Kidney Cancer
About 85% of kidney cancers—also called nephrocarcinoma, renal cell carcinoma, hypernephroma, and Grawitz’s tumor—originate in the kidneys. Others are metastases from various primary-site cancers.
Most kidney tumors are large, firm, nodular, encapsulated, unilateral, and solitary. They may affect either kidney; occasionally they’re bilateral or multifocal.
The incidence of kidney cancer is rising, possibly from exposure to environmental carcinogens and increased longevity. Even so, kidney cancer accounts for only about 2% of all adult cancers. Twice as common in males as in females, kidney cancer typically strikes after age 40.
Pediatric pointerRenal pelvic tumors and Wilms’ tumor occur most commonly in children.
Kidney cancer can be separated histologically into clear cell, granular cell, and spindle cell types. Sometimes the prognosis is considered better for the clear cell type than for the other types; in general, however, the prognosis depends more on the cancer’s stage than on its type. Overall prognosis has improved considerably, with the 5-year survival rate about 50% and the 10-year survival rate at 18% to 23%. Left untreated, kidney cancer is fatal.
Causes
Although the cause of kidney cancer is unknown, some studies implicate particular factors, including heavy cigarette smoking. Patients who receive regular hemodialysis also may be at increased risk. Occupational exposure to chemicals has also been suspected in some cases.
Complications
Hemorrhage, respiratory problems from metastasis to the lungs, neurologic problems from brain metastasis, and GI problems from liver metastasis are possible complications.
Assessment
The patient may complain of hematuria and often a dull, aching flank pain; however, the first sign is usually a painless hematuria, which may go unnoticed. He also may report weight loss, although this is uncommon. Rarely, his temperature may be elevated. Palpation may reveal a smooth, firm, nontender abdominal mass.
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