Kidney cancer
Kidney cancer: Excerpt from Professional Guide to Diseases (Eighth Edition)
Kidney cancer (also known as nephrocarcinoma, renal cell carcinoma, hypernephroma, and Grawitz's tumor) usually occurs in older adults. Renal pelvic tumors and Wilms' tumor occur primarily in children. Kidney tumors, which usually are large, firm, nodular, encapsulated, unilateral, and solitary, can be separated histologically into clear cell, granular, and spindle cell types. (See Staging kidney cancer.) The prognosis ranges from 66% for Stage I to 11% for Stage IV.
Causes and incidence
The causes of kidney cancer aren't known, although smokers develop more renal cell tumors than nonsmokers. However, the incidence of this malignancy is rising, possibly as a result of exposure to environmental carcinogens as well as increased longevity. Even so, this cancer accounts for only about 2% of all adult cancers. Kidney cancer is more common in men than women and peaks in incidence between ages 50 and 70.
Signs and symptoms
Kidney cancer produces a classic clinical triad (hematuria, pain, and a palpable mass), but any one may be the first sign 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 coexist in only about 10% of patients.
Other signs 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 signal advanced disease.
Diagnosis
Studies to identify kidney cancer usually include computed tomography scans, excretory urography, 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, and prolonged prothrombin time. Such results may point to liver metastasis, but if metastasis hasn't occurred, these abnormalities reverse after tumor resection.
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.
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 these cases, high radiation doses are used.
Chemotherapy has been only erratically effective against kidney cancer. Fluorouracil, cyclophosphamide, vinblastine, vincristine, cisplatin, tamoxifen, teniposide, interferons, and hormones such as medroxyprogesterone and testosterone have been used, usually with poor results. Biotherapy (interferon and interleukins), commonly used in advanced disease, has produced few durable remissions.
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 such expected postoperative procedures 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 may result from radiation or chemotherapy.
❑Treat drug adverse effects.
❑Stress compliance with the prescribed outpatient treatment regimen.
Pictures
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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