Having foreign growths in the body can be very disturbing and life-threatening, but having malignant growths has become one disease that a lot of people suffer from, thereby becoming their worst nightmare. According to the World Cancer Research Fund International, In the year 2020, Over 18 million cancer cases were diagnosed, with the highest cases being from Denmark. With Cancer, cells divide rapidly in the body, causing growths that are unwanted in the patients. Unlike human cells that regenerate after the death of a previously existing cell, cancer cells just keep reproducing at any part of the body where they are, and cancer growth can be at almost any part of the body. They could exist in body tissues and organs as tumors, or as defects in blood, bone marrow or lymphatic system, as blood cancer().
In my post today, I will be looking at a cancer that is associated with the kidney, known as Renal Cell Carcinoma. It is the most common type of kidney cancer in an adult. According to the American Cancer Society, about 79,000 new cases of kidney cancer are expected to be diagnosed, and Renal Cell Carcinoma accounts for 85% of the kidney cancers. It is often diagnosed in adults within the age of 50 and 74, and it is rare in adults below the age of 45 years. With Renal Cell Carcinoma, cancer cells grow sporadically in the Renal epithelium (lining of the tubule) of the kidney, and has the tendency of spreading to the lungs and the surrounding parts of the kidney.
Classification Can Sometimes Be Complex
Renal Cell Carcinoma can be histologically classified into Clear cell RCC, papillary RCC, Chromophobe RCC, Oncocytic RCC, Collecting Duct RCC, and Unclassified RCC. The common of all types of Renal Cell carcinoma is the Clear Cell RCC with a 75-85% rate, followed by Papillary RCC with 10 -15% rate. Others have a less than 5% incidence rate.(). When patients are diagnosed with RCC, there is a higher chance that it is a clear cell Renal Cell Carcinoma (ccRCC). In 2013, the International Society of Urological Pathology (ISUP) reclassified Renal Cell Carcinoma into more complex type including; Tubulocystic renal cell carcinoma (RCC), acquired cystic disease-associated RCC, clear cell (tubulo) papillary RCC, MiT family translocation RCCs, and Hereditary leiomyomatosis and renal cell cancer RCC. The classification of this heterogeneous subtype of Renal Cell Carcinoma based on histology by the International Society of Urological Pathology (ISUP) later led to the reclassification by the WHO based on pathology, epidemiology and molecular genetics. In 2016, the WHO reclassification of RCC led to 5 subtypes which are Hereditary leiomyomatosis and RCC syndrome-associated RCC (HLRCC), Succinate dehydrogenase-deficient RCC (SDH deficient), Tubulocystic RCC, Acquired cystic disease-associated RCC, and Clear cell papillary RCC.
Renal Cell Carcinoma Risk Factor and Diagnosis
There are risk factors that could lead to RCC or cancer in general; these factors includes Smoking, Hypertension, Obesity, Chronic Kidney Disease (Cystic Diseases), Toxic Exposure, Analgesics, Sickle Cell Disease, and Hereditary trait (von Hippel-Lindau) . Smoking is the most common factor of Renal Cell Carcinoma, followed by other factors.
Patients with RCC will show symptoms such as Swelling in the leg, Scrotal Swelling in men, Weight Loss, Anemia (low red blood cell count) or Erythrocytosis (High red blood cell count) as a result of the RCC producing Erythropoeitin, Hypercalcemia (high calcium level in the blood), Tumor fever, Stauffer Syndrome (High Alkaline Phosphatase), Amyloidosis
Renal Cell Carcinoma is in stage 1 when the tumor is confined in the Kidney and hasn't spread to other part of the organ. It is in Stage 2 when the tumor is in the adrenal tissue of the kidney. Stage 3 when the tumor is in the vein or the Vena cava, and the lymph nodes of the kidney. Stage 4 Occurs when the Tumor has spread to other organs in the body such as the liver, the pancreas, the colon, and stomach. Patients with Stage 1, 2 and 3 RCC and be treated by surgery either though a radical or partial nephrectomy, and patients with stage 4 disease surgery and other medical method of treatment will be introduced since it has spread through other organs . RCC prognosis could also be done using the UCLA integrated staging.
In other, to Evaluate RCC, a CT or MRI scan of the Chest, abdomen, and pelvis is often required. Urinalysis showing hematuria helps to detect cancer cells in the urine, and Bone scan in some cases (ESMO).
Treatment and Management
In stage 1 to 3 cases of Renal Cell Carcinoma, which is surgically resectable, a surgical excision which would be either a partial or radical (complete) nephrectomy, would be required. In cases where the cancer cells cannot be operated, treatments targeting the areas would be required [Target Therapy]. With partial nephrectomy, the aim is to remove the tumor while making sure that the remaining healthy renal parenchyma is preserved. With Radical Nephrectomy, the kidney, adrenal gland, perirenal fat tissue, and lymph node will be removed. In the case of target therapy, tyrosine kinase inhibitors agents such as sorafenib, sunitinib, pazopanib, axitinib, lenvatinib and cabozantinib can be used.
Much progress has been made in the diagnosis and treatment of Renal Cell Carcinoma. While Surgery tends to be successful, research should be done on ho to increase the lifespan of patients after nephrectomy. According to an article published in the World Journal of Surgical Oncology, the average year for a patient after complete nephrectomy before relapses occur, is 3 years. Patients could live up to 5 years, but very few make it up to 10 years.