The kidneys are part of the urinary system, which eliminates waste and excess fluid and electrolytes from the blood. They also control the production of red blood cells and regulate blood pressure.

A cancer that starts outside the kidney and metastasizes to the kidney is not normally called kidney cancer.

Kidney cancers mainly originate in two parts of the kidney, the renal tubule and the renal pelvis.

Types:

• Urothelial cell carcinoma of the renal pelvis
• Renal cell Carcinoma
• Squamous cell carcinoma
• Juxtaglomerular cell tumor, or reninoma
• Angiomyolipoma
• Renal oncocytoma
• Bellini duct carcinoma
• Clear-cell sarcoma of the kidney
• Mesoblastic nephroma
• Wilms’ tumor, usually diagnosed in children under 5 years of age
• Mixed epithelial stromal tumor

Rarely, potentially cancerous tumors that usually originate in other parts of the body can start off in the kidneys. These include clear cell adenocarcinoma, transitional cell carcinoma, inverted papilloma, renal lymphoma, teratoma, carcinosarcoma, and carcinoid tumor of the renal pelvis.

Most cancers that originate in the renal tubule are renal cell carcinoma and clear cell adenocarcinoma. Those that originate in the renal pelvis are transitional cell carcinoma.

This article focuses mainly on renal cell carcinoma.

Signs and symptoms

Symptoms do not usually appear in the early stages of kidney cancer.

In the later stages, the person may experience:

• Blood in the urine
• A lump or mass in the back, near the kidneys

Less often, there may be:

• A continuous pain in the side, near the kidneys
• A lump in the abdomen
• Anemia
• Constant fever and night sweats
• Tiredness or fatigue
• Weight loss and loss of appetite

Other conditions can lead to similar symptoms, so it is important to see a physician if any of these occur.

Causes and risk factors

Cancer starts when there is a change in the structure of DNA in cells. A genetic mutation causes cells to grow uncontrollably eventually producing tumor cells.

Untreated, cancer grows and spreads, usually through the lymphatic system, a series of nodes or glands that exist throughout the body.

Renal cell carcinoma typically starts in the cells that line the tiny tubes of the nephron. Tumors normally grow as a single mass, but sometimes, more than one tumor can grow in one kidney, and sometimes in both kidneys.

Transitional cell carcinoma develops in the tissue that forms the tubes that connect the kidneys to the bladder. This type of cancer can begin in the ureters and also in the bladder itself.

Wilms’ tumor is a childhood kidney cancer caused by the loss or inactivation of a tumor suppressor gene called QT1 on chromosome 11. Tumor suppressor genes generally suppress tumor growth and control cell growth.

Risk factors for common kidney cancers

Risk factors for renal cell carcinoma, the most common type of kidney cancers, include:

• Age: The risk increases significantly after the age of 60 years
• Sex: For every two women who get kidney cancer, 3 men will do so
• Obesity: People with obesity have a significantly higher risk
• Smoking: Regular tobacco smokers have a much higher risk, but the risk drops when the person quits
• Hypertension, or high blood pressure: The higher risk may be due to the hypertension itself, or it may be due to anti-hypertensive medications
• Smoking, obesity, and hypertension account for around 50 percent of all renal cell carcinomas
• Workers who are exposed to chemicals, such as asbestos, trichloroethylene, and cadmium, are more likely to develop renal cell carcinoma

Asbestos was widely used in the past in construction. Cadmium is a metal used in batteries. Trichloroethylene is an industrial solvent used to strip paint from metals.

Patients receiving long-term dialysis for chronic kidney failure are more likely to develop renal cell carcinoma. This may be due to kidney disease rather than the dialysis itself.

Patients who have received a kidney transplant and are taking immunosuppressant medications have a higher risk of developing renal cell carcinoma. The use of medications such as phenacetin, a pain reliever, has been linked to a higher risk of kidney cancer, and the use of diuretics may contribute.

Von Hippel-Lindau disease is a genetic condition that increases the risk of several kinds of tumors, including renal cell carcinoma. In hereditary papillary renal cell carcinoma, multiple papillary tumors develop in both kidneys. Other diseases that increase the risk include Birt-Hogg-Dube syndrome and hereditary leiomyoma-renal cell carcinoma.

Kidney cancer stages:

One way of staging kidney cancer is a four-stage system:

Stage I: The tumor is under 2.8 inches, or 7 centimeters in diameter and it is limited to the kidney.

Stage II: The tumor is greater than 2.8 inches, or 7 centimeters, in diameter, and it is still limited to the kidney.

Stage III: The cancer is any size but has spread beyond the kidney to at least one other location. It may have reached the adrenal gland, nearby blood vessels, a lymph node, or the fat that surrounds the kidney.

Stage IV: The cancer has spread beyond the fatty tissue around the kidney, it affects at least one lymph node, or it has spread to other organs.

Treatment options

Treatment options depend on several factors, including the patient’s general health, the type and stage of kidney cancer, and the patient’s own preferences.

Nephrectomy involves removing the kidney, the nearby adrenal gland, a border of healthy tissue, and the adjacent lymph nodes. The surgery can be done laparoscopically, through small incisions.

If the tumor is less than 1.5 inches, or 4 centimeters across, the surgeon may remove only part of the kidney in a partial nephrectomy.

If the cancer has spread outside the kidney, surgery may not cure it, but it can ease pain and make other non-surgical treatments more effective.

In nephron-sparing surgery, the tumor, but not the kidney, is surgically removed. This may be an option during the early stage of kidney cancer, or if the patient has only one kidney.

A patient who is unwell or frail may not be able to undergo surgery. In this case, a number of nonsurgical treatment options are possible.

Embolization aims to block the flow of blood to the tumor. The surgeon inserts a small tube known as a catheter into the groin. X-ray images guide the catheter into the blood supply for the kidney. A special material passes through the catheter into the blood vessel, blocking the blood supply to the kidney and starving the tumor of oxygen and nutrients. This causes the tumor to shrink.

Cryoablation involves inserting one or more special needles, known as cryoprobes, through small incisions into the tumor. An imaging scan guides the process. A gas in the needles freezes the cells around the tip of each needle. Another gas warms thaws the tissue, and then the cells are refrozen. This freeze-thaw cycle kills the cancer cells.

Some pain may occur after the procedure, and, rarely, some bleeding, infection, and damage to the tissue close to the tumor.

Advanced or recurrent kidney cancer treatment is for kidney cancer that comes back, or kidney cancer that has spread out of the kidney.

Surgery aims to remove as much of the tumor as possible.

In biological therapy, or immunotherapy, drugs use the body’s own immune system to fight cancer. Examples are interferon and interleukin-2. Both are synthetic versions of chemicals that our bodies make. Side effects include nausea, vomiting, chills, elevated body temperature, and loss of appetite.

In targeted therapy, medicines interrupt the functions that cancer needs to survive, such as the blood supply.

Targeted therapies include:

• Sunitinib, or Sutent
• Sorafenib, or Nexavar
• Bevacizumab
• Temsirolimus

Radiation therapy cannot usually cure kidney cancer, but it may help reduce the spread and the severity of symptoms. Patients typically undergo a few minutes of treatment daily for a number of days. Radiation therapy that is used to control rather than to cure a cancer tends to have less severe side effects.

Side effects can include fatigue, nausea, and vomiting.

Complementary treatments may include taking certain vitamins alongside regular treatment. This should first be discussed with a physician. Some people have found that alternative treatments can relieve symptoms, but these can be unhelpful or hazardous, and should first be discussed with the medical team.

Living with kidney cancer

When a person finds out they have cancer or another serious illness, they may experience feelings of grief, stress, anxiety and depression.

Talking to a well-qualified counselor may help.

It is important to get as much information as possible. Members of the medical team will provide details about the diagnosis, available options, and their effectiveness.

The patient should eat a healthy diet with plenty of fruits and vegetables, sleep at least 7.5 hours each day, and get enough exercise, within the limits set by the physician. This will maximize the benefits of any treatment.

Allow friends and family to help. They can provide practical assistance and support the patient’s mental, emotional, spiritual, and, ultimately, physical health.

Prevention and life expectancy

Measures to reduce the risk of developing kidney and other cancers include:

• Not smoking
• Eating plenty of fruit and vegetables
• Exercising regularly
• Keeping the body weight within normal limits for your height, sex, and age
• Getting at least 7 hours good quality continuous sleep every 24 hours
• Maintaining a healthy blood pressure
• Avoiding toxic chemicals

Getting an early diagnosis for kidney cancer improves the outlook for patients. A patient who receives a diagnosis at Stage I has an 81 percent chance of living for at least another 5 years.

At Stage II, there is a 74 percent chance of surviving for another 5 years, at Stage III, there is a 53 percent chance, and if the disease is diagnosed at Stage IV, the likelihood of surviving 5 years or longer is around 8 percent.

Monomelic amyotrophy (MMA) is characterized by progressive degeneration and loss of motor neurons, the nerve cells in the brain and spinal cord that are responsible for controlling voluntary muscles. It is characterized by weakness and wasting in a single limb, usually an arm and hand rather than a foot and leg. There is no pain associated with MMA. While some physicians contend that mild sensory loss may be associated with this disease, many experts suggest that such symptoms actually indicate a cause other than MMA. MMA occurs in males between the ages of 15 and 25. Onset and progression are slow. MMA is seen most frequently in Asia, particularly in Japan and India. In most cases, the cause is unknown, although there have been a few published reports linking MMA to traumatic or radiation injury. There are also familial forms of MMA. Diagnosis is made by physical exam and medical history. Electromyography (EMG), a special recording technique that detects electrical activity in muscles, shows a loss of the nerve supply, or denervation, in the affected limb; MRI and CT scans may show muscle atrophy. People believed to have MMA should be followed by a neuromuscular disease specialist for a number of months to make certain that no signs of other motor neuron diseases develop.

Treatments:

There is no cure for MMA. Treatment consists of muscle strengthening exercises and training in hand coordination.

Cancer happens when there is uncontrolled growth of abnormal cells that thrive and spread instead of dying as they would in the life cycle of a normal cell.

Lymphoma is a cancer that starts in the white blood cells, or lymphocytes.

Lymphatic cancers are classified by the type of immune cells affected. The two main types are Hodgkin and non-Hodgkin. Within these, there are many subtypes.

Non-Hodgkin, the most common type, affects B and T cells. Classic Hodgkin lymphoma is marked by the presence of cells known as Reed-Sternberg cells. Other subtypes affect different types of cells.

Hodgkin can occur at any age, but it is most common in children and adults under 25 years. It affects men more than women. In most cases, it is curable, but treatment and prognosis vary between sub types.

Tumor Stages are below:

Symptoms

The signs and symptoms of lymphoma are similar to those of illnesses such as viral diseases and the common cold, but they continue for longer than would normally be expected.

Some people will have no symptoms, but some may notice a swelling of the lymph nodes. These are located all around the body, often in the neck, groin, abdomen, or armpits.

The swellings are normally painless, but pain may occur if the enlarged glands press on organs, bones, and other structures. This can be confused with back pain.

Lymph nodes can swell during common infections, such as a cold, but in lymphoma the swelling does not go away. Pain is also more likely to accompany the swelling if it is due to an infection.

The overlap of symptoms can lead to misdiagnosis.

Anyone who has ongoing swelling of the glands should see their doctor.

Other symptoms of both types of lymphoma may include:

• ongoing fever without infection
• night sweats, fever, and chills
• weight loss and loss of appetite
• unusual itching
• persistent fatigue, unusual tiredness, or lack of energy
• pain in lymph nodes after drinking alcohol

Additional symptoms that can indicate Non-Hodgkin lymphoma include:

• persistent coughing
• shortness of breath
• pain or swelling of the abdomen

Pain, weakness, paralysis, or otherwise altered sensation can occur if an enlarged lymph node presses against spinal nerves or the spinal cord.

Lymphoma can spread rapidly from the lymph nodes to other parts of the body through the lymphatic system. As cancerous lymphocytes spread into other tissues, the body’s ability to fight infection weakens.

Causes and risk factors

Exactly what causes lymphoma is unclear, but there are some risk factors.

Non-Hodgkin lymphoma

Risk factors for non-Hodgkin lymphoma include:

• Age: Most lymphomas occur in people aged 60 years and older, but some types are more likely to affect children and young adults.
• Sex: Some types are more likely in women, others are more likely in men.
• Ethnicity and location: It is more common in developed nations.
• Chemicals and radiation: Nuclear radiation and some chemicals used in agriculture have been linked to non-Hodgkin lymphoma.
• Immunodeficiency: A person with a weak immune system is more at risk. This can be due, for example, to HIV ro AIDS, medications taken after an organ transplant.
• Autoimmune disease: This is when the immune system attack the body’s own cells. Examples include rheumatoid arthritis and celiac disease.
• Infection: Certain viral and bacterial infections that transform lymphocytes increase the risk, such as the Epstein-Barr virus (EBV), which causes glandular fever.
• Breast implants: These can cause anaplastic large cell lymphoma in the breast tissue.
• Body weight and diet: Obesity has been implicated in the development of lymphoma, although more research is needed to confirm the link.

Hodgkin lymphoma

Risk factors for Hodgkin lymphoma include:

• Infectious mononucleosis: Infection with EBV can cause mononucleosis, which increases the risk of lymphoma.
• Age: People between the ages of 20 and 30 years and people over the age of 55 years have a higher risk
• Sex: It is slightly more common in men.
• Location: Hodgkin lymphoma is most common in the U.S., Canada, and northern Europe. It is least common in Asia.
• Family: If a sibling has the condition, the risk is slightly higher, and very high if the sibling is an identical twin.
• Affluence: People from higher socioeconomic status are at greater risk
• HIV infection: This can weaken the immune system and increase the risk of lymphoma.

Spread of lymphoma

Lymphatic tissue is connected throughout the body, and the cancer cells can spread easily from their original location to other tissues and organs, including those outside of the lymphatic system.

Lymphoma most often spreads to the liver, bone marrow, or lungs.

In Hodgkin lymphoma, this spread usually affects one lymph node after another in order.

In non-Hodgkin lymphoma, tumors may arise in disparate lymph nodes, skipping some nodes.

Tests for lymphoma

Tests will confirm whether lymphoma is present.

Blood tests and biopsies can detect the presence of lymphoma and distinguish between them.

A biopsy involves taking a sample of lymph tissue for examination in a laboratory. The surgeon may remove a whole lymph or a part of one. In some cases, a needle can be used to take a tissue sample. A bone marrow biopsy may be necessary. This may need a local anesthetic, a sedative, or a general anesthetic.

Biopsies and other tests can confirm the stage of the cancer, to see whether it has spread to other parts of the body.

Imaging tests such as a CT or MRI scan, X-ray imaging of the chest, abdomen, and pelvis, ultrasound scanning, or a PET scan.

A spinal tap, where a long, thin needle is used under local anesthetic to remove and test spinal fluid.

Staging of the cancer depends on the type, growth rate, and cellular characteristics. In stage 0 or I, the cancer is confined to a small area. In stage 4, it has spread to more distant organs.

Lymphoma can also be described as indolent, limited to one place, or aggressive, spreading to other parts of the body.

Treatment:

Treatment depends on the type of lymphoma and the stage it has reached. Indolent, or slow-growing lymphoma may need only watchful waiting and no treatment.

If treatment is necessary, it can involve:

• Biologic therapy: This is a drug treatment that stimulates the immune system to attack the cancer cells by inserting living microorganisms into the body.
• Antibody therapy: Synthetic antibodies are inserted into the bloodstream to combat the cancer’s antigens.
• Chemotherapy: Aggressive drug treatment is used to kills cancer cells.
• Radioimmunotherapy: This delivers high-powered radioactive doses directly into the cancerous B-cells and T-cells to destroy them.
• Radiation therapy: This is used to focus on small areas of cancer.
• Stem-cell transplantation: This can restore damaged bone marrow following high-dose chemotherapy or radiation therapy.
• Steroids: These may be injected to treat lymphoma.
• Surgery: This can be used to remove the spleen or other organs after the lymphoma has spread.

Surgery is used more often for obtaining a biopsy.

Lung cancer is a malignant lung disease primarily caused by cigarette smoking. It often has no obvious symptoms until the disease is quite advanced, and has a low rate of survival. Treatment for lung cancer mainly involves surgery and chemotherapy, while radiation therapy and targeted drug therapies may also be used.

What is lung cancer?

Lung cancer results from abnormal growth of cells in the lining of the lungs, leading to the growth of a malignant tumour.

There are two different types of lung cancer – small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) – which differ in terms of how they grow and spread to other parts of the body and how they’re treated.

Causes

The development of lung cancer is strongly associated with cigarette smoking – approximately 90% of lung cancers are attributable to tobacco use. Pipe and cigar smoking can also cause lung cancer, but the risk is not as high as with cigarette smoking. Tobacco smoke contains more than 4,000 chemical compounds, many of which are cancer-causing (carcinogens).  Passive smoking, i.e. the inhalation of tobacco smoke by non-smokers who live or work with smokers, is also an established risk factor for the development of lung cancer.

Although the majority of lung cancers are linked to tobacco smoking, not all smokers go on to develop lung cancer suggesting that genetic susceptibility (i.e. family history) may play a role in the development of lung cancer.  Other causes of lung cancer include air pollution (from vehicles, industry, and power generation) and inhalation of asbestos fibres (usually in the workplace).

Signs, symptoms, and diagnosis

Symptoms of lung cancer are varied and warning signs are not always obvious. Up to 25% of people who get lung cancer display no symptoms. In people who do display symptoms, they include the following:

• Persistent cough and hoarseness
• Shortness of breath, wheezing, and chest pain
• Blood-streaked sputum
• Chest pain
• Frequent episodes of bronchitis or pneumonia
• Weight loss, weakness, and fatigue.

A wide range of diagnostic tests and procedures are used to diagnose lung cancer, including taking a patient history, physical examination, blood tests, chest x-rays, computerized tomography (CT) and positron emission tomography (PET) scans, bone scans, bronchoscopy, cytological studies of sputum, bronchial washings, and fine needle biopsy. Many of these procedures are also used to determine the stage of the cancer.

Staging of lung cancer

The stage of a lung cancer refers to the extent to which the cancer has spread to other parts of the body. Staging helps to determine how the cancer should be treated. Lung cancer can spread to any organ in the body but the liver, brain, and bones are the most common sites. The two types of lung cancer are staged differently. A simplified overview of staging is as follows:

NSCLC
Stage I: cancer that is confined to the lung
Stage II: cancer that is confined to the chest
Stage III: cancer that is confined to the chest but with larger and more aggressive tumours than at stage II
Stage VI: cancer that has spread to other parts of the body.

SCLC
Limited-stage: cancer confined to the area of the chest
Extensive-stage: cancer that has spread to other parts of the body.

Treatment

Treatment for cancer involves a combination of surgery to remove cancer cells, and chemotherapy and radiation therapy to kill cancer cells. Lung cancer is incurable unless complete surgical removal of the tumour cells can be achieved.

Surgery is the most effective treatment for lung cancer but only about 20% of lung cancers are suitable for surgery i.e. Stage I and II NSCLC and cancer that has not spread beyond the lung.

Radiation therapy may be used for both NSCLC and SCLC and is a good option for people who are not suitable for surgery or who refuse surgery.

Chemotherapy is used for both NSCLC and SCLC. Chemotherapy drugs may be given alone or in combination with surgery or radiation therapy. Chemotherapy is the treatment of first choice for SCLC since it has usually spread extensively in the body by the time it has been diagnosed.

Also used in the treatment of lung cancer are targeted therapies. These are drugs (gefitinib and erlotinib) or antibodies (cetuximab, bevacizumab) that block the growth and spread of cancer by interfering with specific molecules involved in tumour growth and progression. They are used in some patients with NSCLC that does not respond to standard chemotherapy.

Prevention

The most effective measure that can be taken to prevent the development of lung cancer is to stop smoking. Reducing exposure to passive smoking is also an effective method of prevention.

What Is Bone Cancer?

Types of Bone Cancer

What Are the Symptoms of Bone Cancer?