The Kidneys
The
kidneys
are two reddish-brown, bean-shaped organs located just above the waist,
one on each side of the spine. They are part of the urinary
system. Their main function is to filter blood and produce urine
to rid the body of waste. As blood flows through the kidneys, they remove
waste products and unneeded water. The resulting liquid, urine, collects
in the middle of each kidney in an area called the renal pelvis. Urine
drains from each kidney through a long tube, the ureter,
into the bladder,
where it is stored. Urine leaves the body through another tube, called the
urethra.
The kidneys also produce substances that help control blood pressure
and regulate the formation of red
blood cells.
What Is Cancer?
Cancer
is a group of many different diseases that have some important things in
common. They all affect cells, the body's basic unit of life. To
understand cancer, it is helpful to know about normal cells and about what
happens when cells become cancerous.
The body is made up of many types of cells. Normally, cells grow and
divide to produce more cells only when the body needs them. This orderly
process helps keep the body healthy. Sometimes cells keep dividing when
new cells are not needed. A mass of extra tissue
forms, and this mass is called a growth or tumor.
Tumors can be benign
or malignant.
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Benign tumors are not cancer. They often can be removed and,
in most cases, they do not come back. Cells in benign tumors do not
spread to other parts of the body. Most important, benign tumors are
rarely a threat to life.
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Malignant tumors are cancer. Cells in malignant tumors are
abnormal and divide without control or order. These cancer cells can
invade and destroy the tissue around them. Also, cancer cells can break
away from a malignant tumor and enter the bloodstream or lymphatic
system. This process is how cancer spreads from the original
(primary) tumor to form new tumors in other parts of the body. The
spread of cancer is called metastasis.
Kidney Cancer
Several types of cancer can develop in the kidney. This booklet
discusses renal
cell cancer, the most common form of kidney cancer in adults.
Transitional
cell cancer (carcinoma), which affects the renal pelvis, is a less
common form of kidney cancer. It is similar to cancer that occurs in the
bladder and is often treated like bladder cancer. Wilms'
tumor, the most common type of childhood kidney cancer, is
different from kidney cancer in adults. The Cancer Information Service can
provide information about transitional cell cancer and Wilms' tumor.
As kidney cancer grows, it may invade organs near the kidney, such as
the liver, colon, or pancreas. Kidney cancer cells may also break away
from the original tumor and spread (metastasize) to other parts of the
body. When kidney cancer spreads, cancer cells may appear in the lymph
nodes. For this reason, lymph nodes near the kidney may be removed
during surgery. If the pathologist
finds cancer cells in the lymph nodes, it may mean that the disease has
spread to other parts of the body. Kidney cancer may spread and form new
tumors, most often in the bones or lungs. The new tumors have the same
kind of abnormal cells and the same name as the original (primary) tumor
in the kidney. For example, if kidney cancer spreads to the lungs, the
cancer cells in the lungs are kidney cancer cells. The disease is
metastatic kidney cancer; it is not lung cancer.
Kidney Cancer Symptoms
In its early stages, kidney cancer usually causes no obvious signs or
troublesome symptoms. However, as a kidney tumor grows, symptoms may
occur. These may include:
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Blood in the urine. Blood may be present one day and not the next. In
some cases, a person can actually see the blood, or traces of it may be
found in urinalysis,
a lab test often performed as part of a regular medical checkup.
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A lump or mass in the kidney area.
Other less common kidney cancer symptoms may include:
High blood pressure or a lower than normal number of red cells in the
blood (anemia)
may also signal a kidney tumor; however, these symptoms occur less
often.
These symptoms may be caused by cancer or by other, less serious
problems such as an infection or a cyst.
Only a doctor can make a diagnoses. People with any of these symptoms may
see their family doctor or a urologist,
a doctor who specializes in diseases of the urinary system. Usually, early
cancer does not cause pain; it is important not to wait to feel
pain before seeing a doctor.
In most cases, the earlier cancer is diagnosed and treated, the better
a person's chance for a full recovery.
Diagnosis
To find the cause of symptoms, the doctor asks about the patient's
medical history and does a physical exam. In addition to checking for
general signs of health, the doctor may perform blood and urine tests. The
doctor may also carefully feel the abdomen
for lumps or irregular masses.
The doctor usually orders tests that produce pictures of the kidneys
and nearby organs. These pictures can often show changes in the kidney and
surrounding tissue. For example, an IVP
(intravenous pyelogram) is a series of x-rays
of the kidneys, ureters, and bladder after the injection of a dye. The dye
may be placed in the body through a needle or a narrow tube called a catheter.
The pictures produced can show changes in the shape of these organs and
nearby lymph nodes.
Another test, arteriography,
is a series of x-rays of the blood vessels. Dye is injected into a large
blood vessel through a catheter. X-rays show the dye as it moves through
the network of smaller blood vessels in and around the kidney.
Other imaging tests may include CT
scan, MRI,
and ultrasonography,
which can show the difference between diseased and healthy tissues.
If test results suggest that kidney cancer may be present, a biopsy
may be performed; it is the only sure way to diagnose cancer. During a
biopsy for kidney cancer, a thin needle is inserted into the tumor and a
sample of tissue is withdrawn. A pathologist
then examines the tissue under a microscope to check for cancer cells.
Once kidney cancer is diagnosed, the doctor will want to learn the
stage,
or extent, of the disease. Staging is a careful attempt to find out
whether the cancer has spread and, if so, what parts of the body are
affected. This information is needed to plan a patient's treatment.
To stage kidney cancer, the doctor may use additional MRI and x-ray
studies of the tissues and blood vessels in and around the kidney. The
doctor can check for swollen lymph nodes in the chest and abdomen through
CT scans. Chest x-rays can often show whether cancer has spread to the
lungs. Bone scans reveal changes that may be a sign that the cancer has
spread to the bones.
A person who needs a biopsy may want to ask the doctor some of the
following questions:
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How long will it take? Will I be awake? Will it hurt?
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How soon will I know the results?
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If I do have cancer, who will talk with me about treatment?
When?
Kidney Cancer Treatment
Kidney cancer treatment depends on the stage of the disease, the
patient's general health and age, and other factors. The doctor develops a
treatment plan to fit each patient's needs.
People with kidney cancer are often treated by a team of specialists,
which may include a urologist,
an oncologist,
and a radiation
oncologist. Kidney cancer is usually treated with surgery,
radiation
therapy, biological
therapy, chemotherapy,
or hormone
therapy. Sometimes a special treatment called arterial
embolization is used. The doctors may decide to use one treatment
method or a combination of methods.
Some people take part in a clinical
trial (research study) using new treatment methods. Such studies
are designed to improve cancer treatment.
Getting a Second Opinion
Before starting treatment, the patient may want a second pathologist to
review the diagnosis and another specialist to review the treatment plan.
A short delay will not reduce the chance that treatment will be
successful. Some insurance companies require a second opinion; many others
will cover a second opinion if the patient requests it.
There are a number of ways a person can find a doctor who can give a
second opinion:
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The person's doctor may be able to suggest pathologists and
specialists to consult.
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The Cancer Information Service, at 1-800-4-CANCER, can tell callers
about treatment facilities, including cancer centers and other programs
supported by the National Cancer Institute.
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People can get the names of doctors from a local medical society, a
nearby hospital, or a medical school.
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The Directory of Medical Specialists lists doctors' names
along with their specialty and their background. This book is in most
public libraries.
Preparing for Kidney Cancer Treatment
Many people with cancer want to learn all they can about their disease
and their treatment choices so they can take an active part in decisions
about their medical care. When a person is diagnosed with cancer, shock
and stress are natural reactions. These feelings may make it difficult for
patients to think of everything they want to ask the doctor. Often, it
helps to make a list of questions. To help remember what the doctor says,
people may take notes or ask whether they may use a tape recorder. Some
patients also want to have a family member or friend with them when they
talk to the doctor -- to take part in the discussion, to take notes, or
just to listen.
These are some questions a patient may want to ask the doctor before
treatment begins:
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What type of kidney cancer do I have?
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What is the stage of the disease?
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What are the treatment choices? Which do you recommend? Why?
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What are the risks and possible side
effects of each treatment?
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What are the chances that the treatment will be successful?
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What new treatments are being studied in clinical trials 4? Would a clinical trial be
appropriate?
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How long will treatment last?
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Will I have to stay in the hospital?
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Will treatment affect my normal activities? If so, for how long?
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What is the treatment likely to cost?
People do not need to ask all their questions or remember all the
answers at one time. Questions may arise throughout the treatment process.
Patients may wish to ask doctors, nurses, or other members of the health
care team to explain things further or to provide more information.
Kidney Cancer Treatment Methods
Surgery is the most common treatment for kidney cancer. An
operation to remove the kidney is called a nephrectomy.
Most often, the surgeon removes the whole kidney along with the adrenal
gland and the tissue around the kidney. Some lymph nodes in the
area may also be removed. This procedure is called a radical nephrectomy.
In some cases, the surgeon removes only the kidney (simple nephrectomy).
The remaining kidney generally is able to perform the work of both
kidneys. In another procedure, partial nephrectomy, the surgeon removes
just the part of the kidney that contains the tumor.
Arterial embolization is sometimes used before an operation to
make surgery easier. It also may be used to provide relief from pain or
bleeding when removal of the tumor is not possible. Small pieces of a
special gelatin sponge or other material are injected through a catheter
to clog the main renal blood vessel. This procedure shrinks the tumor by
depriving it of the oxygen-carrying blood and other substances it needs to
grow.
These are some questions a patient may want to ask the doctor before
surgery:
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What kind of operation will it be?
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Will further treatment be necessary? What kind?
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How will I feel after the operation?
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If I have pain, how will you help?
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When will I be able to resume my normal activities?
Radiation therapy (also called radiotherapy) uses high-energy
rays to kill cancer cells. Doctors sometimes use radiation therapy to
relieve pain (palliative
therapy) when kidney cancer has spread to the bone.
Radiation therapy for kidney cancer involves external
radiation, which comes from radioactive material outside the body.
A machine aims the rays at a specific area of the body. Most often,
treatment is given on an outpatient basis in a hospital or clinic 5 days a
week for several weeks. This schedule helps protect normal tissue by
spreading out the total dose of radiation. The patient does not need to
stay in the hospital for radiation therapy, and patients are not
radioactive during or after treatment.
These are some questions a patient may want to ask the doctor before
having radiation therapy:
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What is the goal of this treatment?
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When will the treatments begin? When will they end?
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How will I feel during therapy? What are the possible side
effects?
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What can I do to take care of myself during therapy?
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How will I know if the radiation therapy is working?
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Will I be able to continue my normal activities during
treatment?
Surgery and arterial embolization are local
therapy; they affect cancer cells only in the treated area.
Biological therapy, chemotherapy, and hormone therapy, explained below,
are systemic
treatments because they travel through the bloodstream and can reach cells
throughout the body.
Biological therapy (also called immunotherapy) is a form of
treatment that uses the body's natural ability (immune
system) to fight cancer. Interleukin-2
and interferon
are types of biological therapy used to treat advanced kidney cancer.
Clinical trials continue to examine better ways to use biological therapy
while reducing the side effects patients may experience. Many people
having biological therapy stay in the hospital during treatment so that
these side effects can be monitored.
These are some questions patients may want to ask the doctor before
starting biological therapy:
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What is the goal of the treatment?
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What drugs will be used?
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Will the treatment cause side effects? If so, what can be done about
them?
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Will I have to be in the hospital to receive treatment?
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When will I be able to resume my normal activities?
Chemotherapy is the use of drugs to kill cancer cells. Although
useful in the treatment of many other cancers, chemotherapy has shown only
limited effectiveness against kidney cancer. However, researchers continue
to study new drugs and new drug combinations that may prove to be more
useful.
Hormone therapy is used in a small number of patients with
advanced kidney cancer. Some kidney cancers may be treated with hormones
to try to control the growth of cancer cells. More often, it is used as
palliative therapy.
These are some questions a patient may want to ask the doctor before
having chemotherapy or hormone therapy:
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What is the goal of this treatment?
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What drugs will I be taking?
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Will I have side effects? What can I do about them?
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How long will I be on the treatment?
Kidney Cancer Clinical Trials
Many people with kidney cancer take part in clinical trials (treatment
studies). Doctors conduct clinical trials to learn about the effectiveness
and side effects of new treatments. In some clinical trials, all patients
receive the new treatment. In other trials, doctors compare different
therapies by giving the new treatment to one group of patients and the
standard therapy to another group.
People who take part in these studies have the first chance to benefit
from treatments that have shown promise in early research. They also make
an important contribution to medical science.
In clinical trials for kidney cancer, doctors are studying new ways of
giving radiation therapy and chemotherapy, new drugs and drug
combinations, biological therapies, and new ways of combining various
types of treatment. Some trials are designed to study ways to reduce the
side effects of treatment and to improve quality of life.
Patients who are interested in taking part in a trial should talk with
their doctor.
One way to learn about clinical trials is through PDQ, a computerized
resource developed by the National Cancer Institute. PDQ contains
information about cancer treatment and about clinical trials in progress
throughout the country. The Cancer Information Service can provide PDQ
information to patients and the public.
Side Effects of Treatment
It is hard to limit the effects of therapy so that only cancer cells
are removed or destroyed. Because treatment also damages healthy cells and
tissues, it often causes unwanted side effects.
The side effects of cancer therapy depend mainly on the type and extent
of the treatment. Also, side effects may not be the same for each person,
and they may even change from one treatment to the next. Doctors and
nurses can explain the possible side effects of therapy, and they can help
relieve problems that may occur during and after treatment. Patients
should notify a doctor of the side effects they are having, as some may
require immediate medical attention.
Surgery
The side effects of kidney surgery depend on the type of operation, the
patient's general health, and other factors. Nephrectomy is major surgery,
and after the operation most people have pain and discomfort. Patients may
find it difficult to breathe deeply due to discomfort from surgery; they
may have to do special coughing and breathing exercises to help keep their
lungs clear. It is also common for patients who have had surgery to feel
tired or weak for a while.
In addition, patients may need intravenous
(IV)
feeding and fluids for several days before and after the operation. When a
kidney is removed, the one remaining kidney takes over the work of both.
Nurses will monitor the amount of fluid a person takes in and the amount
of urine produced. The length of time it takes to recover from an
operation varies for each person.
Arterial Embolization
Arterial embolization can cause pain, fever, nausea, or vomiting.
Often, people need IV fluids as the body recovers from this
procedure.
Radiation Therapy
With radiation therapy, the side effects depend on the treatment dose
and the part of the body that is treated. Patients are likely to become
very tired, especially in the later weeks of treatment. Resting is
important, but doctors usually advise patients to try to stay as active as
they can.
It is common for the skin in the treated area to become red, dry,
tender, and itchy. There may be permanent darkening or "bronzing" of the
skin in the treated area. Radiation to the kidney and nearby areas may
cause nausea, vomiting, diarrhea, or urinary discomfort. It may also cause
a decrease in the number of white
blood cells, cells that help protect the body against infection.
Biological Therapy
The side effects caused by biological therapy vary with the type of
treatment. These treatments may cause flu-like symptoms such as chills,
fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and
diarrhea. Patients often feel very tired after treatment, and they may
bleed or bruise easily. Some people also get a skin rash. In addition,
interleukin therapy can cause swelling and can interfere with normal liver
or kidney function. These problems can be severe, but they go away after
the treatment stops.
Chemotherapy
The side effects of chemotherapy depend on the drugs that are given. In
general, anticancer drugs affect rapidly growing cells, such as blood
cells that fight infection, cells that line the digestive tract, and cells
in the hair
follicles. As a result, patients may have side effects such as
lower resistance to infection, loss of appetite, nausea, vomiting, or
mouth sores. They may also have less energy and may lose their hair.
Hormone Therapy
The side effects of hormone therapy are usually mild. Progesterone
is the hormone most often used to treat kidney cancer. Drugs containing
progesterone may cause changes in appetite and weight. They may also cause
swelling or fluid retention. These side effects generally go away after
treatment.
Nutrition for Cancer Patients
Eating well during cancer treatment means getting enough calories and
protein to help prevent weight loss and regain strength. Patients who eat
well often feel better and have more energy.
Some people find it hard to eat well during treatment for kidney
cancer. They may lose their appetite. In addition to loss of appetite,
common side effects of treatment, such as nausea, vomiting, or mouth
sores, can make eating difficult. For some people, food tastes different.
Also, people may not feel like eating when they are uncomfortable or
tired.
Doctors, nurses, and dietitians can offer advice for healthy eating
during cancer treatment.
Followup Care
Regular followup by the doctor is important after treatment for kidney
cancer. The doctor will suggest appropriate followup that may include a
physical exam, chest x-rays, and laboratory tests. The doctor sometimes
orders scans and other tests. Patients should continue to have followup
visits. They should also report any problem as soon as it appears.
Support for Cancer Patients
Living with a serious illness is not easy. People with cancer and those
who care about them face many problems and challenges. Coping with these
problems is often easier when people have helpful information and support
services. Several useful booklets, including Taking
Time 8, are available from the Cancer
Information Service.
Friends and relatives can be very supportive. Also, it helps many
people to discuss their concerns with others who have or have had cancer.
Cancer patients often get together in support groups, where they can share
what they have learned about coping with cancer and the effects of
treatment. It is important to keep in mind, however, that each person is
different. Treatments and ways of dealing with cancer that work for one
person may not be right for another -- even if they both have the same
kind of cancer. It is always a good idea to discuss the advice of friends
and family members with the doctor.
People living with cancer may worry about the future. They may worry
about holding their job, caring for their family, or keeping up with daily
activities. Concerns about tests, treatments, hospital stays, and medical
bills are also common. Doctors, nurses, and other members of the health
care team can answer questions about treatment, working, or other
activities. They can also discuss outlook (prognosis)
and the activity level people may be able to manage. Meeting with a social
worker, counselor, or member of the clergy also can be helpful to people
who want to talk about their feelings or discuss their concerns. Often, a
social worker at the hospital or clinic can suggest groups that can help
with rehabilitation, emotional support, financial aid, transportation, or
home care. For example, the American Cancer Society has many services for
patients and their families. Local offices of the American Cancer Society
are listed in the white pages of the telephone directory.
What the Future Holds
People with kidney cancer and their families are naturally concerned
about what the future holds. Sometimes they use statistics to try to
figure out the chances of being cured. It is important to remember,
however, that statistics are averages based on large numbers of people.
They cannot be used to predict what will happen to a particular person
because no two people are alike; treatments and responses vary greatly.
The doctor who takes care of the patient is in the best position to talk
with the patient about the chance of recovery.
The outlook for people with early stage kidney cancer is positive.
Kidney cancer is often cured if it is found and treated before it has
spread. Many researchers are trying to find better ways to detect kidney
cancer at an early stage. They are also continuing to look for new and
better ways to treat advanced kidney cancer.
When doctors talk about surviving cancer, they may use the term remission
rather than cure. Although many kidney cancer patients are cured, doctors
use this term because the disease can return. (The return of cancer after
treatment is called a recurrence.)
Possible Causes and Prevention
Scientists at hospitals and medical centers all across the country are
studying kidney cancer. They are trying to learn what causes this disease
and how to prevent it. At this time, scientists do not know exactly what
causes kidney cancer, and they can seldom explain why one person gets this
disease and another does not. However, it is clear that this disease is
not contagious; no one can "catch" kidney cancer from another person.
Researchers study patterns of cancer in the population to look for
factors that are more common in people who get kidney cancer than in
people who don't get this disease. These studies help researchers find
possible risk factors for kidney cancer. It is important to know that most
people with these risk
factors do not get cancer, and people who do get kidney cancer may
have none of these factors.
As with most other types of cancer, studies show that the risk of
kidney cancer increases with age. It occurs most often between the ages of
50 and 70. It affects almost twice as many men as women. In addition,
kidney cancer is somewhat more common among African American men than
White men. Other risk factors for kidney cancer include:
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Tobacco use: Research shows that smokers are twice as likely
to develop kidney cancer as nonsmokers. In addition, the longer a person
smokes, the higher the risk. However, the risk of kidney cancer
decreases for those who quit smoking.
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Obesity: Obesity may increase the risk of developing kidney
cancer. In several studies, obesity has been associated with increased
risk in women. One report suggests that being overweight may be a risk
factor for men, too. The reasons for this possible link are not
clear.
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Occupational exposure: A number of studies have examined
occupational exposures to see whether they increase workers' chances of
developing kidney cancer. Studies suggest, for example, that coke oven
workers in steel plants have above-average rates of kidney cancer. In
addition, there is some evidence that asbestos in the workplace, which
has been linked to cancers of the lung and mesothelium (a membrane that
surrounds internal organs of the body), also increases the risk of some
kidney cancers.
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Radiation: Women who have been treated with radiation therapy
for disorders of the uterus may have a slightly increased risk of
developing kidney cancer. Also, people who were exposed to thorotrast
(thorium dioxide), a radioactive substance used in the 1920s with
certain diagnostic x-rays, have an increased rate of kidney cancer.
However, this substance is no longer in use, and scientists think that
radiation accounts for an extremely small percentage of the total number
of kidney cancers.
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Phenacetin: Some people have developed kidney cancer after
heavy, long-term use of this drug. This painkilling drug is no longer
sold in the United States.
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Dialysis: Patients on long-term use of dialysis to treat
chronic kidney failure have an increased risk of developing renal cysts
and renal cancer. Further study is needed to learn more about the
long-term effects of dialysis on patients with kidney failure.
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Von Hippel-Lindau (VHL) disease: Researchers have found that
people who have this inherited disorder are at greater risk of
developing renal cell carcinoma, as well as tumors in other organs.
Researchers have found the gene
responsible for VHL, and they believe that the isolation of this gene
may lead to improved methods of diagnosis, treatment, and even
prevention of some kidney cancers.
At Risk?
People who think they may be at risk for developing kidney cancer
should discuss this concern with their doctor. The doctor may suggest ways
to reduce the risk and help plan an appropriate schedule for checkups.
Keeping on Top of Your Condition
Keeping in tune with your disease or condition not only makes treatment less intimidating but also increases its chance of success, and has been shown to lower a patients risk of complications. As well, as an informed patient, you are better able to discuss your condition and treatment options with your physician.
A new service available to patients provides a convenient means of staying informed, and ensures that the information is both reliable and accurate. If you wish to find out more about HealthNewsflash's innovative service, take the tour.
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