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The kidneys are a pair of bean-shaped organs that sits attached to the
back wall of the lower abdomen on either side of the spine. Every day, the
kidneys filter about 200 litre of blood to generate 2 litre of excreted waste (composed
of excess water, urea, salts, etc.) as urine. Urine collects in the renal
pelvis (area at the center of the kidney) and then passes through the ureter,
into the bladder, and out of the body through urethra. The kidneys also make
hormones that help control blood pressure and signal the bone marrow to make
red blood cells when needed. An adult’s kidney is about 4-5 inches long and
weighs between 115-155 grams in females and between 125-170 grams in males. The
structural and functional unit of kidney is called nephron, which utilizes four
processes to alter the blood plasma, which flows to it: filtration,
reabsorption, secretion, and excretion. Although most people have 2 kidneys,
each works independently. This means the body can function with less than 1
complete kidney. With dialysis, a mechanized filtering process, it is possible
to live without functioning kidneys. Dialysis can be done through the blood,
called hemodialysis, or by using the patient’s abdominal cavity, called
peritoneal dialysis.

Some of the intrinsic and extrinsic factors; such as the hereditary
renal cancer syndromes, and excessive smoking and alcohol, respectively can
lead to abnormal growth (tumors/ neoplasia) in one or both the kidneys. Kidney
tumor can be benign (non-cancerous, can grow but will not spread), indolent
(cancerous but rarely spreads to other parts) or malignant (cancerous and can
spread to other parts of the body). Malignant tumor can grow out of control and
these tumor cells can spread (metastasize) to distant organs. Most of the
kidney cancers are detected before they metastasize (spread to near by venous
flow or the lymph nodes and thus spread to different tissues and organs of the
body, e.g. lungs); although in many cases RCC can lead to bone or lung cancer. Cancers
caught early are easier to treat successfully. However, these tumors can grow
to be quite large before the symptoms appear and the cancer is detected.

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Kidney cancer is not a single disease; it is
made up of a number of different types of cancer that occur in the kidney. Each
is caused by a different gene, follows a different clinical course, has a
different histology, and responds differently to therapy (2). The most common
type of kidney cancer in adults is renal cell carcinoma (RCC) and in children
is Wilms (also called nephroblastoma) tumor, which majorly are unilateral in origin
(tumor present in only one kidney) and only in 5% of the cases they may be
bilateral (tumor develops in both the kidneys). RCC originates in the lining of
tubules, located in the kidney and contributes to about 90 percent of all kidney
cancers. The remaining 10 percent of kidney cancers start in the renal pelvis
located in the center of the kidney, which is where urine collects. Globally RCC
is the 7th and 9th most common malignancy in men and women, respectively and
contributes to 6% of all cancers with an incidence peak between 60-70 years of
age (1). Kidney cancer has a high incidence rate but has attracted little
public health attention because of its low ranking among other cancers as a
cause of death.

 

Risk
factors

 

The common risk factors
identified in RCC include several environmental, clinical and genetic factors.
Major risk factors include cigarette smoking, alcohol use, over use of pain
relievers containing phenacetin, hypertension and obesity (with increased body
weight being directly proportional to RCC incidence). Some of the occupational
and environmental factors are extended exposure to cadmium, asbestos, petroleum
products, ionizing radiations, and acetaminophen abuse). Clinically the
patients with acquired cystic kidney disease (ACKD) and hepatitis C appear to
have an increased risk of developing RCC masses (1). RCC is also associated
with numerous hereditary diseases such as (Von Hippel-Lindau disease,
hereditary leiomyomatosis RCC, Birt-Hogg-Dube ? syndrome, hereditary papillary
RCC, hereditary nonpolyposis colorectal cancer syndrome, and autosomal dominant
polycystic kidney disease) (1).

Kidney
Cancer Symptoms

The classic
triad symptoms for renal cancer are flank pain, palpable abdominal mass, and
gross hematuria is rare (6–10%), and these signs typically arise at an advanced
stage with aggressive histology (1). Some other less specific symptoms are
constant tiredness, rapid and unexplained weight loss, and fever not caused by
a cold or flu.

 

Paraneoplastic (caused due
to the humoral factors secreted by the cancer) syndromes are found in
approximately 30% of patients with symptomatic RCCs. A few symptomatic patients
present with symptoms caused by metastatic disease, such as bone pain or
persistent cough (1). When such clinical symptoms as well as arousing
varicocele (enlargement of veins in scrotum) or bilateral lower extremity
oedema (excess collection of body fluid) are present, radiological
investigation should be applied. 

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