Renal cancer and cancer of the Urinary System

Kidney And Bladder Cancer

Is the abnormal growth of cells occurring within the urinary system which includes the kidneys, the ureters, the bladder and the urethra. Of these, cancers arising in the kidneys and bladder are the two most common types.

Cancer of the kidneys or renal cancer usually affects only one kidney, but there can be the rare occasion where it goes on to affect both the kidneys. The commonest type of cancer in the kidneys to affect individuals is renal cell carcinoma, which accounts for about 90% of all kidney cancers. There are about 63,340 new cases of renal cell carcinoma reported each year. Individuals diagnosed with cancer of the kidney have a five year survival rate of about 76%.

Bladder cancer is commonly divided into three different types, which include Urothelial/Transitional cell carcinoma (which is the commonest type of bladder cancer and accounts for about 90% of all cases, and arises in the transitional cells found in the innermost layer of the bladder lining), Adenocarcinoma (arises in the mucus producing cells which line the bladder) and Squamous cell carcinoma (arises from the flattened squamous cells which line the bladder).

There are about 81,190 new cases of bladder cancer reported each year. This type of cancer is much more common in the older population, especially men over the age of 60 years than women. Those diagnosed with bladder cancer have a five year survival rate of about 54%.

What Are the Symptoms of kidney and bladder Cancer?

One of the most common symptoms which may indicate that you are having a problem in the urinary tract is hematuria (blood in the urine), and the hematuria associated with cancer in the urinary tract is usually painless.

Symptoms of renal cancer:

  • Loin pain
  • Presence of a mass in the abdomen
  • Easy fatigability
  • Rapid loss of weight
  • Unexplained episodes of fever

Symptoms of bladder cancer:

  • Burning sensation during the passage of urine
  • The need to pass urine frequently
  • Incomplete emptying of the bladder
  • Lower abdominal pain or pain while passing urine

What causes kidney and bladder cancer?

Although the exact cause of kidney and bladder cancer is not known, certain factors have been associated with an increased risk of developing these conditions. They include:

  • Tobacco smoking
  • Obesity
  • A strong family history of kidney or bladder cancer
  • Exposure to industrial substances such as asbestos, cadmium, textile dyes and petrochemicals
  • Exposure to chemotherapy agent cyclophosphamide

What tests are used to diagnose kidney and bladder cancer?

Diagnosis of these conditions depends on the physical examination carried out by your doctor, as well investigations which will help confirm the diagnosis. During the examination of the abdomen, your doctor might try to feel for a mass on either side of your abdomen or feel for a distended bladder. Investigations which are done for kidney and bladder cancer include:

  • Urine test – which is done to detect the presence of cancer cells in the urine.
  • Blood test – which will help assess the levels of different cell types, and also the presence of cancer markers.
  • Imaging tests – such as X-ray, Ultrasound, CT and MRI which help assess the size of the tumor as well as the spread to other parts of the body.
  • Cystoscopy - this is the gold standard for diagnosing bladder cancer, where your doctor can visualize the inside of the bladder and look for any abnormal areas. During this procedure the doctor will also be able to take a biopsy from the abnormal regions, which can be viewed under the microscope for the presence of cancer cells.
  • Biopsy – this is used in the case of kidney cancer, where a needle is inserted and a tissue sample from your kidney is drawn out, to be viewed under the microscope for the presence of cancer cells.

What is the treatment for kidney and bladder cancer?

Treatment modalities for these conditions depend on the stage of the disease. Staging helps determine the extent of the cancer, by assessing the size and spread of the tumor. Your doctor will make use of the TNM system to do this.

Once the stage of the disease has been determined, a team of medical professionals including your GP, a Urologist, Nephrologist, Medical Oncologist, Radiation Oncologist, cancer nurses as well as other healthcare professionals such as dietician, social worker, physiotherapist and counselor, will decide on the treatment plan for you. The treatment options available are:

  • Active surveillance – this is an option in the case of kidney cancer, because when they are very small, they rarely present any problems to the health of the patient and will not grow any bigger. Therefore your doctor might advise you to undergo routine tests to track the progress of the tumor.
  • Surgery – in the case of bladder cancer, a transurethral resection of the tumor can be performed, and in the case of kidney cancer your doctor might decide to remove part of the affected kidney (partial nephrectomy) or remove the entire kidney (radical nephrectomy).
  • Immunotherapy – where substances to stimulate your immune system are given intravenously, so that your body can destroy the cancer cells.
  • Radiofrequency ablation – is an option in the case of kidney cancer, where the cancer cells are destroyed by heating the kidney tissue.
  • Chemotherapy – if surgery is not an option and the disease has advanced too far, then anti-cancer agents are given intravenously to destroy the cancer cells.

If all treatment modalities fail, then the priority of care is given to patient comfort and symptom relief, which is known as palliative care.

What is the Prognosis of kidney and bladder cancer?

The outcome of kidney and bladder cancer is dependent on many factors such as the stage of the cancer and the type of cancer. The general health condition of the patient such as age, level of fitness and medical history also play a role in determining the outcome of the disease.

Screening for and prevention of kidney and bladder cancer

There are no specific screening methods available for the early detection of kidney and bladder cancer.

Since smoking is thought to play a significant role in the development of these conditions, quitting smoking or not smoking has shown to bring down the risk significantly.