What is the structure and function of the kidneys?
Kidneys are organs that are situated on both sides of our waist that resemble two large beans in the human body and produce urine by filtering the blood. In a typical human, this filtering process takes place for about 180 liters per day. Every day, this volume of blood flows through our kidneys, ensuring that harmful substances are excreted from the body through urine. Hence, each kidney has an artery that carries blood to it, a vein that enables blood to return to the body’s main veins, and a urinary canal that transports filtered urine to the bladder.
What is kidney cancer?
Each kidney comprises approximately 2 million cells that do not increase or decrease under normal circumstances. However, as in other organ cancers, abnormal proliferation of these cells in the kidney occurs for a variety of reasons, resulting in the formation of a mass. These cells vary from regular kidney cells in that they gradually proliferate, grow massively, and then settle in the kidney’s surrounding organs or other organs of the body through the bloodstream, causing cancer in those organs. This condition is called spreading or metastasis. If cancer has spread, it is too late for kidney cancer to treat because neither radiation therapy (Radiotherapy) nor drug therapy (Chemotherapy) can cure these cancers. Therefore, early diagnosis and correct treatment of kidney cancer saves lives.
What causes kidney cancer?
Why kidney cells proliferate abnormally and what triggers this is still unclear. However, some risk factors have been determined based on the collective data of thousands of patients diagnosed with cancer. While having these risk factors does not guarantee that cancer will develop, not having them does not rule out the possibility of cancer developing. Kidney cancer is a type of cancer that usually occurs over the age of 40. Aside from that, the risk factors listed are as follows.
- – Smokers have a two-fold increased risk relative to non-smokers.
- – It affects men twice as much as it does women.
- – Obesity increases the risk.
- – Long-term use of certain pain relievers raises the risk.
- ⁃ Dialysis over a long period of time raises the risk by 4 times.
- – Some genetic diseases in the family increase the risk.
- – Family history of kidney cancer, particularly in siblings
⁃ Exposure to certain chemicals such as asbestosis, cadmium, benzene, and some pesticides increases the risk.
Are all cysts or masses in the kidney malignant (cancer)?
Some of the masses seen in the kidney may be cysts (fluid-filled bubbles), while others may be of tissue consistency. The so-called “simple cysts” are the most common form of kidney cysts in the population, and they often do not cause any harm to the patient and do not require treatment. At the same time, it does not have the potential to become cancerous. However, some of the cysts known as “complicated cysts” may already contain cancer cells and may show cancer transformation in the future.
The tissue-like masses vary widely, including benign ones, as well as many types of malignant kidney cancer. However, the biggest handicap here is that it is very difficult to decide whether these masses are benign or malignant with tomography, ultrasound, and MRI films. These films allow for the clear separation of only a small number of kidney masses. If this distinction cannot be made with radiological examinations, all of these masses are considered malignant and a treatment decision is made accordingly.
What complaints do kidney cancers cause?
Kidney cancers, unfortunately, usually do not show symptoms in the early stages. Once symptoms arise, kidney cancer has typically progressed to an advanced stage and metastasized. Although several patients were diagnosed at this point in the past, the widespread use of ultrasonography, the expansion of hospitals, and the widespread use of check-up culture have all contributed to a rise in the number of kidney cancers discovered by chance. In fact, most of the kidney cancers detected today are cancers that have not caused any complaints and have been found incidentally. If you have one or more of the following, it is absolutely beneficial to go through a check in this respect.
– Blood in urine
– Abdominal swelling in the lower and lateral regions
– Persistent flank pain
– Weight loss of unknown origin
– Fever that lasts for weeks without any infection or cold
– Extreme fatigue
– Swelling in the legs and joints
How is kidney cancer diagnosed?
An advanced stage kidney cancer usually presents as a hard swelling on the side of the body, and this mass can be diagnosed on examination. However, as explained in the previous question, many kidney cancers are discovered by chance. These are usually detected during an abdominal ultrasound or tomography that was requested from the patient who was visiting the doctor for another reason. However, since any mass found during these examinations may not be cancer, it is necessary to do research in this direction. The content of the mass in the kidney is investigated using Contrast-Enhanced Computed Tomography or MRI. Some criteria looked at in these films determine whether the mass is malignant or benign. However, sometimes these criteria are not sufficient to make a clear decision. In this case, the mass is considered malignant and treatment is determined accordingly. Because, if a mass that appears to be benign but has a slight chance of being malignant is not followed up on and operated on, it will cost the person’s life if it spreads across the body. Any surgery, radiotherapy, or medication will be ineffective after this stage.
What is the treatment for kidney cancer?
There is no curative drug therapy for kidney cancers at any stage (early or spread). The only solution is surgery. Nevertheless, drugs are used to reduce the spread and effects of these cancer cells in patients who cannot undergo surgery or who have cancer spread across their bodies.
A cancerous kidney may be entirely removed (Radical Nephrectomy) or treated by removing only the cancerous mass (Partial Nephrectomy). The decision to remove the whole kidney or only the tumor is based on the location and size of the mass in the kidney.
Both operations can be performed both open and closed (laparoscopic). For several years, open surgery has been used to treat kidney cancer. However, in the field of urology, the advancement of laparoscopic (closed) surgery techniques has begun to displace open surgery in favor of closed surgery. Although this technique has become the standard in America and European countries today, open surgery is still performed in many centers in our country. These are based on the insufficiency of equipment as well as the scarcity of experienced urologists trained in this field. However, it should be noted that in some kidney cancer cases, laparoscopic method may be insufficient and open surgery may be required.
What are the advantages of laparoscopy?
One of the most significant advantages is that very small incisions are made instead of the 20-30, and sometimes even 40 cm incisions used previously. This not only means a good cosmetic appearance, but also a quicker and smoother recovery. This condition becomes even more critical in patients with late wound closure or infection sensitivity, such as diabetics. It also has the benefit of allowing patients to spend less time in the hospital as a result of their faster recovery, the ability to return to their everyday lives more quickly, and the ability to resume work sooner. Again, postoperative patients have the advantage of less pain and less medication use. Operation times are shorter than open surgeries, especially in experienced hands, and the patient is provided with less anesthesia.