What are the types of renal cancer?
Of all kidney cancers, renal cell carcinoma (RCC) is the most common type. The abnormal cells typically develop in the lining of very small tubes in the kidney, called tubules. Over time, these cells grow in size into a mass and cause an obstruction. The cancer type develops in one or both kidneys.
The renal cell carcinomas are further classified into:
- Clear cell RCC: These account for approximately 80% of all renal cell carcinomas. When observed under a microscope, these tumor cells appear very pale and clear.
- Papillary RCC: The second most common type of RCC, papillary renal cell carcinoma accounts for 10-15% of kidney cancers. The cancerous cells develop finger-like projections.
- Chromophobe RCC: Like clear cell RCC, chromophobe renal cell carcinoma has tumor cells that appear pale or clear under a microscope. However, these cells appear to be larger in size.
- Collecting duct RCC: These are a rare and aggressive types of RCC, accounting for less than 1% of kidney cancer types. These cells form irregular tubes inside the tumor.
- Unclassified RCC: Another rare type of kidney cancer, these cells cannot be classified based on their appearance under a microscope.
Other kidney cancer types include:
- Transitional cell carcinoma: These develop in the region where the kidney and the ureter join. The ureter is the tube that carries urine from the kidneys to the bladder.
- Renal sarcoma: This is a rare type of kidney cancer that develops in the connective tissue of the kidney.
What is renal cell carcinoma?
Renal cell carcinoma or RCC, also known as renal adenocarcinoma or hypernephroma is the most common type of renal cancer found in adults.
Our kidneys are responsible for filtering out toxins and maintaining the fluid balance in the body.
The small tubes called tubules in the kidney facilitate blood filtration and process waste into urination. RCC is a cancer type when abnormal cells begin to divide explicitly around the tubules. Normally, RCC is a rapidly growing cancer that spreads around the lungs.
The standard renal cell carcinoma treatment includes surgery, radiation therapy, chemotherapy, biologic therapy, and targeted therapy.
Risk factors for RCC
Though the exact cause of RCC is not yet known, there are some known risk factors for the disease. These include:
- Obesity
- Smoking
- Family history of RCC
- Hypertension
- Polycystic kidney disorder
- Dialysis treatment
- Genetic conditions
- Prolonged or overuse of OTC and prescribed drugs
Renal cell carcinoma symptoms
In its early stages, RCC shows no symptoms but as the disease progresses, the patient may experience:
- Fatigue
- Excessive hair growth in females
- Vision problems
- Blood in the urine
- Loss of appetite
- Unexplained weight loss
- Lump in the abdomen
- Persistent pain in the side
Renal cell carcinoma staging
Based on the various stages of tumor, RCC can be categorized into three stages:
- Localized cancer that is confined to the kidney
- Regional cancer, which has spread in nearby areas
- Distant cancer that has progressed to various distant sites
Renal cell carcinoma prognosis
The outlook for an RCC patient depends on two factors: i) whether cancer has spread, ii) how soon the treatment started. That said, the sooner the disease is caught, the more likely you are to have a complete recovery. But if cancer has spread to other organs, the survival rate goes further down. And if the cancer is cured or treated, you may still have to live with long-term effects of the disease, which includes poor kidney function.
Renal cell carcinoma types
- Clear Cell RCC – Most common and accounts for around 75% cases
- Papillary RCC – That affects about 10% to 15% people who have RCC
- Chromophobe RCC – Less frequent and accounts for around 5% of total cases
- Clear cell papillary RCC – Rare disease that accounts for 2-4% of all the cases
Renal cell carcinoma causes
Though the exact cause of RCC is not known, the disease commonly affects the male population between the age group of 50 and 70 years.
Renal cell carcinoma diagnosis
Based on symptoms, if the doctor suspects RCC, he may ask about the patient’s medical history. A physical examination is done to check swelling or lumps in the abdomen area. To confirm the presence of RCC, other tests including CBC, ultrasound, CT scan, urine examination and biopsy are performed.
Renal cell carcinoma stage 4
Although stage 4 RCC is classified as an advanced stage kidney cancer, possible treatment options available are:
Surgery: In some cases, when the main tumor can be easily removed and cancer has not spread extensively, radical nephrectomy may be performed. This involves surgical removal of most or all of the affected kidneys. However, if surgery isn’t possible, tumor embolization may be performed. The procedure cuts off the blood supply to the tumor. Once surgery has been performed to remove tumors, patients may need systemic therapy such as immunotherapy, targeted therapy, radiation, and chemotherapy. This type of therapy treats cancer and can help to reduce cancer recurrences.
Immunotherapy: Immunotherapy or biologic therapy is a treatment that aims to stimulate the immune system to attack abnormal cancer cells. But not all patients with RCC respond well to immunotherapy, and side effects in some cases can be serious. Therefore, immunotherapy is often recommended when the RCC cannot be removed with surgery.
Targeted therapy: Targeted therapy involves the use of drugs that specifically target cancer cells. Targeted drugs are desirable because they don’t harm or kill healthy cells in the body. The treatment has proven promising and the development of these targeted drugs has helped to extend the lives of some stage 4 patients.
Radiation Therapy: Radiation uses high-energy X-ray beams to kill cancer cells. The therapy is prescribed post-surgery to kill any cancer cells left behind after the treatment. However, in advanced RCC patients, it’s often used to relieve symptoms like pain or swelling. This kind of treatment is called palliative care.
Chemotherapy: Chemotherapy is a traditional treatment method used to treat and cure several types of cancers. It uses a drug or combination of drugs to kill abnormal cancer cells. Chemotherapy drugs aren’t targeted, and so they also kill healthy cells and produce some side effects. Chemotherapy doesn’t always work on all renal cancer patients, therefore, your doctor may recommend it only if immunotherapy and targeted treatments haven’t worked.
What is urothelial carcinoma?
Urothelial carcinoma or transitional cell carcinoma is a type of bladder cancer that occurs in urothelial cells present in the urethra and ureters.
Urothelial cells also line other parts of the urinary tract, such as the part of the kidney that connects to the ureter and the urethra.
This is one of the most common forms of bladder cancer.
Urothelial Carcinoma Treatment
There are two major types of treatment alternatives for urothelial carcinoma. This includes surgical intervention as well as drug based therapies.
Surgical Options Surgery: It refers to the removal of the infected cells and some adjoining tissues from the cancer site. Depending on the tumor location and its spread, various surgical approaches are adopted for bladder cancer treatment.
Transurethral bladder tumor resection: TURBT involves the insertion of a cystoscope in the bladder via the urethra to visualize and remove the tumor through fulguration, laser, or wire loop. Prior to the surgery, the patient is administered anesthesia and medicines to alleviate the pain syndromes.
Radical cystectomy: This refers to the procedure of removing the entire bladder and adjoining organs or tissues; while pelvic lymph node dissection involves the removal of lymph nodes present in the pelvic region.
Urinary diversion: This is a process of creating a passage for urination in case the entire bladder is removed. Post-surgery, the patient needs to carry a bag linked to the stoma for collection and draining the urine.
Medication Therapy
Another option to treat the cancer type is the elimination of cancerous tissue by the use of medication. Normally, these drugs are administered orally or intravenously. Drug-based therapies include targeted therapy, immunotherapy, and chemotherapy.
Urothelial carcinoma staging
Urothelial carcinomas are mostly papillary as they account for about 70% of cases, whereas 30% are nonpapillary. According to the TNM staging system, bladder cancer is staged as follows: Ta – Noninvasive papillary carcinoma that is confined to urothelium and it projects toward the lumen Tis Carcinoma in situ: Its a flat tumor with high-grade histologic features that is confined to urothelium
T1 Tumor invades sub-epithelial connective tissue (lamina propria)
T2 Tumor invades the muscle
T2a Tumor invades superficial muscle (inner half)
T2b Tumor invades deep muscle (outer half)
T3 Tumor invades perivesical tissue
T3a Tumor invades perivesical tissue microscopically
T3b Tumor invades perivesical tissue macroscopically
T4 Tumor invades prostate, uterus, vagina, or abdominal wall
T4a Tumor invades prostate, uterus, or vagina
T4b Tumor invades pelvic wall or abdominal wall
N0 No regional lymph node metastases
N1 Metastasis to a single lymph node that is < 2 cm in greatest dimension
N2 Metastasis to a single lymph node that is < 2 cm in greatest dimension N3 Metastasis to a single lymph node that is 2–5 cm in greatest dimension or to multiple lymph nodes, none of which is > 5 cm in greatest dimension
M0 No distant metastasis
M1 Distant metastasis
Urothelial carcinoma prognosis
The outlook for a patient diagnosed with cancer of the renal pelvis and ureter depends on a number of factors. These include:
- Stage of cancer. Patients with advanced-stage have a lower survival rate, even with treatment.
- Location of the tumor.
- Overall kidney health. The survival rate reduces if there are any underlying kidney disorders.
- Cancer recurrence. Cancer recurrences have lower cure and survival rates.
- Metastasis. Cancer that has spread to other organs has lower survival rate.
Urothelial carcinoma symptoms
Urothelial cancer may be asymptomatic at its initial stage, but as the disease progresses some symptoms may appear. These include:
Hematuria: It’s the most common symptom in patients presenting with urothelial tract cancer. It is painless unless obstruction due to a clot/ tumor and/or deeper levels of tumor invasion have already occurred.
Urinary voiding symptoms: Urgency, frequency, and/or dysuria are also seen in patients with cancers of the bladder or ureters but are uncommon in patients with cancers of the renal pelvis.
Vesical irritation without hematuria: This is common in case of patients with carcinoma in situ of the urinary bladder.
Symptoms of advanced disease: Severe pain is the common symptom of more advanced disease.
Papillary urothelial carcinoma
A papillary urothelial carcinoma is a form of bladder cancer. It develops within a type of cell in the inner lining of the bladder, ureters, and lower kidneys. These tumors have a shape like a small mushroom. As compared to other bladder cancers, these tumors are easy to treat and the prognosis is generally good.
What is Wilms tumor? Wilms tumor or nephroblastoma is a rare kidney cancer that’s common among children. It often affects one kidney, though it can also be found in both kidneys at the same time. It is commonly found in children of age group 3-4 years.
Wilms tumor causes Wilms tumor is a solid mass that develops in immature kidney tissues. There is no clear reason known for this type of cancer, however, experts believe that errors in DNA or some environmental factors like contact with hazardous chemicals can enhance the risk of Wilms tumor. In rare cases, the disease is also passed on from a parent to the child.
Wilms tumor treatment Generally, doctors recommend one of the standard treatment options for Wilms tumor, which includes surgery, chemotherapy, and radiation therapy, depending on the health profile of the person.
Surgery, if recommended, may involve partial or complete removal of the kidney or adjoining tissues/organs.
Wilms tumor symptoms Signs and symptoms of Wilms tumor may vary widely. While some children may not show any obvious signs, others may experience one or more of these signs and symptoms as mentioned below:
- Abdominal mass
- Abdominal swelling
- Abdominal pain
Other signs and symptoms may include:
- Fever
- Blood in urine
- Nausea or vomiting or both
- Constipation
- Loss of appetite
- Shortness of breath
- High blood pressure
Wilms tumor prognosis
For Wilms tumor, the five-year survival rate is around 93% which varies with disease progression and stage. Normally, stage I, II, and III Wilms tumors have a four-year survival rate between 95% and 100%.
Wilms tumor diagnosis
To diagnose Wilms’ tumor, the doctor may recommend a physical exam, blood and urine test and imaging tests for indication of the kidney tumor. This is followed by further tests to confirm the diagnosis and assign the stage to cancer.
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