OUR kidneys are vital organs located above the waist, on both sides of the spine.

Though small in size, the reddish-brown, bean-shaped organs filter blood to remove impurities, excess minerals, salts, and extra water. Therefore, we all need functioning kidneys to lead a healthy and normal life.

Globally, World Kidney Cancer Day was commemorated on June 18. It was with this in mind that consultant urologist and president of the Jamaica Urological Society, Dr Richard Mayhew, spoke with the Jamaica Observer recently.

Kidney cancer

Kidney cancer begins when healthy cells in one or both kidneys change and grow rapidly, forming a mass called renal cortical tumour. This tumour can be malignant, which means it is cancerous and can spread to other organs. It can also be indolent, which is also cancerous but rarely spreads to other parts of the body. Finally, it can be benign, meaning the tumour can grow but will not spread.

Dr Mayhew explained that there are several types of kidney cancer, which may occur at random or form due to genetics.

“Kidney cancer is not one entity, they’re different kinds of cancer which occur in the kidney, and so the predisposing factors may depend on a particular kind of kidney cancer,” Dr Mayhew told Your Health Your Wealth. “But, generally speaking, there are some kidney cancers which are what we call sporadic — they just happen. There are some kidney cancers which they are predisposed by way of your genetics, and then there are some kidney cancers [for which] you are put at risk because of smoking [and] certain industrial exposures and so on.”

Adding that some kidney cancers originate in the “feet” of the kidney, while others form in the lining of the urinary tract (renal cell carcinoma) within the kidney, the consultant urologist said they include, but are not limited to, renal cell carcinoma, urothelial carcinoma, sarcoma, Wilms’ tumour, and lymphoma.

According to the World Health Organization (WHO), renal cell carcinoma is the most common type of adult kidney cancer, accounting for about 85 per cent of diagnoses worldwide, while sarcoma, which is developed in the soft tissue of the kidney or the thin layer of connective tissue surrounding the kidney, is the rarest type.

The WHO also noted that there are several types of cells that make up a kidney tumour, and knowing this helps doctors to plan treatment.

About 70 per cent of kidney cancers are made up of clear cells and immunotherapy — a type of cancer treatment that helps your immune system fight cancer — is particularly effective at treating clear cell kidney cancer.

Signs and symptoms

Continuing, Dr Mayhew explained that the most significant signs showing that one might be suffering from this cancer are blood in the urine, lump or mass inside the kidney, or pain near the kidney area.

“You may have symptoms from the cancer spreading. [However], early cancer from the kidney tends to be asymptomatic, so we actually pick up a lot of them [accidentally], in that you were being investigated for something else and then they see something in the kidney and it turns out to be kidney cancer,” Dr Mayhew said, as he confirmed that patients generally start to notice symptoms when the cancer reaches an advanced stage.

He also clarified that there is no symptom that specifically means that the cancer has advanced, as some patients have advanced cancer and they have no symptoms, while others have symptoms which may be present in advanced kidney cancer but the patient is not yet at that stage.

Diagnosis

“[We know] when it is advanced based on the imaging and CT (computed tomography) scans. You would use ultrasound, CT scans [and] MRI (magnetic resonance imaging), once you have [concluded] that there may be something there in the kidney. We sometimes do a biopsy to try and confirm the diagnosis, but a lot of the time the diagnosis is pretty clear based on the image in the scan,” he said.

“Overall, there are some kinds of kidney cancer which occur primarily in infants and children, and there [are] some kinds which are associated with older age groups. The age group prevalence will depend on the type of kidney cancer,” he noted.

The WHO cited Wilms’ tumour, which makes up about one per cent of kidney cancers, as the most common kidney cancer in children.

“For most of them (kidney cancer), they are probably not preventable,” Dr Mayhew commented. “If the person indulges in something that could be a risk, like smoking, then they can give up smoking, but for most others there is not something they can do to prevent it. They cannot change their diet and expect to prevent it, especially those that may be genetic,” he explained.

Treatment

Noting that surgery is the standard procedure for treating this type of cancer, Dr Mayhew explained that, “when we see somebody who has a cancer in the kidney, removal of parts or all of the kidney is usually discussed, depending on how big the tumour is. If it is small enough, we try to spare as much of the kidney as possible… depending on the location in the kidney, then we might have to take out the entire organ.”

He further explained that if cancer has already spread when it was diagnosed, then surgery doesn’t offer a lot of benefits. Dr Mayhew said, “We’re really trying to get the cancer before it has a chance to spread. There is nothing else that really works to cure most types of kidney cancers, you may have chemotherapy done, you may have radiotherapy done, but usually that is to try and control the disease that has already spread.”

“There are a couple [kidney cancers] that may respond to chemotherapy and respond enough that it cures it. For instance, you can even get a lymphoma — which is really a blood-based type of cancer but it can originate in the kidney — sometimes chemotherapy can have a significant effect. But most of the time, chemotherapy is being used to help with kidney cancers which have already spread or if there is a recurrence and you haven’t taken the kidney out,” Dr Mayhew said.

Additionally, the Jamaica Urological Society president stated that the chances of kidney cancer recurring often depend on the point in time that the tumour was removed. He said if the tumour was found early enough and it is removed quickly, the recurrence rate is relatively low. However, if it is actually a large tumour at the time of removal, there is a greater risk of recurrence.