Your cancer

Living with the disease

Kidney cancer

What is it ?

The kidney is a vital organ, responsible for filtering the blood and producing urine in order to eliminate waste from the circulatory system. Kidney cancer occurs when a cell, most frequently located in the renal parenchyma, begins reproducing in an uncontrolled manner, forming a tumor. Although kidney cancer is relatively rare, its occurrence is rising, particularly in industrialized countries.

Témoignage Patient

Olivier confides in you his fight against kidney cancer, which he managed to overcome with the precious help of his entourage.

Kidney cancers

Although there are numerous sub-types of kidney cancers, clear cell renal carcinoma is the most common, followed by papillary carcinoma (type I and type II) and chromophobe renal cell carcinoma. There are over 50 different sub-types of kidney cancer in total
In rare cases, kidney cancer can be caused by hereditary genetic conditions and be accompanied by extra-renal pathologies (e.g., Von Hippel-Lindau syndrome). Patients under the age of 45 who are diagnosed with bilateral and/or multifocal tumors should have his/her first-degree relatives undergo genetic tests.

The symptoms

In the majority of cases, kidney cancer is asymptomatic and discovered by chance.

Fatigue

weight loss 

loss of appetite

haematuria

Lower back pain

Palpable mass in the abdomen

Fever

Screening

There is no mass screening strategy for kidney cancer. Only individuals who are hereditarily predisposed to this type of cancer are systemically monitored.

Diagnostic Process

Diagnosis is made following a uroscan, which may or may not include the injection of a contrast medium. An abdominal MRI scan also permits the clear identification and characteristic definition of the lesion. Lastly, contrast echography may be used.
Contrary to the majority of tumors, biopsies are rarely used as a method of diagnosis confirmation.
As 20% of renal tumors are metastatic (i.e. will have spread to locations which are remote from the kidney), assessment will be extended to include a full body scan and/or a MRI brain scan and a bone scan.

Risk factors

There are some risk factors for kidney cancer which cannot be changed:
Age
(the risk increases with age, particularly after the age of 70)
Gender
(there are twice as many cases in men)
Consumption of tobacco
(6% of cases)
Excessive weight and obesity
(25% of cases)
Occupational exposure to carcinogens.
Certain pathologies increase the risk of developing a renal carcinoma, such as AHT (arterial hypertension)
Chronic renal failure
(particularly in dialysis/transplant patients)
Hereditary conditions
(between 2 and 8% of cases)

Treatments

The therapeutic strategy depends on the condition’s stage.

1. At the localized stage, focal therapy (i.e., a treatment which is intended to remove or neutralize malignant cells) is generally preferred. Various treatment options are available depending on the context (size and location of the tumor, initial renal function, the existence of a hereditary condition, etc.) and should be suggested by a specialized urological surgeon and/or an interventional radiologist:

Surgical options include:

   *total (in the majority of cases): the affected kidney is removed along with the surrounding fat and the homolateral suprarenal gland

    *partial: if the tumor is located at the kidney’s perimeter and is limited in size, or in the context of a hereditary pathology involving a risk of multiple tumors

Traitements en radiologie interventionnelle :

*radiofrequency ablation: a probe is positioned percutaneously in contact with the tumor and tumoral cells are killed by heat (at a temperature between 50 and 100°C).

*cryoablation: also administered percutaneously, in this case the probe freezes the lesion (-47°C).

Although not generally reimbursed by insurance, immunotherapy may become available as an adjuvant therapy, i.e., following the ablative treatment of a localized tumor.
2. When kidney cancer is or becomes metastatic, the oncologist may suggest a variety of therapies. Kidney cancer is not susceptible to chemotherapy – consequently, this treatment will not be offered. Treatment is based upon targeted oral therapies or immunotherapy administered by perfusion, or a combination of the two. Finally, if metastatic lesions are limited in number, a focal treatment may be proposed (radiotherapy, surgery or interventional radiology).

Change in care

The development of state-of-the-art immunotherapy has transformed kidney cancer care over the last 20 years.

Immunotherapy

The latest immunotherapies, which “train” the patient’s immune system to target and destroy tumoral cells (see attached report), have achieved high response rates, including a full response in up where immunotherapies are combined.

Neoangiogenesis

Kidney cancer benefits from mechanism described as “neoangiogenesis,” the cancer is able to create its own vascular system to foster its growth.A number of molecules have recently been developed to block this mechanism, improving the prognosis for patients with metastatic kidney cancer.

The future

Clinical trials are in progress to determine which types of patients will benefit most from one or more of the above therapies. 

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