|Classification and external resources|
The two most common types of kidney cancer are renal cell carcinoma (RCC) and urothelial cell carcinoma (UCC) of the renal pelvis. These names reflect the type of cell from which the cancer developed.
The different types of kidney cancer (such as RCC and UCC) develop in different ways, meaning that the diseases have different outlooks (or prognosis), and need to be staged and treated in different ways. RCC is responsible for approximately 80% of primary renal cancers, and UCC accounts the majority of the remainder.
In addition to renal cell carcinoma and renal pelvis carcinoma, other, less common types of kidney cancer include:
- Squamous cell carcinoma
- Juxtaglomerular cell tumor (reninoma)
- Renal oncocytoma
- Bellini duct carcinoma
- Clear-cell sarcoma of the kidney
- Mesoblastic nephroma
- Wilms' tumor, usually is reported in children under the age of 5.
- Mixed epithelial stromal tumor
Rarely, some other types of cancer and potentially cancerous tumors that more usually originate elsewhere can originate in the kidneys. These include:
- Clear cell adenocarcinoma
- Transitional cell carcinoma
- Inverted papilloma
- Renal lymphoma
- Carcinoid tumor of the renal pelvis
Cancer in the kidney may also be secondary, the result of metastasis from a primary cancer elsewhere in the body.
Location within the kidney
Kidney cancer originates in the kidney in two principal locations: the renal tubule and the renal pelvis. Most cancers in the renal tubule are renal cell carcinoma and clear cell adenocarcinoma. Most cancers in the renal pelvis are transitional cell carcinoma.
Signs and symptoms
The most common signs and symptoms of kidney cancer are a mass in the abdomen and/or blood in the urine (or hematuria). Other symptoms may include tiredness, loss of appetite, weight loss, a high temperature and heavy sweating, and persistent pain in the abdomen. However, many of these symptoms can be caused by other conditions, and there may also be no signs or symptoms in a person with kidney cancer, especially in the early stages of the disease.
Around 208,500 new cases of kidney cancer are diagnosed in the world each year, accounting for just under 2% of all cancers. The highest rates are recorded in Northern America and the lowest rates in Asian and African regions.
The United States' NIH estimates for 2013 around 64,770 new cases of kidney cancer and 13,570 deaths from the disease. In the UK, 8,757 people were diagnosed with kidney cancer in 2008, and the disease caused 3,848 deaths.
The most recent estimates of incidence of kidney cancer suggest that there are 63,300 new cases annually in the EU25. In Europe, kidney cancer accounts for nearly 3% of all cancer cases.
In the UK kidney cancer is the eighth most common cancer in men (5,377 new cases diagnosed in 2008), and the ninth most common cancer in women (3,380 new cases in 2008), giving a male:female ratio of over 3:2. The number of cases of kidney cancer in men in the UK has doubled from 7 per 100,000 to 14.8 per 100,000 between 1975-1977 and 2006-2008. In women the rates have more than doubled over the same period, rising from 3.2 to 7.5 per 100,000.
The incidence of kidney cancer is also increasing in the United States. This is thought to be a real increase, not only due to changes in the way the disease is diagnosed.
Risks and causes
Factors that increase the risk of kidney cancer include smoking, which can double the risk of the disease; regular use of NSAIDs such as ibuprofen and naproxen, which may increase the risk by 51% or may not; obesity; faulty genes; a family history of kidney cancer; having kidney disease that needs dialysis; being infected with hepatitis C; and previous treatment for testicular cancer or cervical cancer.
There are also other possible risk factors such as high blood pressure, which are being investigated by scientists.
Treatment for kidney cancer depends on the type and stage of the disease. Surgery is typically the mainstay of treatment and it usually doesn't involve chemotherapy and radiotherapy, as kidney cancers often do not respond to these treatments.
If the cancer has not spread, it will usually be removed by surgery. Sometimes this involves removing the whole kidney, which is called nephrectomy but most tumors are amenable to partial nephrectomy which is removing of the kidney tumor only and preserving the remaining normal kidney. Unfortunately, surgery is not always possible - for example the patient may have other medical conditions that prevent it, or the cancer may have spread around the body and doctors may not be able to remove it. There is currently no evidence that body-wide medical therapy after surgery where there is no known residual disease, that is, adjuvant therapy, helps to improve survival in kidney cancer.
If the cancer can't be cured with surgery, sometimes doctors may use other techniques such as cryotherapy (freezing the tumour away) or radiofrequency ablation (burning the tumour away). However these are not yet used as standard treatments for kidney cancer. Other treatment options include biological therapies (drug treatments that use natural substances from the body) such as Everolimus (Afinitor), Temsirolimus (Torisel), Sorafenib (Nexavar), Sunitinib (Sutent), and Axitinib (Inlyta), the use of immunotherapy including interferon and interleukin-2. Immunotherapy has the potential to induce complete remissions or durable partial remissions in some patients, although it works in only about 10 to 15% of patients.
In Wilms' tumor (a type of kidney cancer that affects children), chemotherapy, radiotherapy and surgery are the accepted treatments, depending on the stage of the disease when it is diagnosed. Other rare forms of kidney cancer are not discussed here.
IMA901 is used to treat patients with cancer of the kidneys. It is composed of ten synthetic tumor-associated peptides (TUMAPs), which activate the body's own killer T-cells against the tumor. Unlike chemotherapy, this process targets the body's immune responses and mobilizes them to attack the cancer.
The majority of kidney cancers reported in children are Wilms' tumors. These tumors can begin to grow when a baby is still developing the womb, and may not cause problems until the child is a few years old. Wilms' tumor is most common in children under the age of 5, but can rarely be diagnosed in older children or in adults. It is still not clear what causes most Wilms' tumors. The most common symptoms are swelling of the abdomen and blood in the child's urine.
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