Kidney cancer
Kidney cancer: Excerpt from Handbook of Diseases
Kidney cancer is also known as nephrocarcinoma, renal cell carcinoma, hypernephroma, and Grawitz’s tumor. It usually occurs in older adults, with about 85% of tumors originating in the kidneys and others resulting from metastasis from other primary sites. Renal pelvic tumors and Wilms’tumor occur primarily in children.
Kidney tumors — which are usually large, firm, nodular, encapsulated, unilateral, and solitary — can be separated histologically into clear cell, granular, and spindle cell types. The 5-year survival rate for patients with kidney cancer is about 50%; the 10-year survival rate is lower.
Causes
The cause of kidney cancer is unknown. However, the incidence of this cancer is rising, possibly as a result of exposure to environmental carcinogens as well as increased longevity. Even so, kidney cancer accounts for only about 2% of all adult cancers. It’s twice as common in men as in women and usually affects patients older than age 40.
Signs and symptoms
Kidney cancer produces a classic triad of signs and symptoms — hematuria, pain, and a palpable mass — but any one may be the first indication of cancer. Microscopic or gross hematuria (which may be intermittent) suggests that the cancer has spread to the renal pelvis.
Constant abdominal or flank pain may be dull or, if the cancer causes bleeding or blood clots, acute and colicky. The mass is generally smooth, firm, and nontender. All three signs of kidney cancer coexist in only about 10% of patients.
Other signs and symptoms include fever (perhaps from hemorrhage or necrosis), hypertension (from compression of the renal artery with renal parenchymal ischemia), rapidly progressing hypercalcemia (possibly from ectopic parathyroid hormone production by the tumor), and urine retention. Weight loss, edema in the legs, nausea, and vomiting are signs and symptoms of advanced kidney cancer.
CLINICAL TIP: Bone pain or fracture from a metastatic lesion may also be a chief complaint.
Diagnosis
Studies to identify kidney cancer usually include computed tomography scans, excretory urography and retrograde pyelography, ultrasound, cystoscopy (to rule out associated bladder cancer), and nephrotomography or renal angiography to distinguish a kidney cyst from a tumor.
Related tests include liver function studies showing increased levels of alkaline phosphatase, bilirubin, alanine aminotransferase, and aspartate aminotransferase as well as prolonged prothrombin time. Such results may point to liver metastasis, but if metastasis hasn’t occurred, these abnormalities reverse after the tumor has been resected.
Routine laboratory findings of hematuria, anemia (unrelated to blood loss), polycythemia, hypercalcemia, and increased erythrocyte sedimentation rate call for more testing to rule out kidney cancer. A bone scan should also be performed to rule out skeletal metastasis.
Treatment
Radical nephrectomy, with or without regional lymph node dissection, offers the only chance of cure. Because the disease is radiation-resistant, radiation is used only if the cancer spreads to the perinephric region or the lymph nodes or if the primary tumor or metastatic sites can’t be fully excised. In such cases, high doses of radiation are used.
Chemotherapy has been only erratically effective against kidney cancer and includes various drugs. Interferons and hormones, such as medroxyprogesterone and testosterone, have also been used. Biotherapy (lymphokine-activated killer cells with recombinant interleukin-2) shows promise, but causes adverse reactions. Interferon is somewhat effective in advanced disease. Hormone therapy may be tried in advanced cases.
Special considerations
❑ Meticulous postoperative care, supportive treatment during other therapy, and psychological support can hasten recovery and minimize complications.
❑ Before surgery, assure the patient that his body will adapt to the loss of a kidney.
❑ Teach the patient about expected postoperative actions, such as diaphragmatic breathing, coughing properly, splinting his incision, and others.
❑ After surgery, encourage diaphragmatic breathing and coughing.
❑ Assist the patient with leg exercises, and turn him every 2 hours.
❑ Check dressings often for excessive bleeding. Watch for signs of internal bleeding, such as restlessness, sweating, and increased pulse rate.
❑ Place the patient on the operative side to allow the pressure of adjacent organs to fill the dead space at the operative site, improving dependent drainage. If possible, help the patient walk within 24 hours after surgery.
❑ Maintain adequate fluid intake, and monitor intake and output. Monitor laboratory results for anemia, polycythemia, or abnormal blood values that may point to bone or liver involvement or that may result from radiation or chemotherapy.
❑ Treat any adverse reactions to the prescribed drug therapy.
❑ Stress the need to comply with the prescribed outpatient treatment regimen.
Book Source Details
- Book Title: Handbook of Diseases
- Author(s): Springhouse
- Year of Publication: 2003
- Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Handbook of Diseases
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2003
ISBN: 1-58255-266-5
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