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Kidney neoplasms are a wide group of diseases with various courses. The most important issue to be resolved in the diagnosis of kidney cancer is the nature of the detected lesion - benign or malignant. What are the most common types of kidney cancer? What are the symptoms of a kidney cancer? How is kidney cancer diagnosis and treatment going?

Kidney tumorscan be benign or malignant. The management and prognosis of kidney neoplasms differ depending on the type of cancer diagnosed. Benign neoplasms of the kidneys are usually not a cause of great concern and in many cases require only observation. However, suspicion of a malignant kidney tumor requires a thorough diagnosis and prompt treatment.

Kidney cancer - general information

The diagnosis of a neoplastic lesion is usually of great concern to patients. It is no different in the case of kidney cancer - such a diagnosis is associated with uncertainty regarding the need to undergo diagnostic tests and the treatment process.

It is worth knowing, however, that kidney cancer is a group of over a dozen diseases with a very diverse course and prognosis. There are no universal methods of diagnosing or treating kidney cancer; each case is treated individually depending on the type of change, the stage of the disease and the presence of its possible complications.

Kidney neoplasms are divided into two main groups: benign and malignant neoplasms.

  • The characteristic features of benign tumors are slow growth and good separation from the surrounding tissues. Examples of benign neoplasms of the kidney are: eosinophilic adenoma (Latin: oncocytoma), angiomyolipoma (Latin: AML) or papilloma. Benign tumors do not form distant metastases in other organs. Many benign kidney tumors only require regular observation. Removal of a benign tumor may be indicated when the tumor becomes large or causes clinical symptoms.
  • Malignant neoplasms of the kidney are characterized by a more aggressive course. Their cells multiply faster and invade nearby structures. Malignant tumors are also capable of forming distant metastases. The most common malignant neoplasm of the kidneythere is kidney cancer in the adult population. The most common malignant kidney cancer among children is fetal nephroblastoma, also known as Wilms' tumor.

In the process of kidney cancer diagnosis, it is necessary to answer the key question: is it a benign or a malignant lesion? The nature of the detected neoplasm is the main factor determining further treatment procedures.

The most important diagnostic tools in kidney neoplasms are imaging tests: ultrasound, computed tomography and magnetic resonance imaging of the abdominal cavity. In some cases, it is also necessary to perform additional tests.

Benign and malignant tumors have features that allow their initial differentiation in imaging tests. Unfortunately, in some cases it is impossible to make a reliable diagnosis based solely on imaging tests. Then a histopathological examination of a fragment of the tumor is necessary. The material for the study can be obtained during a biopsy or as a result of surgery to remove the tumor.

Knowing the type of a specific kidney cancer allows you to choose the most optimal type of procedure.

Two basic therapeutic pathways in kidney cancer are: conservative treatment (observation, possibly symptomatic treatment) and surgery (surgical procedures of varying degrees of extent).

In some cases, minimally invasive surgical treatment is also possible. An example of such therapy is the closing (the so-called embolization) of the vessels supplying blood to the tumor.

Kidney cancer - causes

Why do kidney tumors arise? Most of the time, we don't know the answer to this question. The basis of the development of any kidney cancer is the uncontrolled multiplication of cells. In many cases it is a genetically determined phenomenon.

Some kidney cancers may occur as part of other disease syndromes. For example, clear cell carcinoma of the kidney can develop in the course of von Hippel-Lindau syndrome. It is a genetic disorder that leads to the development of various types of cancer (mainly central nervous system hemangiomas, kidney cancer and adrenal gland tumors).

In turn, the angiomyolipoma of the kidney is a lesion typical of another genetically determined disease - tuberous sclerosis.

It should be remembered, however, that although kidney tumors can develop in the course of a genetic disorder, most of them appear spontaneously and unrelated to other syndromes.

Research on risk factors for kidney cancer focuses primarily on the most commonan existing malignant neoplasm of the kidney - kidney cancer. It has been proven that the factors increasing the risk of developing kidney cancer include: smoking, obesity, arterial hypertension and long-term dialysis therapy.

Kidney cancer - symptoms

Many kidney cancers do not cause any clinical symptoms, especially in the early stages of the disease. A large proportion (even 60-70%) of changes in the kidneys are detected accidentally, for example during ultrasound of the abdomen performed for other indications.

An accidentally detected, asymptomatic organ tumor is called an incidentaloma in medicine. The visibility of this type of change requires a decision as to what to do next. Depending on the size and characteristics of the tumor on imaging examination, only observation or initiation of treatment may be indicated.

The symptoms of kidney cancer most often appear as a result of an increase in tumor size. One of the most common symptoms is pain in the side of the torso or in the lumbar region.

A tumor of considerable size may be palpated on the abdominal cavity. In some cases, it is also possible to enlarge the abdominal circumference.

The growth of any neoplasm is the result of an intensive multiplication of neoplastic cells. As a result of this process, the tumor tissue requires a great deal of nutrients supplied with the blood.

The presence of blood vessels in a kidney tumor may result in blood in the urine. This symptom is called haematuria. Blood in the urine can be seen with the naked eye - then we are talking about macrohematuria.

Small amounts of blood may also enter the urine, which do not change its color and can only be detected by microscopic examination. This situation is called microhematuria.

Tumor bleeding is a particularly common symptom of kidney angiomyolipoma. Chronic loss of even a small amount of blood in the urine can cause anemia (anemia). In extreme cases, bleeding into the tumor may become very intense, causing a sudden loss of a large volume of blood. Such a situation always requires quick intervention.

One of the important functions of the kidney is the regulation of blood pressure. This process is mediated by renin, a hormone produced in the kidney. Renin is one of the factors responsible for the increase in blood pressure. The development of kidney cancer may disturb the regulation of renin secretion and lead to the development of arterial hypertension.

The most common malignant neoplasm of the kidney is kidney cancer. It is a cancer that can causespecific clinical symptoms. Since kidney cancer tends to infiltrate and compress the veins, its symptoms may be related to obstruction of venous outflow (especially from the lower body).

Venous blood stagnation in the lower extremities may be manifested by their swelling. A characteristic symptom of men is also varicocele.

Malignant neoplasms of the kidney can cause systemic symptoms. They are the so-called "Red flags", indicating the need for oncological diagnostics. The most common symptoms of advanced cancer are unexplained weight loss, the presence of a chronic or low-grade fever, and a feeling of constant weakness.

Kidney cancer - diagnosis

The most important diagnostic tool for the diagnosis of kidney cancer is imaging. The structure of the kidneys is most often assessed by ultrasound examination (USG) of the abdominal cavity. Usually, it is during this examination that a kidney tumor is first visualized.

Renal neoplasms have many features that allow their differentiation in ultrasound examination. The doctor conducting the examination notes the separation of the tumor from the kidney parenchyma, the appearance and nature of the tumor tissue, and the presence of calcifications or necrosis in its structure. The nature of the blood supply to the neoplastic lesion is also very important.

A useful tool for blood flow assessment is Doppler ultrasound. Sometimes angiography is also used to visualize the tumor vessels. If ultrasound is uncertain as to the type of lesion, it may be necessary to perform additional imaging tests - computed tomography or magnetic resonance imaging of the abdominal cavity.

The most important question that the doctor who interprets imaging tests must answer is the type of lesion detected. Some neoplasms have such a characteristic appearance that their assessment is not difficult. Unfortunately, in many cases, imaging tests of the kidneys are not sufficient to classify the neoplasm into a benign or malignant category.

It is also worth knowing that there are cases of benign and malignant neoplasms in one kidney. For this reason, in some cases it is necessary to deepen the diagnosis in order to obtain a reliable diagnosis.

The examination that determines the nature of the detected lesion is the microscopic evaluation (histopathological examination) of the tumor tissue. Material for examination can be obtained in two ways: by percutaneous biopsy or surgical tumor excision.

There is a biopsya less invasive examination, however, carries the risk of a false-negative result (when tissue is collected with a needle, it is possible to "miss" the tumor area). Examination of the material obtained during the surgery, on the other hand, enables the assessment of the entire tumor, not only its fragments.

Kidney cancer - treatment

There are many factors that must be taken into account when planning kidney cancer treatment. The most important of these is, of course, the type of neoplasm found. Additional factors are the size of the tumor, the presence of clinical symptoms, and the general he alth of the patient. Benign neoplasms often do not require any treatment - in many cases only regular observation is advisable.

The need to remove them may appear when the tumor grows to a significant size or causes clinical symptoms (e.g. pain).

The basic method of treating malignant kidney tumors is surgery. Tumor removal surgery is also performed in cases of "suspicious" neoplasms, the nature of which (benign or malignant) is difficult to assess in imaging tests.

Depending on the type and size of the tumor, two basic types of surgery are performed: conservative or radical nephrectomy. Sparing nephrectomy means the removal of the tumor along with the adjacent part of the renal parenchyma. Its purpose, however, is to keep the active kidney as large as possible.

In a radical nephrectomy, it is necessary to remove the tumor along with the entire kidney. In some situations, it may also be appropriate to remove other nearby neoplastic tissue (e.g., surrounding fat, lymph nodes, or adrenal glands).

Some kidney cancers may require additional treatment (for example, with drug therapy). In the case of selected lesions (especially small and properly located), it is possible to use minimally invasive treatment techniques.

An example of such therapy is cryoablation, i.e. destroying the tumor tissue with the use of very low temperatures. Another procedure used in some kidney cancers is embolization of the tumor vessels.

Embolization is the introduction of a special substance into the blood vessels, which causes the vessel lumen to close. In this way, the blood supply is blocked and the tumor's ischemic tissue dies. Tumor vascular embolization is sometimes used, for example, in the treatment of angiomyolipomas of the kidney.

Benign neoplasms of kidneys

  • kidney eosinophil (oncocytoma)

Adenomaeosinophilic kidney disease is also known as an oncocytoma. The name oncocytoma comes from the characteristic tumor-building cells - oncocytes. Oncocytoma belongs to the benign changes of the kidney.

However, it can be difficult to distinguish from malignant tumors in imaging studies. Moreover, in some cases, oncocytomas have coexistence of renal cancer foci. For this reason, suspected oncocytoma is an indication for surgical removal of the lesion. A certain diagnosis of this neoplasm is usually obtained by postoperative histopathological examination.

  • renal adenoma

A kidney adenoma is usually located in the cortex (outer part) of this organ. Adenomas are one of the most common benign kidney tumors. Adenomas are usually small in size and rarely cause clinical symptoms; they are often detected accidentally in imaging examinations of the abdominal cavity.

Depending on the size of the adenoma, only observation or surgical removal may be indicated.

  • renal urothelial papilloma

Renal papillomas are neoplasms that develop in the epithelium of the urine-discharge pathway. The epithelium lining the urinary tract is called urothelium - hence the name urothelial papilloma. The structures of the kidney where papillomas can develop are the calyxes and the renal pelvis. Papillomas are benign lesions, but their growth may nevertheless cause clinical symptoms - urinary retention, haematuria and urinary tract infections. In such cases, the papillomas may need to be removed.

  • kidney angiomyolipoma

The angiomyolipoma of the kidney is a benign tumor, composed of three types of tissue: vascular, muscle and adipose tissue. One of the important characteristics of angiomyolipomas is the presence of a dense network of blood vessels in the tumor tissue. Its rich blood supply can cause bleeding (sometimes of high intensity).

It is now believed that small angiomyolipomas require only regular observation. In the case of major changes, it may be advisable to remove them. One of the methods of treating angiomyolipomas is embolization (closure) of the blood vessels supplying the tumor.

  • other benign neoplasms of kidney

The most common benign neoplasms of the kidney are presented above. However, it is worth knowing that other benign tumors may also develop in the kidneys.Among them are fibromas, lipomas, neuromas, fibroids and the so-called tumors from the glomerular apparatus (the structure of the kidney responsible for the production of renin, the hormone that regulates blood pressure).

Most of these changes are asymptomatic and only require periodic monitoring. If clinical symptoms appear or the tumor is of significant size, it may be advisable to remove it.

Malignant neoplasms of kidneys

  • kidney cancer

Kidney cancer is the most common malignant neoplasm of this organ. Kidney cancer accounts for approx. 3% of all malignant neoplasms diagnosed in adults. The most common symptoms of kidney cancer are pain in the lumbar region and blood in the urine. In more advanced stages of the disease, they may be accompanied by a sudden weight loss, fever and significant weakness.

Some kidney cancers (especially those with low stage disease) are asymptomatic - such tumors can be detected completely by chance. The primary method of treating kidney cancer is surgical removal of the tumor with an adequate margin of he althy tissue. In some cases, it is recommended to use complementary therapy (immunotherapy, chemotherapy).

The prognosis of kidney cancer depends on the severity of the disease at the time of diagnosis. The histological type of the tumor is also important. A characteristic feature of kidney cancer is the presence of paraneoplastic syndromes, i.e. symptoms resulting from the development of the tumor in the body.

Examples of paraneoplastic syndromes occurring in the course of kidney cancer are hypercalcemia (increase in blood calcium levels), arterial hypertension and anemia. Paraneoplastic syndromes may be the first symptom of kidney cancer.

  • nephroblastoma - Wilms' tumor

Fetal kidney disease, also known as Wilms' tumor or nephroblastoma, is the most common malignant neoplasm of the kidney found in the pediatric population. Fetal kidney disease most often affects children between the ages of two and five.

The first symptom of nephroma is usually the presence of a tumor in the abdomen. In the treatment of fetal nephroma, chemotherapy and surgery are used (in selected cases combined with radiotherapy).

The treatment results in the majority of fetal nephromas are very good: the cure rate is estimated at 90%. Early cancer detection and quick treatment implementation increase the chances of the therapy being effective.

  • other malignant neoplasms of kidney

Although the most commonthe kidney malignant neoplasm is kidney cancer, this organ may be the site of development of other malignant neoplasms. One example is cancer of the renal pelvis, which develops in the epithelium of the urinary tract.

Sarcomas and lymphomas are much less common in the kidney. You should also remember about the possibility of tumor metastasis from other organs (most often these are metastases of breast and lung cancer).

Read also:

  • Kidneys: structure and functions
  • Kidney pain - causes, symptoms and treatment of kidney pain
  • Kidney injuries (reflected, cracked, bruised kidney) - classification, symptoms, treatment
  • Mobile (wandering) kidney - causes, symptoms and treatment
  • Kidney Failure - Symptoms and Treatment
  • Kidney diseases develop in hiding
About the authorKrzysztof BialaziteA medical student at Collegium Medicum in Krakow, slowly entering the world of constant challenges of the doctor's work. She is particularly interested in gynecology and obstetrics, paediatrics and lifestyle medicine. A lover of foreign languages, travel and mountain hiking.

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Oncology