Is kidney cancer a common type of cancer?

According to 2017 national data on the Ministry of Health website, kidney cancer was identified as the 7th most common cancer in men in our country. Urological cancer was not found among the top 10 cancers in women.

In 1 year, 7.2 out of every 100,000 men are diagnosed with kidney cancer, while this rate is 3.4 out of every 100,000 women.

In what age range is kidney cancer seen?

It is rarely seen before the age of 50; however, it may occur at an earlier age in some genetic diseases.

What are the genetic diseases that increase the frequency of kidney cancer?

von Hippel-Lindau disease (VHL).

Hereditary leiomyomatosis and kidney cancer (HLRCC).

Birt-Hogg-Dubé syndrome (BHD).

Hereditary papillary kidney cancer (HPRC).

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What are the factors that increase the frequency of kidney cancer, other than genetic diseases?

Smoking
Excess weight
Hypertension disease
Dialysis
Some kidney cysts

What are the symptoms of kidney cancer?

In the past, symptoms such as flank pain, abdominal swelling, and blood in the urine were common signs of kidney tumors. However, with the development of imaging techniques, especially the widespread use of ultrasound, most kidney tumors can now be detected without causing any symptoms.

What should be done after a kidney tumor is detected on ultrasound?

To differentiate whether the observed mass is benign or cancerous, a medicated tomography or MRI should be performed. If the tumor is determined to be cancerous, metastasis should be investigated. Since kidney cancer will most commonly spread to the lungs, the lungs should be evaluated with a tomography.

Are all kidney tumors seen on ultrasound cancer?

No. Renal adenoma, oncocytoma, angiomyolipoma, lipoma, and fibroma are benign masses that can be detected in the kidney.

The differentiation of these masses from cancer is made by their appearance on contrast-enhanced tomography and MRI, which typically show characteristics distinct from cancer. In some cases, these benign masses may appear similar to cancer. In such cases, a kidney biopsy may be performed.

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Is kidney biopsy definitive in diagnosis?

No. Sometimes, a mass may appear to be benign in pathological evaluation even though it is cancerous; however, if definitive results cannot be obtained from imaging methods and surgery is risky, or if the mass is planned to be removed with a non-surgical method called minimally invasive, a biopsy should be performed.

Is treatment necessary for benign kidney tumors?

No, but if the mass causes symptoms such as pain, bleeding, or if it impairs kidney function or if there is a risk of future problems, it should be treated. For example, masses called angiomyolipomas contain many blood vessels; especially if they reach sizes larger than 4 cm, they can cause bleeding and even death. In these cases, the mass can be removed surgically or the tumor can be reduced by closing the vessels leading to the mass with angioplasty (embolization).

How is kidney cancer staged?

The disease is staged according to the size of the tumor, its relationship with the renal vein, the membrane around the kidney (Gerota's membrane), and the main vein (vena cava). Staging is extremely important in treatment selection.

How is kidney cancer treated?

The most effective treatment for kidney cancer that has not spread to the body is surgery. Surgery can be done openly, laparoscopically or robot-assisted laparoscopically. These methods have no superiority over each other in terms of treatment success. The advantages of laparoscopic methods are shorter hospital discharge, smaller scars and less pain after surgery.

Is the entire kidney removed with surgery, or is only the tumor removed?

The decision is made according to the stage of the tumor, its location, and the condition of the other kidney. The surgery in which the kidney is removed is called nephrectomy, while the surgery in which only the tumor is removed is called partial nephrectomy. Both surgeries can be performed openly or laparoscopically or robot-assisted laparoscopically.

How to decide which surgery to perform?

In general, only the tumor is removed in masses smaller than 7 cm. In tumors larger than 7 cm that can be removed without damaging the kidney, the non-cancerous kidney tissue can be preserved. In particular, in patients who do not have another kidney or who are genetically predisposed to kidney cancer and who are likely to develop a tumor in the other kidney in the future, an attempt is made to protect the kidney. Unfortunately, sometimes, in tumors smaller than 7 cm that cannot be removed without damaging the main vessels of the kidney, the entire kidney may need to be removed. Before the surgery, a detailed radiological evaluation is made to decide which surgery to perform, but during the surgery, anatomical conditions that cannot be detected by imaging methods may sometimes be encountered. In such cases, the decision may be changed during the surgery and the decision may be made to remove the entire kidney or only the tumor. Since advanced MRI and tomography technology provide the surgeon with extremely detailed anatomical information about the kidney and surrounding organs before the surgery, changes during the surgery are extremely rare today.

Is one kidney enough for the body?

If there is no problem with the remaining kidney after the surgery, there is no obstacle for the person to continue their life as before the surgery. However, if it is considered that most patients with kidney tumors are over the age of 50 and have chronic diseases such as high blood pressure and/or diabetes that damage the kidney, the remaining single kidney may not be able to meet the body's needs at an ideal level. Urea levels may increase after the kidney is removed. This is usually not advanced enough to require dialysis.

What is the treatment for kidney cancer that has spread throughout the body?

If there are not many foci of spread (metastasis) and these foci can be removed with surgery, these foci are also removed with surgery along with the kidney cancer.

If there is a lot of spread (metastasis), only kidney cancer surgery is performed and drug treatment is started, or only drug treatment is given without surgery.

How is kidney cancer treated in patients who cannot undergo surgery?

Kidney cancer can be destroyed in the body with techniques we call minimally invasive methods. In these techniques, needles that heat the tumor with radiofrequency or freeze it with liquid nitrogen are placed under the guidance of imaging methods to a degree that will cause cell death. The tumor is tried to be shrunk by killing the cancer cells by overheating or freezing the cancer. Since the long-term success of these methods is not as good as surgery, they are not recommended for patients who do not have a condition that prevents surgery.

What is the follow-up like in kidney cancer?

Kidney cancer recurrence is monitored by imaging the lungs and abdomen. Even if the kidney is completely removed, recurrence can occur in the area where the kidney was removed. If only cancer is removed, the remaining kidney tissue should be monitored for recurrence.