Your cancer

Living with the disease

Kidney cancer

What is it ?

The kidney is a vital organ, the key function of which is the filtration of blood and the production of urine for the elimination of wastes from the circulatory system. A kidney cancer is a tumour originating from a cell which has acquired the capacity to reproduce in an uncontrolled manner, most frequently in the renal parenchyma. Although this is a rare condition, its occurrence is rising constantly, particularly in industrialized countries. With over 15,000 new cases per annum in France, kidney cancer is the third most common urological cancer.

Kidney cancers

Although there are numerous sub-types of kidney cancers, the most common (accounting for 80% of cases) is described as “clear cell renal carcinoma”. The other most common histologies (i.e. categories of kidney cancer defined according to the type of cells affected) are papillary carcinoma (type I and type II) and chromophobe renal cell carcinoma. In total, over 50 different sub-types occur.
Kidney cancer may sometimes fall within the scope of hereditary genetic conditions, and be accompanied by extra-renal pathologies (for example, Von Hippel-Lindau syndrome). Although rare, these situations must be identified and confirmed by genetic analyses. Accordingly, in the event of the diagnosis of bilateral and/or multifocal tumours before the age of 45, a dedicated genetic consultation of cases among first-degree relatives will be requested.

Symptoms

In the majority of cases, kidney cancer is discovered by chance, independently of any symptoms (in 65% of cases).

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. Systematic monitoring is only undertaken among individuals who have hereditary predispositions to this type of cancer.

Diagnostic Process

The key examination for the confirmation of a diagnosis is a uroscan, with or without the injection of a contrast medium. An abdominal MRI scan also permits the clear identification and characteristic definition of the lesion. Finally, contrast echography can also be employed.
Conversely to the majority of tumours, it is rare for a biopsy to be executed by way of confirmation. A biopsy will only be undertaken in the event of potential for the modification of the treatment strategy, relative to the diagnosis of kidney cancer established by imaging.
As 20% of renal tumours are metastatic, i.e. will have spread to locations which are remote from the kidney, an assessment of extension will be systematically executed in the form of a full body scan +/- a MRI brain scan and a bone scan, depending upon the symptoms observed at the time of diagnosis.

Risk factors

here are some risk factors for kidney cancer which cannot be changed:
The 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.
Finally, certain pathologies in themselves increase the risk of developing a renal carcinoma: AHT (arterial hypertension)
chronic renal failure
(particularly in dialysis/transplant patients)
Hereditary conditions
(between 2 and 8% of cases)

Treatments

Therapeutic strategy is essentially dependent upon the stage of progress of the condition.

1. At the localized stage, a focal treatment will be preferred (i.e. a treatment which is intended to remove or neutralize malignant cells). Depending upon the context (size and location of the tumour, initial renal function, the existence of a hereditary condition, etc.), various options are available, and will be described to you by a specialized urological surgeon and/or an interventional radiologist:

Surgical options are as follows:

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

    *partial, if the tumour is located at the periphery of the kidney and is limited in size, or in the context of a hereditary pathology involving a risk of multiple tumours;

Interventional radiology treatments are as follows:

*radiofrequency ablation: administered by the percutaneous route, a probe is positioned in contact with the tumour, and tumoral cells are killed by heat (at a temperature between 50 and 100°).

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

Although reimbursement is not yet available, immunotherapy might soon be offered as an adjuvant therapy, i.e. following the ablative treatment of a localized tumour.
2. Where kidney cancer is, or becomes metastatic, the oncologist has a range of therapies at their disposal, which has expanded considerably in recent years. 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).

Transformed kidney cancer care

The development of state-of-the-art immunotherapy has transformed kidney cancer care. Although it was known over 20 years ago that this condition did not respond to chemotherapy but already responded to previous immunotherapies, the secondary effects of the latter were very severe, and in some cases fatal.

Immunotherapies

The latest immunotherapies, which target the immune system of the patient such that, in turn, the patient’s immune system targets and destroys tumoral cells (c.f. dedicated report) have permitted the achievement of high response rates, including a full response in up to 10% of cases, where immunotherapies are mutually combined.

La néoanguigénèse

The specific nature of kidney cancer also stems from its association with a mechanism described as “neoangiogenesis”, which is the capacity of the cancer to create its own vascular system as a means of fostering its uncontrolled growth. The recent development of a number of molecules which block this mechanism has permitted an improvement in the prognosis for metastatic kidney cancer.

Le futur

The key issue for the future will be the optimum selection of those patients who will benefit from one of these strategies, or a combination thereof. Clinical trials are in progress.