Kidney Cancer

Much like any other kind of cancer, kidney cancer is a fatal disease if diagnosed past the treatable stages. 2.04% of total kidney cases in the UAE are renal pelvis and kidney cancer cases. While the stats of kidney cancer are not as bad as breast cancer or colo-rectal cancer, it still remains to be a dangerous disease. The good thing is that most kidney cancers can be treated if they are diagnosed early on. Almost 30% of all kidney cancer cases are at the risk of becoming metastatic or advanced. Let’s cover all different types of kidney cancers, their symptoms, diagnosis, treatment and insurance options available for the same. 

Types of Kidney Cancers 

• Renal Cell Carcinoma: Renal cell carcinoma amounts to around 85% of kidney cancers making it the most common kidney cancers in not only the UAE but the world. The proximal renal cell carcinoma develops in the renal tubules that are responsible for the filtration system in the kidneys. And there are over a thousand small tubules like these in the kidneys which means that the cancer can develop in any of these tubules. 
• Urothelial Carcinoma: One of the rare kidney cancers, the urothelial carcinoma only makes up 5-10% of all the adult kidney cancer cases. It is also popularly known as the transitional cell carcinoma. This type of cancer begins in the renal pelvis where the urine is collected in the kidneys before it finally moves to the bladder. The cells that line the renal pelvis are the same one that line the bladder. This is why these cancers are treated as bladder cancers only. 
• Sarcoma: Developed in the soft tissue present inside the kidney, sarcoma of the kidneys is one of the rarest types of kidney cancer. The soft tissues surround the kidney are connective tissue also known as capsules. Sarcoma is generally treated using surgery. But since sarcoma is a type of cancer that spreads to other parts of the body or return in the kidney, chemotherapy is prescribed after surgery as well. If the cancer does return, further surgery is recommended with chemo. 
• Wilms Tumour: A common tumour among children, Wilms tumour sees a slightly different procedure than what is followed for kidney cancer treatment in adults. Radiation and chemotherapy are two main ways to treat this type of tumour. Almost 1% of all the cancer cases. Surgery is not seen as a potential type of treatment for Wilms tumours like it is for kidney cancer in adults. 
• Lymphoma: This type of cancer is related to lymphadenopathy i.e., enlarged lymph nodes which are generally found in the neck, chest, abdomen and the kidneys as well. Kidney lymphoma is a rare case where it can come out as a sole tumour. Enlarged lymph nodes can be a part of this type of tumour as well. Like Wilms tumour, lymphoma is also treated by chemo instead of surgeries. If there is a chance that a patient may have lymphoma, the doctor does a biopsy and changes treatment plans to chemo instead of surgery. 

Types of Kidney Cancer Cells

• Clear cell: The majority of kidney cancers are made up of clear cells. Almost 70% of kidney cancers are made up of clear cells. Cancers made with these cells can be anything from the slowest growing ones to the fastest growing ones too. Immunotherapy and targeted therapy are two potential plans of treatment for clear cell cancer. 
• Papillary: Found in two different forms categorised as type 1 papillary cancer cells and type 2 papillary cancer cells, papillary cancer cells make over 10-15% of total kidney cancer cells. This type of cancer cells is generally treated using surgery. If papillary cancer spreads, blood vessel blocking agents are added to the treatment plan. Further treatment options for papillary cancer cells are still being researched. One top contender in the list is immunotherapy.  
• Sarcomatoid Features: When examining kidney cancer cells like clear cells, papillary cells or chromophobe cells, several disorganised features may often come forward. These unique structures are classified as sarcomatoid features of cancer cells. Even though sarcomotoid is not a different subtype of cancer cells itself, it greatly affects the treatment plan if found. Cancer cells with sarcomatoid features are seen as aggressive cancers and hence treated accordingly. Immunotherapy is seen as one of the most promising treatment plans to go with for sarcomatoid developments. Combination of several immunotherapy drugs have been tried recently to check the effects of the procedure. Results have been promising so far. 
• Medullary: This type of cancer cells is generally categorised as renal cortical tumours. It is one of the most aggressive yet the rarest cancer type of all. Medullary cancer cells are more likely to develop in people from African ethnicity or people who inherit the sickle diseases gene. People who already have the sickle disease are even more likely to get medullary cancer cells. Blood vessel inhibitors with chemotherapy are used to treat this type of cancer cells. However, clinical trials are still in process to find the best possible treatment method for medullary cancer cell. 
• Collecting duct Carcinoma: This type of cancer begins in the collecting ducts of the kidney, as the name suggest it. It is more likely to occur in younger people aging 20-30 years mostly. Collecting duct carcinoma is quite similar to transitional cell carcinoma but is fairly difficult to be treated. A combination of surgery and chemo is generally prescribed to treat it. However, successful long-term treatments are still a far-fetched possibility. 
• Chromophobe: This is a type of a lazy tumour that does not generally spread to other body parts. However, if it does, it is most likely to be very aggressive. The best possible way to treat this cancer has still not been identified yet. Trials have been going on for it.
• Oncocytoma: This is a rather rare type of cancer cell. It rarely ever comes forward or grow for that matter. Oncocytoma also doesn’t generally spreads to other parts of the body. Surgery is generally suggested as a potential treatment for it.
• Angiomyolipoma: Angiomyolipoma is a benign tumor that has a unique appearance on a CT scan and when viewed under a microscope. Usually, it is less likely to grow and spread. It is usually treated with surgery or, if it is small, with active surveillance (see Types of Treatment). Significant bleeding is a rare event but more likely in pregnant and premenopausal women. An aggressive form of angiomyolipoma, called epithelioid, can in rare instances invade the renal vein and inferior vena cava and spread to nearby lymph nodes or organs, such as the liver.

Stages of Kidney Cancer

Just like any other type of cancer, kidney cancer can also be categorised in four different stages:

• Stage 1: The first stage of kidney cancer is when the kidney tumour is only 7 cm or smaller than that. Here, the cancer has still not spread to the lymph nodes.
• Stage 2: Stage 3 cancer is still a kidney tumour in the kidney and has not spread to the lymph nodes yet. However, the size of the tumour is larger than 7 cm. 
• Stage 3: On this stage, the kidney tumour can be greater or smaller than 7 cm but has already spread to lymph nodes. In addition to other parts of the body.  
• Stage 4: There are two conditions that meet stage 4 kidney cancer criteria. The first one is – tumour has spread to the lymph nodes, beyond Gerota’s fascia and has further extended to the adrenal gland. However, it has not spread to any other body part. The second condition is when the kidney tumour has spread to other body parts like the lungs or the liver as well as the lymph nodes. 

Kidney Cancer Symptoms

• Finding blood when urinating
• A feeling of pressure or pain in the side or the back 
• A lump in the back or the side 
• Swollen ankle and legs
• Anemia
• Hypertension or high blood pressure
• Tiredness and weakness
• Lost appetite
• Unwarranted weight loss
• A very persistent fever that has no explanation like cold, flu or other kind of viral and bacterial infection 
• A sudden appearance of enlarged veins around the right testicle may be a sign of large kidney tumour. 

Kidney Cancer Risk Factors 

• Smoking: A cause and risk factor for very many diseases, smoking can make a huge difference when it comes to kidney cancer specifically. It has been believed to almost double the risk of getting kidney cancer. Almost 30% of men with kidney cancer have it because of smoking as well as 25% of the women. If a person already at risk of having kidney cancer due to unchangeable factors also smokes, their chances of having kidney cancer several folds. 
• Nutrition: While the exact relation is not defined, some connection is shown to be present between kidney and obesity. Since nutrition plays an important role when obesity is concerned, it plays an important role as kidney cancer risk factors. 
• Age and Gender: People older than 50 years of age are more likely to get kidney cancer as compared to younger people. In addition to that, men are almost 3 times more likely to get kidney cancer as compared to women. So, men who have crossed middle age are the most likely to get kidney cancer.
• Overuse of Medicines: Many kinds of pain killers are proven to have a link with kidney cancer. Some very common examples include medicines like aspirin and ibuprofen. Overuse and overdose of these medicine significantly increases the chances of having kidney cancer. 
• Hypertension: High blood pressure is known to change functioning of the kidneys which increases the chance of developing kidney tumours. 
• Cadmium Exposure: Commonly found in batteries, welding material, and paint, the metallic element cadmium is known to increase the risk of having kidney cancer. Add the risk increment that smoking brings to it and the danger becomes quite significant. 
• Family History of Kidney Cancer: Whether its second- or first-degree relatives, having a family history of kidney cancer increases a person’s chance to get it themselves quite a lot. The first-degree relatives would include your father, mother and siblings while the second-degree relatives would be grandparents, cousins, uncles and aunts. From hereditary kidney diseases to rare kidney tumour, bilaterality kidney tumours and multiple tumours are some of the diseases that family history can bring forth. 
• Dialysis History: People who have been staying on dialysis support for a long time have the chances of developing cancerous cysts in their kidneys. But since these patients are already under supervision of the doctor, any and every cyst is found early enough to be treated completely or removed. 
• Chronic Kidney Diseases: Even without the need for dialysis, people with chronic kidney diseases have a higher chance of getting kidney cancer. 
• Genetics: A few genetic conditions may also lead to cancerous growth in the kidneys. These conditions can include BHD syndrome, VHL syndrome, HLRCC, Hereditary papillary renal cell carcinoma (HPRCC), SDH complex syndrome, etc. 

Kidney Cancer Diagnosis Procedures

• Biopsy: The patient is given local anaesthesia and then a small cluster of tissues is removed from the kidney to be diagnosed under the microscope for cancerous growth. Biopsy is one of the most trusted diagnostic processes to only identify and confirm the presence of cancerous cells in the body part but also to determine the type of cancer cells involved in the kidney tumour present. A pathology report is generated after a biopsy which contains everything about the cancer cells found in the tumour. This reports not only goes in the permanent medical records of the patients but becomes an important piece of information for the doctors to decide the course of treatment for the cancer cells present in the kidney tumour. 
• Blood and Urine Tests: Blood and urine tests are two of the most common primary tests taken to determine the presence of kidney cancer. Blood tests may be done to see the level of red blood cells in the body while the urine test is done to determine the presence of certain bacteria, blood or cancer cells in it. One of the main kidney cancer symptoms is blood in the urine. These two tests cannot used to confirm kidney cancer however they still play an important role as primary diagnostic tests for kidney cancer cases. 
• CT-Scan: X-rays are used to create pictures of the kidney from various angles. These pictures are then combined in a computer to create a complete diagram of the kidney in 3-dimensional form. The scan results can be used to identify growth of any unfamiliar mass in the kidney. CT scan is perfect to find out the size of the kidney tumour as well. if the scan is being taken to find a renal mass, no contrast dye is used. However, if the CT scan is bring done to find a renal tumour or any other kind of tumour, contrast dye is injected in the veins of the patient to get clearer pictures. Renal tumours with fatty tissues present are benign tumours will show up on the CT scan done without the contrast dye. If the patient is already suffering from a chronic kidney disease, using the dye is regarded unsafe for them. 
• X-rays: As evident, x-rays reports use x-rays and a little bit of radiation to get pictures of the organs. 
• MRIs: Instead of x-rays, magnetic resonance imaging or MRIs use magnetic fields to create the images of the kidney. Just like CT scans, MRIs can be used to determine the size of a kidney tumour and designate it a stage. A contrast dye is used to create clearer pictures for MRIs as well. Radiations used in MRIs are not as high as CT scans.  
• Cystoscopy and Nephro-ureteroscopy: These two special diagnosis systems are only used to identify only a few types of cancers like cancers of the urinary tract or renal pelvic cancer, etc. Renal carcinoma and other similar kind of cancers are not generally identified with these tests. The patient is given some kind of anaesthesia for sedation at first. Once sedated, a small tube is inserted into the bladder via the urethra. The tube goes all the way up into the kidney where it can be used to collected samples from the potential cancerous growth. These two processes can not only be used to obtain samples for biopsies but also to destroy tumour cells for good. 

Treatment for Kidney Cancer 

• Surgery: Three main kinds of surgeries can be opted for when it comes to kidney cancer. Radical nephrectomy is the first one in line. This surgery is recommended when the kidney tumour is not only large but also affects the surrounding organs of the kidney as well. If the tumour has spread to the nearby lymph nodes and nor much health tissue remains, the tumour, the lymph nodes and the complete kidney is removed by performing a radical nephrectomy. Another option for surgery is a partial nephrectomy. Here, only the kidney tumour is removed and the rest of the kidney remains in place. This surgery is only effective for stage 1 kidney cancers where the tumour is benign and has not yet gotten to lymph nodes. The third and final surgical option is Laparoscopic and/or robotic surgery. Small incisions are made in the abdomen and the kidney or the kidney tumour only are removed depending upon the requirements of the hour. The surgery may be performed by a doctor or a robotic arm as well.
• Radiofrequency Ablation: A thin needle is inserted inside the kidney to send electric shockwaves and destroy it. This method is generally used when the patient is too sick to go through a surgery. The patient is sedated first and then a radiologist with a urologist perform the treatment procedure. 
• Cryoablation: Also known as cryotherapy, in cryoablation, the cancer cells are frozen using safe freezing elements. Ultrasound and other similar diagnostic tests may be used to guide the doctor when performing the procedure. the patient is of course sedated throughout the process but constant survellience is conducted. 
• Immunotherapy: This is a drug-based therapy that aims to enable the immune system to fight and kill the cancer cells on its own. The immunotherapy drugs functions as a booster for the immune system. Immunotherapy is generally recommended for later stage kidney cancers where other treatment options like surgery are not an option anymore. The drugs or checkpoint inhibitors used in this procedure rejuvenates the immune system an reprograms it to kill the cancer cells. 
• Targetted Therapy: Certain drugs are used to target cancer cells or the cells that supply nutrients for their growth in order to hinder the supply and stop the growth of the cells altogether. For example, clear cell cancers of kidney generally develop a mutation o VHL genes. Here a certain protein name VEGF is produced in copious amounts in the body. This protein forms new blood cells which supply the nutrient to clear cell cancer growth in the kidney. The anti-angiogenesis therapy is used to target the production of VEGF protein and stop it at the initial point itself. 
• Chemotherapy: Another drug-based therapy, anti-cancer drugs are used in chemotherapy to target the cancer cells in the kidney directly. The drugs are given in cycles depending on the requirements of the patient. One or more drugs can be used in combination to treat cancer cells, prevent them from growing and slowly destroying them. 
• Radiation Therapy: High-energy rays, generally x-rays are used to destroy the tumour growing inside the kidney. Radiation therapy is only prescribed for small-sized tumours since the x-rays also destroys healthy cells in the way. If the kidney tumour has spread in a larger area, radiation therapy is not recommended. 

Kidney Cancer Prevention 

Try and quit smoking since it is a root cause for not only kidney cancer but many other lethal diseases. Maintain a healthy weight by eating healthy and getting plenty of exercises. Try to exercise at least 4 days every week for an hour or half. Ensure that your blood pressure stays at a healthy level too. There isn’t much one can do about the risk factors like genetics and family history but the rest can be control. However, the rest can be controlled. Ensure that you get checked at the first sign of discomfort or a related symptom. 

Health Insurance for Kidney Cancer 

Kidney cancer may lead to kidney failure which is covered by several critical illness plans in the UAE. Kidney cancer, like all other cancers covered by health insurance, may also be covered by critical illness plans depending on the provider and the coverage level of the plan. When covered by a critical illness plan, the policyholder can receive a compensation lump sum amount to cover the treatment costs of kidney cancer after the diagnosis. There is a survival period of 15 to 30 days which has to be cleared after being diagnosed with the disease. You can even get health insurance if you have already been diagnosed and treated for kidney cancer or any other kidney disease. However, the waiting period applicable for pre-existing diseases will apply. The waiting period can range from 6 months to 2 years. 

In a Nutshell 

Kidney cancers are not as common as other kinds of cancers but it is equally dangerous. In addition to the danger that cancerous growth brings, kidneys are also exposed to chronic kidney diseases after being treated for kidney tumours. It becomes important to pay complete attention to the initial kidney cancer symptoms and get tested as soon as you notice something wrong. Just have a health insurance plan as a back up if you are at a higher risk of getting kidney cancer.