Renal Cell Carcinoma (Hypernephroma) - Causes, Symptoms, Stages, Diagnosis, and Management

What Is Renal Cell Carcinoma or Hypernephroma?

As the name suggests, renal cell carcinoma is a cancer of the kidneys. The kidneys are a crucial organ of the urogenital tract. They are bean-shaped organs situated below the rib cage on either side of the body. The right kidney is at a lower level than the left because of the space occupied by the liver. The kidneys work to filter the blood, from urine, regulate the pH (potential of hydrogen) of blood, and maintain the fluid and electrolyte levels of the body. Kidney cancer or carcinoma occurs when the cells present in the kidneys divide rapidly. These cells might spread to the other organs and interfere with their functions. The kidneys consist of small tubules that work as filtration units. When the cancer-causing cells are present in the lining of these tubules, the condition is known as renal cell carcinoma. Although it is a serious condition, timely diagnosis and treatment help the patient survive the condition.

What Are Some of the Causes and Risk Factors of Renal Cell Carcinoma?

The exact cause of renal cell carcinoma is still unknown. However, scientists believe that there might be some defects in the genes of the kidneys. As a result, the kidney cells divide rapidly and give rise to renal cell carcinoma. Certain factors increase the risk of renal cell carcinoma. The risk factors are listed below:

1. Smoking - The exact mechanism by which smoking causes renal cell carcinoma is still unknown. However, smokers are at a higher risk of developing cancer compared to non-smokers because smoking induces gene mutations and cell damage.

2. Obesity - Excessive body weight or obesity increases the risk of kidney cancer. It is because fats increase the insulin levels of the body. If the insulin levels remain high for a prolonged period, the patient is likely to suffer from breast, prostate, and kidney cancers.

3. Hypertension - When the blood flows under high pressure (hypertension), there is a change in the functions of the kidneys. As a result, the kidneys become more vulnerable to carcinogens and tumor growth, resulting in cancer.

4. Family History - The risk of renal cell carcinoma increases if a family member has been diagnosed with it. There is a chance that the defective genes are passed on from the parents to their children.

5. Medications - The painkillers and anti-inflammatory drugs like Ibuprofen, Naproxen, and Celebrex have been consumed by people for a long time. The risk of kidney cancer increases when people become addicted to these drugs and misuse them. Prolonged use of these medications is not good for the kidneys.

6. Von Hippel-Lindau Disease - It is a condition in which the tumors and cysts form in multiple organs of the body. It is caused by mutations in the genes and increases the risk of renal cancer.

7. Dialysis - Patients suffering from chronic kidney disease need an artificial kidney machine known as dialysis to filter the blood. As the kidneys have failed to work in these patients, the risk of cancer increases.

8. Hepatitis-C - Hepatitis C virus forms abnormal proteins in the body, changes the structure of the cells, and causes kidney injury. These factors increase the risk of renal cell carcinoma.

What Are the Signs and Symptoms of Renal Cell Carcinoma?

The patient is unaware of the disease in the initial stages and does not present with any symptoms. However, the following signs and symptoms are noted in the later stages:

• Abdominal swelling.

• The patient feels tired throughout the day.

• Hematuria, or the presence of blood in the urine, is commonly seen.

• The patient presents with fever, nausea, and vomiting.

• Pain in the abdomen is commonly seen due to swelling.

• The patient does not feel like eating anything.

• Presence of severe pain in the sides and lower back that does not subside.

• The patient starts losing weight suddenly.

• Problems related to vision are seen in some patients.

• Women show excessive hair growth.

• Anemia might occur due to low red blood cell count.

What Are the Different Stages of Renal Cell Carcinoma?

After the patient has been diagnosed with renal cell carcinoma, the doctor assigns grades or stages to it. It helps to know the severity of the damage caused by the tumor and the treatment plan. Cancer spreads to the other body organs through the tissues, blood vessels, and lymph nodes. The stages or grades of cancer have been described in the table below:

How to Diagnose Renal Cell Carcinoma?

The diagnosis of renal cell carcinoma is based on the medical history, physical examination, laboratory, and imaging tests. The diagnostic methods have been described below:

1. Medical History - The medical history provides an idea about the general health of the patient, the symptoms of the condition, the time of their onset, and the family history. The medical history provides the doctor with a better understanding of the health of the patient.

2. Physical Examination - The doctor examines the patient to check the physical signs of renal cell carcinoma, like abdominal pain and the presence of a lump or mass in the abdomen. The vitals like blood pressure, respiratory rate, pulse, and temperature are also measured to check the other symptoms.

3. Laboratory Tests - The following laboratory tests are usually recommended to know about the general health of the patient:

• Blood Test - The doctor recommends the patient undergo a blood test to know about the general health of the body and if any other infection is present in the body. The patients suffering from renal cell carcinoma have high blood calcium levels and a reduced number of red blood cells.

• Urinalysis - The patient collects the urine in a container or a sterile bag provided by the hospital. The urine sample is then sent to the laboratory for examination under a microscope. It is done to detect blood, bacteria, white blood cells, and stones in the urine.

4. Imaging Tests - The following imaging tests are usually recommended to check the spread of cancer:

• Ultrasound - It is an imaging test in which the sound waves are sent to the body to obtain images of the internal organs. The doctor moves a device known as a transducer over the abdomen of the patient. The images are obtained on the computer screen. These images help to detect the problems present in the kidneys, including tumors.

• Computerized Tomography (CT) Scans - In this procedure, the patient is laid on a table that slides into a tunnel-like device where the X-rays are taken at different angulations. A dye can be injected into the body before taking X-rays to obtain more clear images. It is commonly used to diagnose tumors because it provides three-dimensional (3D) images of the kidneys and other organs.

• Magnetic Resonance Imaging (MRI) Technique - As the name suggests, this technique uses magnetic fields and radio waves to produce images of the organs. It is one of the most effective imaging methods used commonly to diagnose renal cell carcinoma.

• Chest X-Ray - The X-ray machine is positioned near the chest of the patient to obtain the images. A chest X-ray is taken to check if cancer has spread to the lungs or not.

• Bone Scan - It is a procedure done to check if the cancer cells are present in the bones. Radioactive material is injected into the body through the veins and scanned as it flows into the blood. If cancer cells are present, radioactive materials get collected in the bones.

5. Biopsy - In this procedure, the doctor inserts a needle into the body to obtain a tissue sample. Next, the sample is examined in the laboratory under a microscope to detect the cancer cells.

How Is Renal Cell Carcinoma Managed?

There are different types of treatment options available to treat renal cell carcinoma depending upon the stages. Some are under trial, while some of them are used commonly. The treatment options for renal cell carcinoma have been described below:

• Surgery - Surgical intervention is required when cancer spreads from the kidneys to the lymph nodes and adrenal glands. The person can easily survive with one kidney but needs dialysis or a kidney transplant if both the kidneys have been removed surgically. The surgical methods used to treat renal cell carcinoma have been described below:

  • Partial Nephrectomy - It is a procedure in which the tumor, along with a small part of the kidney, is removed. The surrounding tissues that have got infected are usually removed. If the patient is surviving on only one kidney and the cancer is in the initial stage, a partial nephrectomy is done.

  • Radical Nephrectomy - In this procedure, the kidneys and the surrounding tissues are removed along with the ureters, lymph nodes, and adrenal glands. The patient is left with one kidney that works to filter the blood and carry out other functions.

  • Simple Nephrectomy - It is a procedure in which both the kidneys are removed.

  • Arterial Embolization - First, a small tube, known as a catheter, is inserted into the blood vessel that supplies the kidneys. Next, the gelatin sponge is injected into the blood vessel through the catheter. This sponge does not allow the blood and oxygen to reach the cancer cells present in the kidneys. As a result, the tumor shrinks due to the failure of the growth of cancer cells.

  • Dialysis - It is a procedure in which the blood is filtered through an artificial kidney machine and sent back to the body. The person suffering from chronic kidney disease needs to be on dialysis.

  • Kidney Transplant - If both the kidneys have been removed due to cancer, the kidney is transferred from the healthy person to the diseased. The patient can survive if one of the kidneys is working.

• Radiotherapy - Radiation therapy is a procedure used to kill or inhibit the growth of cancer cells. The patient is laid on a table, and an X-ray machine is positioned over him. The machine moves around the patient and emits high-energy radiation that passes through the body to kill cancer cells. The cancer cells are damaged to the extent that they are unable to repair themselves and die. Radiation therapy is recommended in grade three and grade four cancer where the surgical treatment is ineffective.

• Targeted Therapy - It is a type of treatment in which drugs or other substances are used to identify and kill cancer cells specifically. Targeted therapy is better than chemotherapy because it kills only the cancer cells and not the healthy cells. Monoclonal antibodies and kinase inhibitors are used as targeted therapy agents to kill cancer cells.

• Immunotherapy - Immunotherapy uses the immune system of the patient to fight cancer. The proteins present in the body or made in the laboratory are used to boost the defense system of the body and fight cancer.

• Chemotherapy - Chemotherapy is a procedure in which powerful drugs are administered to the patient to kill the cancer cells. It might be used before the surgery to reduce the size of the tumor or after the surgery to kill the remaining tumor cells. The side effects of chemotherapy drugs include nausea, hair fall, tiredness, vomiting, and increased risk of infections. The drugs used to treat renal cell carcinoma are listed below:

  • Axitinib.

  • Bavencio.

  • Sorafenib Tosylate.

  • Lenvima.

  • Everolimus.

  • Belzutifan.

  • Nivolumab.

  • Proleukin.

  • Cabozantinib.

Conclusion:

Renal cell carcinoma or kidney cancer occurs when the cells present in the kidneys divide rapidly. Renal cell carcinoma has been divided into four stages depending upon the severity and the spread of cancer to other organs. However, the patient needs to take care of himself after the treatment. A good diet, exercise, regular checkup, and emotional and mental support is required the most after the treatment is complete. The patient must consult the doctor, follow his advice and have a positive outlook on life to survive cancer.