| Kidney cancer (renal cell carcinoma) occurs when a deadly (malignant) tumor grows in the kidney. The kidneys are located on each side of the spine. Blood is filtered by the kidneys to remove toxic waste from the body in the form of urine. This cancer is usually identified late in the course of the disease. Kidney cancer has five types: clear cell, papillary, chromophobe, collecting duct and unclassified. Clear cell is the most common and it affects 70% to 80% of individuals with kidney cancer. Papillary affects 10% to 15% of individuals with kidney cancer and looks like papillae under the microscope. Only 5% are caused by chromophobe cancer, which is composed of big clear cells. Collecting duct cancer is extremely rare and is composed of tubes without a regular shape ("Kidney Cancer"). Due to its unique appearance under the microscope roughly 5% of kidney cancer is the unclassified type; half of kidney cancers are found incidentally while evaluating another condition, such as a urinary infection, and 25% of individuals with kidney cancer will present with a tumor that has already spread (metastasized) beyond the kidney, mainly to the lungs or bones ("Kidney Cancer"). Risk: The most significant risk factors for renal cell carcinoma appear to be tobacco use and obesity. Other suspected risk factors include analgesic abuse and the chronic irritation associated with kidney stones (renal calculi). Occupational exposure to cadmium, petroleum products, asbestos, herbicides, benzene, and organic solvents such as trichloroethylene are associated with an elevated risk of kidney cancer. Some known genetic conditions can cause kidney cancer such as: Von Hippel-Lindau disease, hereditary renal oncocytoma, and hereditary papillary renal cell carcinoma. Incidence and Prevalence: Renal cancer accounts for 5% of all adult cancers, and most cases occur between the ages of 50 and 70. The condition is 2 to 3 times more prevalent in men than women. There are 35,710 projected new cases of renal cell carcinoma for the year 2004 in the US, with approximately 12,000 deaths from kidney cancer also projected for 2004 ("Kidney Cancer"). |
Source: Medical Disability Advisor
| 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, and/or shortness of breath. Physical exam: A mass may be felt during abdominal exam (palpation). However, in the vast majority of individuals, there are no remarkable findings on physical examination. Tests: Urinalysis may reveal blood in the urine. A complete blood count (CBC) may be performed to determine the number of red blood cells in the blood, and results may show a low red cell count (anemia). High-frequency sound waves (renal ultrasonography) or a CT can provide additional information, such as the size of the tumor, whether it is fluid-filled (cystic) or solid, and if the circulatory system and/or lymph nodes are involved. X-ray analysis of the kidney (intravenous pyelogram or 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 or not the cancer involves the arteries. MRI is another tool that may be used to assess involvement of the renal veins or inferior vena cava. A chest x-ray will determine if the cancer has spread to the lungs. There is no screening test to detect renal cell carcinoma in its early stages. Positron emission tomography (PET) scans can be used to detect metastasis of the cancer to the lymph nodes and other body organs. Bone scans can help identify if the cancer has metastasized to the bone. |
Source: Medical Disability Advisor
| Complete surgical removal 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 spread (metastasized) to other organs, radical nephrectomy may be of little use unless the tumor mass is causing problems such as pain or bleeding (hemorrhage). In this case, radical nephrectomy may be performed for pain relief and to arrest bleeding rather than to achieve a cure. Individuals with metastatic renal carcinoma are typically treated with chemotherapy or antibodies attached to cancer-fighting biological agents, such as interferon-alpha (immunotherapy). Radiation therapy may be employed for renal cancer that has metastasized into the bones or lungs. |
Source: Medical Disability Advisor
| Spontaneous regression of renal tumors occurs in less than 1% of all cases. Otherwise, the predicted outcome of renal cancer depends on the stage of the tumor at the time of treatment. The 5-year survival rate is about 90% for tumors confined to the kidney, about 60% if the cancer has spread only to nearby tissues, and about 9% if it has spread to distant sites ("Kidney Cancer"). |
Source: Medical Disability Advisor
| Individuals recovering from kidney cancer will benefit from several types of rehabilitation. Supportive rehabilitation allows individuals to gain some control over ordinary activities of life and helps them cope emotionally. It may include group vocational rehabilitation to help the individual transition back into the workplace or a return to school and/or retraining if the individual cannot physically return to the previous workplace and career. Palliative rehabilitation addresses the pain an individual experiences, allows some level of physical comfort, and provides emotional support and assistance in day-to-day functioning.
Physical rehabilitation 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 vary among individuals with kidney cancer. The intensity and progression of the exercises introduced in physical therapy depend on the prognosis, on whether or not surgery was performed, on whether or not the individual is receiving any current cancer treatment, on the extent of the disease, and on the individual's overall health. |
Source: Medical Disability Advisor
| Complications occur when the carcinoma has spread to other areas of the body, including the lungs, bone, lymph nodes, liver, and central nervous system. A urinary fistula may develop. Metastasis into these other organs may produce bone pain, pneumonia, fatigue, and weight loss. Fracture of a long bone may occur from this cancer. |
Source: Medical Disability Advisor
| Job restrictions may include a leave of absence or accommodations. The individual will spend at least a week in the hospital following nephrectomy. Extensive time may be needed to allow full recovery from surgery, chemotherapy, and/or radiation therapy.
The incision used for nephrectomy is extensive and may cause significant discomfort. Muscular pain usually results from this surgery, and accommodations should be made to alleviate this problem. Accommodations may include proper positioning, massage, heat, and analgesics. Bowel function may be altered, and appropriate bathroom facilities should be made easily available. Less strenuous or stationary work should be considered until the individual recovers. |
Source: Medical Disability Advisor
| 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:
- Does individual have a urinary fistula?
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Were other conditions, such as benign renal cyst or tumor, kidney abscess, tuberculosis, or cancer of the adrenal gland, ruled out?
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Was diagnosis of renal cancer confirmed?
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Has carcinoma metastasized to other areas of the body, including lungs, bone, lymph nodes, liver, and the central nervous system?
Regarding treatment:
- If not a cure, would surgery provide symptom relief?
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If symptoms are not relieved through current therapy, what other options are available?
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Would individual benefit from the addition of adjuvant therapies such as chemotherapy, immunotherapy, or radiation therapy?
Regarding prognosis:
- Has tumor metastasized into other organ systems?
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Would surgery help relieve symptoms and improve the quality of life?
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Does individual have a functional support system in place?
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Would individual benefit from psychological counseling or enrollment in a support group?
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Source: Medical Disability Advisor
| "Kidney Cancer: What Are the Key Statistics for Kidney Cancer (Renal Cell Carcinoma)?" American Cancer Society. 23 Sep. 2004 <http://www.cancer.org>. |
Source: Medical Disability Advisor
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