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Renal cell cancer 101
Though it’s chemoresistant, there are a few treatments available
R
enal cell cancer commonly refers to cancer of the
kidney, though there are actually many varieties of
the disease.
“The most common is the clear cell type, which
accounts for some three-quarters of all renal cell
cancers. The second most common is papillary cell
cancer, which affects 15 percent of patients. Other
forms, such as chromophobe and Xp11 translocation
cancer, are rarely diagnosed,” said Dr Tay Miah Hiang,
senior consultant medical oncologist at OncoCare
Centre in Singapore.
Though the hereditary syndrome von-Hippel Lindau
(vHL) is famously related to it, renal cell cancer is rarely
hereditary. vHL is associated with the loss of a gene
on the third chromosome and results in the aberrant
formation of cysts, excessive blood vessels growth and
renal cell cancer. However, less than one percent of all
renal cell cancers is associated with vHL syndrome.
Smoking, excessive alcohol use and obesity increase
the risk of developing renal cell cancer, which occurs
more in men than women, and commonly in the elderly.
As is often the case, most patients with early-stage
renal cell cancer do not show symptoms. Over time,
though, several symptoms can emerge including
intermittent painless episodes of passing blood in
urine, flank pain, a palpable mass in the abdomen and
unexplained fever.
Most renal cell cancers are diagnosed radiologically
through a CT scan. A biopsy is rarely taken as doing
so can result in a spillage of cells leading to the cancer
spreading to other tissues.
The cancer is usually staged depending on the
size of the tumour, and whether there is invasion into
surrounding tissue or veins, or even further afield.
Though renal cell cancers don’t respond to
chemotherapy, one key pillar of cancer treatment, there
are other options to deal with them.
“The usual treatment for localised renal cell cancer
is surgery. Surgical resection of the entire kidney is
known as nephrectomy while partial nephrectomy
refers to having part of the kidney removed. A
nephrectomy entails the surgical removal of the entire
kidney and ureter. This can be performed as open
surgery, laparoscopically or using robotic surgery,”
explained Dr Tay.
One drawback of this procedure is that it could
potentially damage the functions of the second kidney,
especially in the elderly or those with already weakened
kidney function. However, this is an uncommon
occurrence as over time the healthy kidney usually
hypertrophies, or increases in size, to take over the
functions of the removed one.
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Cryoablation, a minimally invasive procedure
that destroys cancer cells through extremely cold
temperatures, is one suitable alternative to surgery in
cases of small, isolated nodules in the kidney. It should
also be considered for patients with an interest in
preserving their kidney function, such as those who have
only one working kidney.
Once the cancer is treated, doctors and patients need
to make sure that kidney function is not damaged further,
such as through uncontrolled high blood pressure, or
by medication like pain killers, which may also harm the
kidneys.
An expert in genitourinary (testicular, kidney, bladder,
prostate) cancers, Dr Tay Miah Hiang is a senior
consultant medical oncologist at OncoCare Cancer
Centre in Singapore. He was previously a consultant at
the National Cancer Centre Singapore’s Department
of Medical Oncology and chairperson of the Patient
Education & Patient Survivorship programmes. Dr Tay
also served on the board of the Singapore Children’s
Cancer Foundation from 2006 until 2015, and was the
foundation’s chairperson from 2011 to 2013, while he’s
now serving as advisor.
Dr Tay Miah Hiang
MARCH 2020
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