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Where Does Kidney Cancer Usually Spread To First

What Side Effects Can I Expect And How Do I Manage Them

Kidney Cancer Canada “Ask the Expert” – Dr Jennifer Knox, Medical Oncologist

Common side effects associated with immunotherapy include diarrhea, shortness of breath, a persistent cough, or a skin rash. Common side effects linked with targeted therapy include fatigue, high blood pressure, mouth sores or nausea. Depending on what drug you are taking, there are various ways to manage the side effects, including reducing the dose, putting the therapy on hold, or prescribing other medications that can curtail the side effects. Its important to ask your doctor what to expect so you can let them know right away if you encounter any.

Types Of Cancers That Are More Likely To Go Undetected

Some cancers are more easily detected than others. For example, certain types of skin cancer can be diagnosed initially just by visual inspection though a biopsy is necessary to confirm the diagnosis.

But other cancers can form and grow undetected for 10 years or more, as one study found, making diagnosis and treatment that much more difficult.

This table provides an overview of common cancers that often display little or no symptoms early on, and how theyre typically detected and diagnosed:

Type of cancer

New Ultrasound Treatment Controls Pain From Kidney Cancer Bone Mets

How frequently do you hear about kidney cancer? Chances are, not very often. Yet kidney cancer is one of the 10 most common cancers. While more men than women are diagnosed with kidney cancer, nearly 64,000 new cases occur in the U.S. annually.

When kidney cancer is diagnosed early, 5-year survival rates are high. According to the Integrated Staging System developed by UCLA:

  • For patients with localized kidney cancer , 5-year survival rates were 97% for the low-risk group, 81% for intermediate-risk group, and 62% for the high-risk group.
  • For patients with kidney cancer that had spread to the lymph nodes or distant organs when it was first found, 5-year survival rates were 41% for the low-risk group, 18% for intermediate-risk group, and 8% for the high-risk group.

It is estimated that at the time of diagnosis, 20-50% of patients will be found to have kidney cancer that has begun to grow beyond the organ, or has already spread to distant locations.i

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How Is It Treated

Whenever possible, doctors use surgery to remove kidney cancer. When the cancer is in its early stages and hasn’t spread, doctors are often able to remove it all, and no further treatment is needed.

When surgery isn’t possible, or if the cancer is advanced, doctors may use:

When kidney cancer is found before it has spread, about 9 out of 10 people will live 5 years or longer.footnote 1 Doctors use 5-year survival rates to show the percentage of people still alive 5 years after treatment. Of course, many people live much longer than that. In fact, for many people, the cancer never returns.

After the cancer has spread beyond the kidney, how long a person lives usually depends on how much the cancer has spread. The more the cancer has spread, the lower the survival rate.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society or visit its website at www.cancer.org.

Impending And Pathologic Fractures

How Fast Does Kidney Cancer Spread

Any skeletal lesion may cause a pathologic fracture. Certain criteria for selecting patients for prophylactic fixation have gradually evolved. Early efforts were based solely on retrospective observations of pathologic fractures in the proximal femur and hip, as this area is related to significant morbidity and mortality.

The first set of combined guidelines for prophylactic fixation of proximal femur were presented in 1986 as: greater than 50% cortical destruction seen on CT, a lytic lesion of the proximal femur> 2.5cm in diameter and avulsion of the lesser trochanter . While these guidelines were helpful for lytic lesions of the femur, they failed to account for other patterns of mixed or permeative lesions and would not be readily applied to other sites. These guidelines could not account for the lesions suitable for nonsurgical managements and adjuvant therapy .

Mirels proposed a scoring system to recommend for or against the prophylactic internal fixation of impending fractures. It is based on four characteristics, site of lesion, nature of lesion, size of lesion and pain . All the features were assigned progressive scores ranging from 1 to 3. Prophylactic fixation is highly indicated for a lesion with an overall score of 9 or greater .

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What Is Kidney Cancer Again

Behind your gut sit two potato-shaped organs that filter your blood, make pee, and keep your blood pressure and red blood cell count in checkthese are your kidneys. If a solid mass forms inside these organs, then grows and spreads, its called a cancerous tumor. When tumors develop in the pipelines of the kidney that filter blood, the cancer is called a renal cell carcinoma , and thats what this guide will focus on.

There are a bunch of different renal cell carcinomas, depending on what the cancer cells look like under a microscope. The most common variety is called clear cell renal cell carcinoma , which shows up in about three-quarters of renal cell carcinoma patients.

Besides knowing what type of kidney cancer you have , youll also find out how far the cancer has progressed, or the cancer stage . When cancer cells spread and form tumors outside of the kidney, thats called metastasis, and is considered stage IV , or advanced kidney cancer.

Assessing The Extent And Spread

If you are found to have a kidney cancer then other tests are likely to be advised. These may include one or more of: a CT scan or magnetic resonance imaging scan of the abdomen and chest, a chest X-ray, kidney function blood tests and sometimes other tests. This assessment is called staging of the cancer.

The aim of staging is to find out:

  • How much the tumour in the kidney has grown and whether it has grown to the edge, or through the outer part of the kidney.
  • Whether the cancer has spread to local lymph glands .
  • Whether the cancer has spread to other areas of the body .

Finding out the stage of the cancer helps doctors to advise on the best treatment options. It also gives a reasonable indication of outlook . See the separate leaflet called Stages of Cancer for more details.

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Preparing For Your Treatment Visit

When it comes to creating a treatment plan, its important to stay informed. Before beginning treatment, the ACS recommends asking your care team the following questions:

  • What stage is my kidney cancer?
  • Where is it?
  • Has it spread outside my kidney?
  • Will I need more tests or surgery to find out the stage?
  • What are my treatment options?
  • What treatments do you recommend and why?
  • Whats the goal of treatment?
  • When will treatment start?
  • What can I do to prepare for treatment?

Expert

Bone Cells And Immune System

Kidney Cancer: Treatments for Kidney Cancer

A complex system of interaction exists between bone and body immune system at molecular level. This includes RANK, RANKL and natural decoy receptor osteoprotegerin . Higher serum ratio of RANKL/OPG promotes osteoclastogensis . Mikami at el . stated that expression of RANKL and RANK is directly related to stage of primary lesion and metastasis to bone and other organ.

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Bone Cells And Renal Cell Carcinoma

The pathogenesis of skeletal metastasis in RCC is same as for breast cancer. A vicious cycle exists between tumor cells and bone. Osteoclast activation due to presence of malignant cells lead to bone destruction with secretion of different bone-derived growth factors and cytokines which facilitate cancer cell proliferation and enhance tumor growth. These include transforming growth factor-beta , fibroblast growth factors , insulin like growth factors and bone morphogenic protein and many more. These factors not only stimulate the local growth of RCC cells but also circulate and stimulate remote metastatic growth . Tumor cells are responsible for release of prostaglandins, activated vitamin D, tumor necrosis factor , para-thyroid hormone and its related peptide, these activates osteoblast and stromal cells on bone marrow by interacting through RANKL system and ultimately stimulates osteoclast activity.

What Do The Kidneys Do

The kidneys have four main functions in the body:

  • To maintain fluid balance.
  • To remove waste products.
  • To control blood pressure.
  • To produce hormones needed to make blood and to maintain strong bones .

Blood passes through the kidneys to be cleaned before returning to the heart. Blood enters the kidneys through two vessels called renal arteries. Within the kidney are millions of tiny structures called nephrons. The nephrons are the actual filters that remove the waste products and fluid from the blood.

The kidneys also produce urine, which is made up of excess water and waste products filtered from the blood. The urine travels to the bladder through two tubes called ureters. The bladder empties urine from the body through another tube called the urethra.

The kidneys regulate blood pressure by controlling how much water is in the blood . More blood volume means the heart has more fluid to pump and there is more force against the walls of the blood vessels, which results in higher blood pressure. The kidneys control blood volume by secreting a special hormone and by changing the balance of certain chemicals in the blood. These chemicals include potassium and sodium.

The kidneys also produce several important hormones, including:

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Tnm Staging And The Stages Of Kidney Cancer

Kidney cancer is described in stages that the American Joint Committee on Cancer developed. The system is better known as the TNM system.

  • T refers to the tumor. Doctors assign a T with a number thats based on the size and growth of the tumor.
  • N describes whether the cancer has spread to any nodes in the lymph system.
  • M means the cancer has metastasized.

Based on the characteristics above, doctors assign RCC a stage. The stage is based on the size of the tumor and the spread of the cancer.

There are four stages:

  • Stages 1 and 2 describe cancers in which the tumor is still in the kidney. Stage 2 means that the tumor is larger than seven centimeters across.
  • Stages 3 and 4 mean the cancer has either spread into a major vein or nearby tissue or to lymph nodes.
  • Stage 4 is the most advanced form of the disease. Stage 4 means that the cancer has spread to the adrenal gland or has spread to distant lymph nodes or other organs. Because the adrenal gland is attached to the kidney, the cancer often spreads there first.

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What Is The First Sign Of Kidney Cancer

Kidney Cancer, What are the kidneys?, What is wilms
  • What Is the First Sign of Kidney Cancer? Center
  • When cells in the kidney become malignant or cancerous, they grow out of control forming a tumor, in one or both kidneys, resulting inkidney cancer. In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can occur rarely. Young children are more likely to develop a kind of kidney cancer called Wilms tumor. RCC accounts for 90 percent of all kidney cancers. The cancerous cells typically develop in the lining of very small tubes in the kidney, called tubules. Kidney cancer usually doesnt have signs or symptoms in its early stages. Sometimes, symptoms do not appear until cancer has spread to other parts of the body, usually the lymph nodes, lungs or ong bones.

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    If Kidney Cancer Spreads

      Cancer cells can spread from the kidney to other parts of the body. This spread is called metastasis.

      Understanding how a type of cancer usually grows and spreads helps your healthcare team plan your treatment and future care. If kidney cancer spreads, it can spread to the following:

      • lymph nodes around the kidney
      • the main vein in the kidney
      • the large vein in the abdomen leading to the heart
      • the other kidney
      • American Cancer Society. Kidney Cancer Stages. 2017: .
      • Lane BR, Canter DJ, Rin BL, et al. Cancer of the kidney. DeVita VT Jr, Lawrence TS, Rosenberg SA. Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2015: 63:865-884.
      • National Cancer Institute. Renal Cell Cancer Treatment Health Professional Version. 2018: .
      • National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology: Kidney Cancer . .

      Stage Iv Metastatic Kidney Cancer

      Metastatic kidney cancer is also referred to as stage IV the most advanced stage of cancer. At this point, cancer has invaded the lymphatic system and/or other organs, such as the brain, bones, or liver.

      Unfortunately, most types of kidney cancer are not recognized during the early stages when the tumor is small and confined to the kidney. Symptoms are mild and nonspecific until the cancer is far advanced.

      Up to 25 percent of people who are diagnosed with kidney cancer have cancer that has already metastasized, this according to one report from the Japanese Journal of Clinical Oncology. According to the American Cancer Society, the survival rate for Stage IV kidney cancer is 8 percent.

      People who survive stage IV kidney cancer more than five years do so because their metastases are isolated to one area and can be surgically removed. In general, metastatic cancer cannot be cured, but survival chances improve if the cancer is removable from the kidney and other organs.

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      Pathophysiology Of Tumor Metastasis

      Skeletal metastatic lesions are divided into three types: Osteolytic, osteoblastic and mixed. Activity of osteoclasts is responsible for osteolytic lesion and their activating mechanism varies according to different types of primary malignancies. Osteoclasts are derived from hematopoietic stem cells and mainly they resorb mineralized bone matrix by creating microenvironment and ultimately undergo apoptosis. In normal metabolism, bone micro-environment enhances osteoclast production by forming different molecules like macrophage colony stimulating factors and receptor activator of nuclear factor kB and its ligand by stromal cells, osteoblast, activated T-cells, tumor cells and osteoclast precursor cells. Bone metastases develop by occupation of bone erythropoietic system by cancer cells. Interaction of tumor cells and bone micro-environment induces immune cells to release factors that attract and stimulate osteoclasts thereby causing increased bone turnover and destruction .

      Why Kidney Cancer Doesnt Always Need Treatment

      Treating Kidney Cancer

      About 80 percent of the patients I see for kidney cancer are diagnosed while they are being treated for an unrelated reason. A patient may have a computed tomography scan or magnetic resonance imaging scan after a car accident, injury, or for another condition, and their doctor notices a growth on their kidney. A little more than half of these are stage 1 tumors, meaning the tumors are small, early-stage, and arent causing any symptoms. Generally speaking, these types of tumors arent a short-term threat to patients. They are slow-growing, and their risk of spreading at this stage is incredibly low.

      When a patient is diagnosed with kidney cancer in this early stage, we often dont need to treat it right away. In fact, many older patients dont need to be treated at all. Instead, many of my patients choose an option called active monitoring for their kidney cancer as opposed to surgery or other treatments.

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      What Is The Outlook

      The outlook is best in those whose cancer is diagnosed when it is still confined within a kidney and has not spread, and who are otherwise in general good health. Surgical removal of an affected kidney in this situation gives a good chance of cure. However, many people with kidney cancer are diagnosed when the cancer has already spread. In this situation a cure is less likely. However, treatment can often slow down the progression of the cancer.

      The response to treatment can also vary from case to case. This may be partly related to the exact subtype or grade of the cancer. Some kidney cancers, even some which are advanced and have spread, respond much better to immunotherapy than others.

      The treatment of cancer is a developing area of medicine. New treatments continue to be developed and the information on outlook above is very general. The specialist who knows your case can give more accurate information about your particular outlook, and how well your type of cancer and stage of cancer are likely to respond to treatment.

      How Fast Does A Kidney Cancer Tumor Grow

      4.8/5tumorcarcinomagrow fastercarcinoma

      Keeping this in consideration, is Kidney Cancer a slow growing cancer?

      Because of the slow-moving, slowgrowing nature of kidney cancer, there’s a much lower short-term risk to the patient than there may be with other cancers. Early detection of kidney cancer usually leads to the best outcomes. When we find it early in the disease process, there usually isn’t an urgent need for treatment.

      One may also ask, where does kidney cancer usually spread to first? Kidney cancer most often spreads to the lungs and bones, but it can also go to the brain, liver, ovaries, and testicles. Because it has no symptoms early on, it can spread before you even know you have it.

      Accordingly, how long can you live with stage 1 kidney cancer?

      The five-year survival rate for stage 1 kidney cancer is 81 percent. That means that out of 100 people, 81people diagnosed with stage 1 kidney cancer are still alive five years after their original diagnosis.

      How fast do cancer tumors grow?

      Scientists have found that for most breast and bowel cancers, the tumours begin to grow around ten years before they’re detected. And for prostate cancer, tumours can be many decades old.

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