Kidney cancers are actually rare cancers. They constitute about 3% of all cancers.
In our country, their frequency is in the 8th place in men with 6.3/100,000 new patients per year, while in women it is in the 13th place with 3.5/100,000 patients. . In this case, around 4,500
new patients are expected annually in Turkey.
The frequency of kidney cancer is gradually increasing. The main reason for this is the need to consult a physician more frequently and advances in diagnosis, as well as the detection of small tumors under 7 cm in the early stage before they cause any symptoms. It is a disease of advanced age and is most commonly seen around the age of 65.
While complete cure can be achieved with surgery in small tumors when caught early, approximately 35-40% of patients are in advanced stages. Because of this, palliative treatments are used.
In advanced stages, they usually metastasize to the lungs and bones, and at this stage their treatment
becomes a little more difficult.
RISK FACTORS
Some factors increase the risk of kidney cancer. In the light of epidemiological studies
use of cigarettes and other tobacco products, obesity, long-term painkiller use, cystic
kidney disease and some genetically transmitted diseases have emerged as risk factors
has been established.
Kidney cancers are not a single type of cancer, but they show some differences depending on where they first appear in the kidney
. The most common type is the clear cell type, which originates from proximal tubule epithelial cells and is seen in approximately 80%. Genetic events play an important role, especially in the transparent cell type. The detection of the tumor suppressor von Hippel Lindau (VHL) gene in patients has revolutionized treatment. Mutation in the VHL gene has been detected in 90% of patients with this type of kidney cancer. As a result of this mutation, the tumor suppressor VHL gene is silenced, hypoxia-inducible factor (HIF) accumulates and kidney tumors occur.
SYMPTOMS
Kidney tumors usually do not cause symptoms until they become large masses. Flank pain, bleeding in the urine, and kidney pain, formerly known as the classic triad for kidney cancer. A palpable mass in the abdomen is less common. The majority of patients are detected and diagnosed incidentally
during examinations such as ultrasonography or tomography performed for other reasons.
Although other symptoms are rarer, they may present with complaints such as fever, weight loss, weakness due to anemia, or in widespread disease, depending on the location of the disease, such as bone pain in bone metastases, cough in lung metastases.
Contrast-enhanced tomography (CT) and ultrasonography are most commonly used for diagnosis. Magnetic resonance (MRI) imaging of the abdominal region or PET-CT are other methods.
TREATMENT
Definitive treatment for early stage cancers. It is surgery. Significant progress has been made in kidney tumor surgery. In the past, complete removal of the kidney through open surgery was the standard treatment. Nowadays, laparoscopy or robotic surgery is routinely performed.
Especially in small-sized tumors, it may not be necessary to remove the entire kidney. The results in patients who underwent kidney-sparing surgery are almost the same as in patients in whom the kidney was completely removed with radical nephrectomy.
In tumors that are not very large, it is possible to preserve the kidney if it is removed only by leaving a clean area around the mass.
Tyrosine kinase inhibitors (sunitinib, pazopanib, sorafenib and axitinib) also disrupt tumor
vascularization and new vessel formation and prevent tumor growth and further
spread. They prevent. They generally show their effects by preventing the growth of the tumor without reducing its size. In some cases, although this is not very common, regression of the tumor can be achieved. After a certain period of time, resistance develops against these drugs and they become ineffective.
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