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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Cancer, Kidney


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Duration Trends | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
189.0 - Malignant Neoplasm of Kidney and Other and Unspecified Urinary Organs; Kidney, except Pelvis; Kidney NOS; Kidney Parenchyma
189.1 - Malignant Neoplasm of Kidney and Other and Unspecified Urinary Organs; Renal Pelvis; Renal Calyces; Ureteropelvic Junction
198.0 - Secondary Malignant Neoplasm of Other Specified Sites; Kidney
233.9 - Carcinoma in Situ of Other and Unspecified Urinary Organs
236.90 - Neoplasms of Uncertain Behavior or Genitourinary Organs, Urinary Organ, Unspecified
236.91 - Neoplasm of Uncertain Behavior of Genitourinary Organs; Kidney and Ureter

Related Terms

  • Adenocarcinoma
  • Adenocarcinoma of the Kidney
  • Cancer of the Kidney
  • Hypernephroma
  • Kidney Cancer
  • Kidney Neoplasm
  • Renal Cancer
  • Renal Cell Carcinoma
  • Renal Neoplasm

Overview

Kidney (renal) cancer develops when certain types of kidney cells change and begin to divide and grow uncontrollably at an abnormally rapid rate and develop into a cancerous (malignant) tumor. Kidney cancer most often occurs as the result of gene mutations, which can be either hereditary or sporadic (nonhereditary). The kidneys are two organs located one on each side of the spine at about waist level. Their function is to filter blood to remove toxic metabolic waste and excess fluid from the body. These are excreted in the form of urine

Symptoms are absent in the early stages of kidney cancer resulting in diagnosis late in the course of the disease. This cancer often is found incidentally while evaluating another condition such as a urinary tract infection. Because of the late diagnosis, some individuals with kidney cancer will present with a tumor that has already spread (metastasized) beyond the kidney, most often to the lungs or bones. Approximately 3% of adult malignancies and 90% to 95% of kidney-related malignancies are renal cell carcinoma (Sachdeva). Transitional cell carcinoma of the renal pelvis is the other renal malignancy.

According to the type and microscopic characteristics (histologic subtypes) of the renal cells forming the tumor, kidney cancer is classified into five types: clear cell, chromophilic, chromophobic, oncocytic, and collecting duct. The clear cell subtype is the most common (75% of renal cell carcinomas): the characteristic cells are proximal tubule cells that are clear with fatty cytoplasm. In the chromophilic cell subtype (15% of renal cell carcinomas): the cell of origin is also the proximal tubule cell, but the cancerous cells look like nipple-shaped bumps (papillae) under the microscope. It the chromophobic cell subtype (only 5%) of renal cell carcinomas), the characteristic cells are a type of cortical collecting-duct cells that are large with pale cytoplasm. In the oncocytic renal cell carcinoma (roughly 3%), cortical collecting-duct cells grow into tumor "nests", this type of kidney cancer rarely metastasizes to other organs. Collecting duct cancer is rare and very aggressive, affecting younger adults; the cell of origin is the medullary collecting-duct cell (Sachdeva).

According to the tumor/node/metastasis (TNM) staging system, the stages of kidney cancer are as follows: stage I cancer is less than 7 cm across and is confined to the kidney; stage II cancer is more than 7 cm across and also is confined to the kidney; stage III cancer has involved only a single nearby regional lymph node and may have spread to nearby tissues such as the adrenal gland, renal vein, or inferior vena cava; and stage IV cancer has spread to distant sites, invades directly beyond the local area, or has involved more than one lymph node.

Incidence and Prevalence: Kidney cancer accounts for 3% of all adult cancers and incidence has been increasing by about 3% per year since the 1960s (Sachdeva). The American Cancer Society predicted 58,240 new cases of renal cell carcinoma for the year 2010 in the US, affecting about 35,370 men and 22,870 women, with approximately 13,140 deaths (“Detailed Guide"). By contrast, 51,590 cases were predicted for 2007 (Sachdeva). The highest incidence is found in the American Indian and Alaska Native populations; the greatest increase in incidence is found in blacks (“Cancer: Kidney and Renal Pelvis”).

The exact worldwide incidence of kidney cancer is not known but deaths worldwide are reported to exceed 100,000 (Sachdeva).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Age and gender are significant risk factors. Most people who develop kidney cancer are older adults between the ages of 55 and 84 (“Detailed Guide”), with a mean age at diagnosis of 64 (“Cancer: Kidney and Renal Pelvis”). Only 1.3% of individuals are diagnosed under age 20, while 1.5% are diagnosed between ages 20 and 34, 6.1% between 35 and 44, 16.4% between 45 and 54, 24.6% between 55 and 64, 24.3% between 65 and 74, 20% after age 75 and only 5.7% after age 85 (Cancer: Kidney and Renal Pelvis”). Men are at greater risk for kidney cancer than women; the male to female ratio is 1.6 to 1 (Sachdeva).

People of Northern European heritage, especially Scandinavian, and North Americans are at greater risk for kidney cancer than those of Asian or African heritage, although in the US, incidence of kidney cancer is increasing markedly in black Americans (Sachdeva).

Specific gene mutations increase risk for developing kidney cancer and are responsible for most cases of renal cell carcinoma. The genetic abnormality can be either a sporadic, nonhereditary gene alteration or an alteration found in 1 of 4 hereditary syndromes. Both hereditary and nonhereditary genetic causes arise from alteration of a specific chromosome (the short arm of chromosome 3 designated 3p) or the translocation of this chromosome with other chromosomes. The four hereditary syndromes associated with kidney cancer are: Von Hippel-Lindau syndrome (VHL), hereditary papillary renal cell carcinoma (HPRCC), familial renal oncocytoma (FRO) also known as Birt-Hogg-Dube syndrome, and hereditary renal carcinoma (HRC). VHL also predisposes individuals to other cancers, including a type of adrenal gland tumor (pheochromocytoma) and benign tumors (hemangioblastomas) of the central nervous system (Sachdeva).

Source: Medical Disability Advisor



Diagnosis

History: Most individuals will not report any symptoms in the early stage of renal cell carcinoma. In the more advanced stage, individuals may report blood in the urine (hematuria), pain in the flank, weight loss, night sweats, malaise, and/or shortness of breath (dyspnea).

Physical exam: A mass may be felt during abdominal exam (palpation) in about 25% of cases (Sachdeva) and blood pressure may be abnormally high (hypertension), but in the majority of individuals, there are no remarkable findings on physical examination. Because so many kidney cancers are diagnosed at a late stage, the physical exam must assess for metastases into other organs such as lungs, liver, bone, soft tissue, and central nervous system.

Tests: There is no screening test to detect renal cell carcinoma in its early stages. In later stages, urinalysis may reveal red blood cells (RBCs) in the urine when viewed microscopically; gross hematuria with passage of clots may suggest upper urinary tract bleeding. A complete blood count (CBC) with differential may be performed to determine the number of RBCs, white blood cells (WBCs), and the hemoglobin level; a low RBC or low hemoglobin indicates anemia, and an elevated WBC count indicates infection. Blood chemistries may be performed, including measurement of electrolytes, calcium (elevation of calcium often occurs in renal cell carcinoma), liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST]), and renal function profile. An erythrocyte sedimentation rate (ESR) may be done to assess inflammation. Clotting (coagulation) tests may be done such as prothrombin time (PT) and activated partial thromboplastin time (PTT).

Diagnostic imaging will be performed. High-frequency sound waves (renal ultrasonography) or contrast-enhanced computed tomography (CT) scanning is the imaging of choice for diagnosing and staging renal cell carcinoma. These may reveal the presence of a tumor, the size of the tumor, whether the tumor is fluid-filled (cystic) or solid, and if the circulatory system (renal vein and inferior vena cava) and/or lymph nodes are involved. Ultrasound (renal ultrasonography) may be used to evaluate possible cystic renal lesions, although large papillary tumors may not be visualized by ultrasound. Percutaneous cyst puncture and fluid analysis may be used to evaluate renal lesions found with ultrasound or CT imaging. X-ray analysis of the kidney (intravenous pyelogram [IVP]) can be used to accurately identify a renal tumor. Visualization of the blood vessels following injection of a radiopaque dye (arteriography) may determine whether the cancer involves the renal vein or inferior vena cava. Magnetic resonance imaging (MRI) is another tool that may be used to assess involvement of the renal vein or inferior vena cava. A chest x-ray will determine if cancer has spread to the lungs. Positron emission tomography (PET) scans can be used to detect metastasis of the cancer to the lymph nodes and other body organs but is not useful in identifying the primary renal cell cancer. Bone scans can help identify if the cancer has metastasized to the bone. Histological examination of tumor cells by a pathologist provides definitive confirmation of renal cell carcinoma and the type of cells involved. Cells may be obtained either by biopsy of the tumor or at the time of surgery to remove the tumor or kidney.

Source: Medical Disability Advisor



Treatment

Treatment of renal cell carcinoma depends upon the stage of the cancer. Options for treatment include surgery, radiation therapy, chemotherapy, hormonal therapy, immunotherapy, or some combination of these treatments. For certain patients, immune modulating drugs may be used first with reportedly good results for early stage disease. Other drug therapies such as multikinase inhibitors (e.g., sorafenib, sunitinib, temsirolimus) may be administered to treat advanced renal cell cancer based on the results of a large study in which progression-free survival was demonstrated (Sachdeva).

Complete surgical removal (resection) of the kidney, regional lymph nodes, adrenal gland, and part of the ureter (radical nephrectomy) is the treatment of choice for localized renal carcinoma. If the tumor has metastasized, radical nephrectomy may be of little use unless the tumor mass is causing problems such as pain or bleeding. In this case, radical nephrectomy may be performed for pain relief and to arrest bleeding rather than to achieve a cure. Laparoscopic nephrectomy is performed in some cases, even with metastatic cancer, because it is less invasive, has lower morbidity and fewer complications, causes less blood loss, and has a shorter recovery time. The need for pain medications also is reduced with laparoscopy.

Individuals with metastatic renal carcinoma typically are treated with chemotherapy, although renal cell carcinoma is known for multidrug resistance due to a glycoprotein found in renal tumors. Biologic therapies such as the interferons are used for their antiviral, antiproliferative, and immunomodulating effects and because they can be used effectively in combination with chemotherapy. Radiation therapy may be employed as palliative treatment for late stage renal cancer that has metastasized into the bones or lungs. Peripheral blood stem cell transplantation and vaccines are experimental treatments being evaluated in clinical trials.

Source: Medical Disability Advisor



Prognosis

The predicted outcome of renal cancer depends on the stage of the tumor at the time of diagnosis. Of those diagnosed in an early stage, 50% or more are expected to recover (Sachdeva). The 5-year survival rate after nephrectomy is about 95% for individuals with stage I tumors; about 64% for stage II; 42% for stage III; and about 11% for stage IV (Sachdeva). The prognosis for stage IV disease is poor. Among cancer-related causes of death, renal cell carcinoma is about ninth (Sachdeva).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Oncologist
  • Radiology Oncologist
  • Urologist

Source: Medical Disability Advisor



Rehabilitation

Individuals recovering from kidney cancer will benefit from several types of rehabilitation. Supportive rehabilitation allows individuals to gain some control over activities of daily life and helps them cope emotionally. Supportive rehabilitation may include group vocational rehabilitation to help the individual transition back into the workplace or return to school and/or retraining if the individual cannot physically return to his or her previous job responsibilities. Palliative rehabilitation addresses the pain an individual may experience, increases physical comfort, and provides emotional support and assistance in day-to-day functioning in those whose cancer is advanced.

Physical therapy allows individuals to regain strength and stamina that were lost due to the disease process and during treatment. The frequency and duration of the rehabilitation program will vary among individuals with kidney cancer. The intensity and progression of the exercises introduced depends on the prognosis, on whether surgery was performed, whether the individual is receiving any current cancer treatment, the extent of the disease (stage at diagnosis), and on the individual's overall health.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Complications occur when kidney cancer has spread to other areas of the body, including the lungs, bone, lymph nodes, liver, and central nervous system. Brain metastasis develops in about 11% of those with kidney cancer (Sachdeva). A urinary fistula may develop. Metastasis into these other organs may produce bone pain, pneumonia, fatigue, and weight loss. Spontaneous fracture of a long bone may result from bone metastasis.

Compression of the spinal cord as a result of metastatic renal cancer may be revealed by sharp pain across the back. Immediate treatment is required.

Source: Medical Disability Advisor



Factors Influencing Duration

Factors influencing the duration of disability include the type and stage of the disease at initial presentation, the individual's overall health, the type of treatment used (adjuvant therapies such as chemotherapy, immunotherapy, or radiation therapy), and complications such as infection, hemorrhage, or metastasis of the cancer.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

The individual will spend at least a week in the hospital following radical nephrectomy. Extensive time may be needed to allow full recovery from surgery, chemotherapy, and/or radiation therapy. Accommodations, including a shortened work day or reassignment of duties may be necessary upon return to work.

The incision used for open nephrectomy is extensive and may cause significant discomfort. Muscular pain usually results from this surgery, and accommodations must be made to increase comfort of the individual. Accommodations may include proper positioning, massage, heat, and analgesics. Company policy on medication usage should be reviewed to determine if pain medication use is compatible with job safety and function. Bowel function may be altered, and appropriate bathroom facilities should be made easily available. Transfer to less strenuous or more sedentary work may be required until the individual recovers.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Did individual have an absence of symptoms at initial diagnosis or did individual report urine in the blood, flank pain, or weight loss?
  • Was a mass detected on palpation of the abdomen?
  • Were appropriate blood tests, urine tests, and diagnostic imaging performed?
  • Were other conditions, such as benign renal cyst or tumor, kidney abscess, tuberculosis, or cancer of the adrenal gland, ruled out?
  • Was diagnosis of renal cancer confirmed by biopsy?
  • What stage was the cancer at diagnosis?

Regarding treatment:

  • Has radical nephrectomy been performed? Laparoscopic nephrectomy?
  • If not a cure, did surgery provide symptom relief in the presence of metastatic disease?
  • Have immune modulating drugs or multikinase inhibitors been administered?
  • If symptoms are not relieved through current therapy, what other options are available?
  • Would individual benefit from the addition of adjuvant therapies such as chemotherapy, immunotherapy, hormonal therapy, radiation therapy, or a combination of these?

Regarding prognosis:

  • Has tumor metastasized into other organ systems?
  • Have complications occurred such as urinary fistula or spinal cord compression?
  • Has individual responded to medical and surgical treatment?
  • Does individual have a functional support system in place?
  • Would individual benefit from psychological counseling or enrollment in a support group?

Source: Medical Disability Advisor



References

Cited

"Cancer: Kidney and Renal Pelvis.” SEER (Surveillance, Epidemiology, and End Results) Stat Fact Sheets." Natonal Cancer Institute. Dec. 2007. U.S. National Institutes of Health. 21 Aug. 2009 <http://www.seer.cancer.gov>.

American Cancer Society. "Detailed Guide: Kidney Cancer." All About Kidney Cancer. 14 May. 2009. American Cancer Society. 21 Aug. 2009 <http://www.cancer.org/docroot/CRI/CRI_2_3x.asp?dt=22>.

Sachdeva, Kush, et al. "Renal Cell Carcinoma." eMedicine. Eds. Michael Perry, et al. 25 Jun. 2009. Medscape. 21 Aug. 2009 <http://emedicine.medscape.com/article/281340-overview>.

Source: Medical Disability Advisor