Kidney cancer affects the organs responsible for filtering waste from the blood. While a diagnosis can be daunting, survival is possible, and advancements in understanding and treating the disease have significantly improved prospects. The outlook depends on individual circumstances and the specific characteristics of the cancer.
Understanding Kidney Cancer
Kidney cancer typically begins in the lining of the tiny tubes within the kidney that filter blood and produce urine. The most common type, renal cell carcinoma (RCC), accounts for approximately 90% of adult kidney cancers. RCC often appears as a single tumor in one kidney, though multiple tumors or involvement of both kidneys can occur.
Other less common types of kidney cancer include transitional cell carcinoma, which starts in the renal pelvis, and Wilms tumor, primarily seen in children. Renal sarcomas are a rare type originating in the connective tissues. Early kidney cancer often does not cause noticeable symptoms, leading to its incidental discovery during imaging tests for other conditions.
Factors Influencing Survival
The cancer’s stage at diagnosis is a primary factor influencing survival, describing tumor size and spread. Doctors use the TNM (Tumor, Node, Metastasis) system: “T” for tumor size/extent, “N” for lymph node involvement, and “M” for distant spread. Lower stage numbers (I-IV) indicate less spread and a more favorable outlook. For example, localized kidney cancer has a 5-year survival rate around 93%, compared to approximately 15.3% for cancer that has spread.
The specific histological type and grade of kidney cancer also influence prognosis. Clear cell RCC, while common, varies in aggressiveness. Papillary and chromophobe renal cell carcinomas are other types. The cancer’s grade, typically on a scale of 1 to 4 (Fuhrman system), indicates how abnormal cells appear under a microscope and their likely growth rate, with lower grades having a better outlook.
A patient’s overall health and age play an important role in their ability to undergo and recover from treatment, impacting survival. Conditions like heart disease or diabetes can affect treatment options and outcomes. Younger individuals are generally associated with better 5-year survival rates. The cancer’s response to initial treatment also influences the long-term outlook.
Treatment Approaches
Surgery is often the primary treatment for kidney cancer, especially when the disease is localized. A partial nephrectomy involves removing only the cancerous part of the kidney, preserving healthy tissue. For larger tumors or if a partial removal is not feasible, a radical nephrectomy, which removes the entire kidney, may be performed. Surgery aims to eliminate the tumor and can be highly effective for early-stage disease.
Targeted therapies interfere with molecules or genes that promote cancer growth. VEGF inhibitors, such as sunitinib and pazopanib, block new blood vessel formation that tumors need. mTOR inhibitors, like everolimus, block a protein that helps kidney cancer cells multiply. These therapies are used for advanced or metastatic kidney cancer to slow disease progression.
Immunotherapy harnesses the body’s immune system to fight cancer cells. Checkpoint inhibitors, including drugs like nivolumab and pembrolizumab, block proteins cancer cells use to evade detection. These treatments can shrink tumors and improve outcomes, particularly for advanced or metastatic kidney cancer.
Radiation therapy has a more limited role in treating primary kidney cancer due to its relative resistance to conventional radiation. However, it is valuable for palliative care, helping to manage symptoms such as pain or bleeding, and to treat cancer that has spread to areas like the brain or bones. Highly precise techniques like stereotactic body radiation therapy (SBRT) can deliver high doses of radiation to specific tumor sites.
Chemotherapy is generally not as effective for the most common type of kidney cancer (RCC) compared to other cancer types. However, it may be considered for rare forms, such as transitional cell carcinoma or collecting duct carcinoma. Treatment decisions are individualized, considering the cancer’s stage, type, and the patient’s overall health.
Life After Treatment
After active treatment, regular follow-up care is an ongoing part of managing health. This involves scheduled visits with imaging scans (e.g., CT scans) and blood tests to monitor kidney function and check for recurrence. Appointment frequency varies based on the cancer’s initial stage and recurrence risk, typically starting every few months and gradually becoming annual.
Managing potential long-term side effects from treatment is also an important part of life after kidney cancer. Surgical side effects might include changes in kidney function or persistent fatigue. Systemic therapies like targeted therapy and immunotherapy can lead to side effects such as high blood pressure, skin rashes, or digestive issues. Open communication with the healthcare team is important to address and manage these effects, often through medication adjustments or lifestyle changes.
While follow-up aims to detect recurrence early, it is a possibility for some. If cancer returns, further treatment options are available, tailored to the new situation. Beyond medical monitoring, focusing on quality of life involves psychological support, healthy lifestyle habits like diet and exercise, and developing a survivorship care plan with the medical team.