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Dx Renal Cancer Treatments:

Renal Cancer

The Merck Manual Home Edition
"Kidney Cancer

*Cancers may cause blood in the urine or crampy pain in the side.
*Diagnosis is usually by computed tomography.
*Treatment is removal of the kidney and ureter.

Cancer can occur in the cells lining the central collecting area of the kidney (the renal pelvis—usually a type called transitional cell carcinoma of the renal pelvis) and in the slender tubes that carry urine from the kidney to the bladder (ureters). Cancers of the renal pelvis and ureter are much less common than cancers of the rest of the kidney or bladder. They probably occur in fewer than 6,000 people in the United States each year.

Blood in the urine is usually the first symptom. People may also have pain and burning during urination and an urgent, frequent need to urinate. Crampy pain in the flank (the space between the ribs and hip) or lower abdomen may occur if the flow of urine is obstructed (for example, because a blood clot blocks the ureter).

The cancer is usually detected by using computed tomography (CT) or ultrasonography. CT and often ultrasonography can help doctors distinguish other noncancerous (benign) kidney and ureteral problems such as stones or blood clots. Microscopic examination of a urine sample may reveal cancer cells. A flexible viewing tube—a ureteroscope—threaded up through the bladder may be used to view cancers, obtain tissue samples for confirmation of the diagnosis, and occasionally even treat small cancers. To determine how extensive cancers are and how far they have spread, CT scans of the abdomen and pelvis and chest x-ray are done.

If the cancer has not spread and if it can be completely removed surgically, cure is likely. However, if the cancer has spread into the wall of the renal pelvis or ureter or to distant sites, cure is unlikely.

If the cancer has not spread beyond the area of the renal pelvis and ureter, the usual treatment is surgical removal of the entire kidney and ureter (nephro-ureterectomy) along with a small part of the bladder. However, in some situations—for example, when the kidneys are not functioning well or a person has only one kidney—the kidney is usually not removed because the person would then become dependent on dialysis. Some cancers in the renal pelvis and ureter may be treated with a laser to destroy the cancer cells or with surgery that removes only the cancer itself while leaving the kidney, the noncancerous portion of the ureter, and the bladder in place. Occasionally, a drug, such as mitomycin C or bacille Calmette-Guérin (BCG—a substance that stimulates the body's immune system) is instilled into the ureter or a chemotherapy drug is given. It is not clear how effective laser treatments and drug instillations are.

A cystoscopy (insertion of a flexible viewing tube to examine the inside of the bladder) is done periodically after surgery, indefinitely, because people who have had this type of cancer are at risk of developing bladder cancer.

*[Editor]: The Spanish Oncology Genitourinary Group recommended the following for treatment of metastatic renal cancer "since there are low benefits of chemotherapy": Both sunitinib and pazopanib are TKIs that constitute the first-line treatment option in patients with metastatic RCC. As second-line treatment, sequential therapy with a second TKI or a mTOR inhibitor is recommended.

Medications Used in Treatment:
1. Progestins: Depo-Provera®
3. VEGF Antibodies: Avastin®/vevacizumab
4. Lymphocyte Growth Factors: Proleukin®/aldesleukin, IL-2

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*N.H.S. Choices (with Video)

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