor for another medical issue or symptoms they dont believe are related to a serious disease.
Urinalysis This could detect small amounts of blood in a urine sample. Sometimes blood in the urine could result from kidney stones, urinary tract infections, or another medical problem. Even if someone does have kidney cancer, they might not have blood in their urine if the tumor is small or has not spread.
Imaging Magnetic resonance imaging and computed tomography scans could detect small forms of kidney cancer however, they are expensive. If you dont have health insurance, you could end up spending thousands of dollars. An ultrasound is a cheaper option and could discover an early type of kidney cancer. Unfortunately, imaging tests cant distinguish between benign tumors and renal cell carcinomas.
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People At Increased Risk
Anyone with inherited conditions is at a higher risk of developing kidney cancer and should undergo regular imaging testing to locate tumors and determine if theyre cancerous. Whether you get an MRI, CT, or ultrasound will depend on your specific situation. You can discuss this with your doctor to determine the best option and how often you should see them.
Your doctor might recommend genetic testing if any of your blood relatives were diagnosed with an inherited condition associated with cancer or kidney cancer, especially if they were young at the time. Genetic tests can detect gene mutations that lead to certain conditions in your DNA. It is only meant to diagnose inherited conditions, not to detect cancer. However, if you have an inherited condition, you could have increased risk of developing kidney cancer.
How Is Kidney Cancer Treated
Treatment depends on the type of cancer, the stage, and grade of the tumor, and the patients age and overall health.
Surgery is the most common treatment for kidney cancer. Several surgical options may be considered, including:
- Partial nephrectomy: The surgeon removes just the part of the kidney that contains the tumor.
- Radical nephrectomy: The surgeon removes the whole kidney and some of the tissue around the kidney. Some lymph nodes in the area also may be removed.
When one kidney is removed, the remaining kidney usually is able to perform the work of both kidneys.
Surgery is the treatment of choice for most stages of kidney cancer. For chemotherapy for kidney cancer, there are many relatively new agents that block the blood flow to the tumor and put it into remission. These medications are typically taken by mouth and are generally well tolerated. The other approach is to use medication that activates the bodys own immune system to fight the tumor.
Some people with kidney cancer participate in clinical trials. Clinical trials are research programs conducted with patients to evaluate new medical treatments, drugs or devices. Clinical trials also are being conducted on new chemotherapy drugs and on new ways to use biological therapy for patients with kidney cancer.
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Imaging Tests To Look For Kidney Cancer
Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests are done for a number of reasons, such as:
- To look at suspicious areas that might be cancer
- To learn how far cancer might have spread
- To help determine if treatment is working
- To look for possible signs of cancer coming back after treatment
Unlike most other cancers, doctors can often diagnose kidney cancer with fair certainty based on imaging tests without doing a biopsy . Some patients, however, may need a biopsy.
Kidney Cancer Risk Factors
As noted above, there currently arent any kidney cancer screening tests recommended for routine use among the general public. However, in cases where an individual has an especially high risk of developing this disease, a physician may regularly look for kidney cancer tumors using imaging tests such as ultrasounds, intravenous pyelograms , computerized tomography scans and magnetic resonance imaging scans . Risk factors for kidney cancer include:
- Von Hippel-Lindau disease
- A family history of kidney cancer
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Causes Of Kidney Cancer
The causes of kidney cancer are unknown. But there are certain things that can affect the chances of developing kidney cancer. These are called risk factors.
Having a risk factor does not mean you will definitely get kidney cancer. And if you do not have any risk factors, you may still develop kidney cancer.
Is It Possible To Prevent Kidney Cancer
Since the cause of kidney cancer is unknown, there isnt a definitive solution for preventing this disease. However, you might be able to reduce your risk of getting it by improving your overall health and taking certain precautions.
Quit smoking It is widely known that smoking can cause cancer and other types of diseases. You might be able to reduce your risk of kidney cancer if you quit. There are many options that could help you quit. This can be discussed with your doctor or while attending a support program.
Lower blood pressure Schedule an appointment with your primary care physician to check your blood pressure. If its high, there are lifestyle changes you could make to lower it. Dietary changes, weight loss, and exercise could all help. If necessary, your doctor could prescribe medication.
Maintain weight Obesity is a known risk factor for kidney cancer. If you are obese or overweight, you could try increasing your daily physical activity or cut high-fat foods out of your diet. A nutritionist or personal trainer could assist you with this issue.
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