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Kidney-Cancer


OVERVIEW OF Kidney-Cancer :

When a kidney cells grows out of control it is defined as the bladder cancer.


STRUCTURE of Kidney-Cancer :

  The nephrons are the functional unit of the kidney. The kidney consists of proximal convoluted kidney, distal convoluted kidney, collecting duct.  A nephron consists of the two parts namely the corpuscles and tubules. The tubules aids the kidney in monitoring the passasges of fluids and chemicals. The tubules includes the distal convoluted tubule, proximal convoluted tubule, loop of henle and the collecting duct. The cortex is the outer covering structure of the kidney. It leads to medulla where the renal pyramids are located. The renal pyramids consists of collecting ducts.

 

Types of bladder cancer:

Types of bladder cancer include:

 Renal cell carcinoma:

The renal cell carcinoma is the most common cause of the renal cancer. It is most commonly seen in the proximal convoluted tubule.

Urothelial carcinoma:

Urothelial carcinoma, previously called transitional cell carcinoma, occurs in the cells that line the inside of the bladder. Urothelial cells expand when your bladder is full and contract when your bladder is empty. These same cells line the inside of the ureters and the urethra, and cancers can form in those places as well.

Sarcoma:

It is seen in the soft tissues surrounding the kidney. Mainly it is seen capsule.

Wilms tumour:

This type of cancer is more common among the children when compared to an adults. It is best cure with the chemotherapy and radiation therpay.

Lymphoma:

It affects both the kidneys and also the lymph nodes surrounding it.

The following are the cells which makes up the cancer cells:

Clear cell:

About 70 % of the kidney cancer includes the clear cells. Immunotherapy and targeted therapy are  the most useful treatment.

Papillary:

It has subtypes into type 1 and type 2. Localized papillary carcinoma that it is defines to one specific site is often treated with surgery. If papillary kidney cancer spreads or metastasizes it is often treated with blood vessel blocking agents.

Medullary cancer:

It is highly aggressive cancer but it considered as renal cortical tumour. Combinations of chemotherapy and blood vessel inhibitors are commonly recommended treatment.

Collecting duct carcinoma:

It is similar to the urothelioma or transitional cell cancer and it is best treated with the chemotherapy.

Chromophobe:

It is the another uncommon cancer that may form tumours and are unlikely to spread. If it starts spreading then it leads in fatality of the patients.

Oncocytoma: it is rarely spreading tumour.

Angiomyolipoma:

It more commonly occurs in the blood vessels and muscles surrounding the renal system.


EPIDEMIOLOGY :

It occurs in the old indivduals


CAUSES :

  • Mutations that ocuurs in the cells
  • Genetics
  • Previous UTI
  • Voiding dysfunction
  • Smoking
  • Alcohol consumption
  • Being exposure to certain chemicals such as arsenic, leather and latex and paint products
  • Hypertension
  • Obesity
  • Treatment for kidney failure


PATHOPHYSIOLOGY :

 The two most common genes involved in the pathogenesis of RCC are the Von Hippel–Lindau ( VHL) gene and the protein polybromo-1 ( PBRM-1) gene, BRA1 asociated protein gene. These will be discussed separately in this article. The most common acquired risk factors for RCC are smoking, hypertension, obesity, chronic analgesic use, and diabetes 


COMMON CLINICAL SIGNS AND SYMPTOMS :

  • burning with urination
  • increased frequency of urination without passing much urine
  • increased urgency of urination
  • lethargy
  • bloody urine
  • cloudy urine
  • urine that looks like cola or tea
  • urine that has a strong odour
  • pelvic pain in women
  • rectal pain in men
  • constipation
  • pain during micturition
  • oliguria(small amount of urine in the increased time of interval)
  • loss of apetite


DIAGNOSTIC :

Tests and procedures used to diagnose bladder cancer may include:

  • Cystoscopy:

It is the small, narrow tube (cystoscope) through the urethra. The cystoscope has a lens and also it emits light and what happens in the inside of your urethra and bladder, to examine these structures for signs of disease.

Biopsy:

It is the procedure of removing the tissue from the kidney

In cystoscopic procedure , it has some specialized  tool through which the scope and into your bladder to collect a cell sample (biopsy) .

Examining a urine sample (urine cytology). A sample of your urine is analyzed under a microscope to check for cancer cells in a procedure called urine cytology.

  • Imaging tests. Imaging tests, such as computerized tomography (CT) urogram or retrograde pyelogram, are used to reveal the structures in the urinary tract.

During a CT urogram, a contrast dye is injected intravenously by the hand and eventually flows into your kidneys, ureters and bladder. X-ray images taken during the test provide a detailed view of your urinary tract

Retrograde pyelogram is an X-ray exam used to get a detailed look at the upper urinary tract. The threads a thin tube (catheter) through your urethra and into your bladder to inject contrast dye into your ureters. The dye then flows into your kidneys while X-ray images are captured.

Determining the extent of the cancer:

After determining  the above mentioned test the doctor might suggest the following diagnostic test:

Tests may include:

  • CT scan
  • Magnetic resonance imaging (MRI)
  • Positron emission tomography (PET)
  • Bone scan
  • Chest X-ray

Stages in the kidney cancer:

Stage 0:

The cancer is not spread but has potential development of the cancer in the future which is termed as carcinoma insitu.

Stage 1:

The cancer cells are consider to the localized area. This is also called the early stage cancer

Stage 2 and Stage 3:

It indicates that the cancer cell has spread to the nearby lymphnodes or tissues.

Type 4 :

It indicates that the cancer has spread to other parts of the body and also it easily gets metastasis. This is also called an advanced type of cancer.

 


TREATMENT AND PROGNOSIS :

Surgeries:

Surgery to remove part or all of the kidney is often used to treat renal cell cancer. The following types of surgery may be used:

 

 

 

Urinary diversion. If the bladder is removed, the doctor will create a new way to pass urine out of the body. One way to do this is to use a section of the small intestine or colon to divert urine to a stoma or ostomy (an opening) on the outside of the body. The patient then must wear a bag attached to the stoma to collect and drain urine.

 

Chemotherapy:

A chemotherapy is after the sugery or before the surgery to shrink the cancer cells. A chemotherapy is nothing but the delivery of drug intravenously

Radiation therapy:

It uses powerful x rays or emission of protons to destroy the cells. The radiation therapy also aids  in shrinkage of the cells and also relief the symptoms caused by the cancer.

Immunotherapy

it is a drug treatment that uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells from recognizing the cancer cells. This immunotherapy boos those cells and helps the body to fight against it.


PROGNOSIS :

The prognosis of cancer is good in its  first and second stages. But as the stages advance the prognosis is very bad. It might cause fatality of the patient.The five year survival rate for kidney cancer is 75%. But if the cancer stage crosses the 4th stage it might results in fatality of the patient


PREVENTION :

Take healthy diet

Drink lots of water

Avoid chronic exposure to chemicals

Be hygienic while voiding urine and during sexual practices

Avoid smoking

Avoid consumption of alcohol

Take lots of fiber containing fruits and vegetables

Don’t get stress.


Recovery Period :

It might takes 6 weeks to recover from the cancer after surgery.


Medicines used in the Treatment :

Nivolumab

Sunitinib

Pembrozolimab

Avelumab

Cabozantinib

Tivozanib

bevazizumab


REFERENCE :

https://www.mayoclinic.org/diseases-conditions/kidney-cancer/symptoms-causes/syc-20352664

www.niddk.nih.gov/.../kidneys-how-they-work

https://www.webmd.com/cancer/kidney-cancer-stages-prognosis

https://www.cancer.gov/types/kidney/patient/kidney-treatment-pd

https://news.cancerconnect.com/renal-cancer/top-medications-used-to-treat-kidney-renal-cell-cancer https://news.cancerconnect.com/renal-cancer/top-medications-used-to-treat-kidney-renal-cell-cancer