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At Boston Medical Center (BMC), caring for patients is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality-of-life.
As the primary teaching affiliate of the Boston University School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.
Patients with kidney cancer, also called renal cell carcinoma (RCC), work with a urologist who takes the lead in the diagnosis, monitoring, and treatment planning of individual patients. Surgery is usually the first treatment for patients with malignant kidney tumors.
The surgeons at BMC offer state-of-the-art surgical treatment and have extensive experience with using laparoscopic and robotic techniques to operate on kidneys. In fact, they performed some of the earliest such cases in the Boston area. When possible, the surgeons perform a partial nephrectomy, which involves removing only part of the kidney rather than a total radical nephrectomy, in which the entire kidney is removed.
The BMC team follows the National Cancer Institute and the American Urological Association guidelines for the treatment of renal cell carcinoma.
What is Kidney Cancer?
Kidney cancer begins in the kidneys. Each of the two kidneys are about the size of an adult fist, bean-shaped and weigh around 150 grams each. One kidney is located at each side of the backbone, just under the rib cage. They are protected from injury by a large padding of fat, the lower ribs, and several muscles.
The kidneys play a major role in maintaining general health and wellbeing. Their purpose is to continuously sort non-recyclable waste from recyclable waste in the body while also cleaning the blood. The kidneys make urine from excess fluid and unwanted chemicals or waste in the blood.
Kidney cancer is caused by the abnormal growth of cells in the kidneys. Renal cell carcinomas (RCCs) make up approximately 90% of kidney cancer cases. Other types of kidney cancers include:
- Transitional cell carcinoma, or kidney pelvis cancer which begins in the lining of the kidney pelvis
- Wilms tumor (nephroblastoma), the most common cancer in children 14 and under
- Renal sarcoma, which is rare, develops in the soft tissue of the kidney
According to the American Cancer Society, kidney is the ninth most common cancer in the United States, accounting for approximately 3.7% of new cancer cases in 2016. Among men, the kidneys and renal pelvis (combined) is one of the top 10 cancer sites, and the seventh most common cancer.
Causes of Kidney Cancer
There are several risk factors of kidney cancer, including gender, age, race, and lifestyle choices. Men are nearly twice as likely to develop RCC as women. Kidney cancer is typically found in people age 50-75, with the average age of diagnosis being 64. The risk of developing the disease is slightly higher for African Americans and American Indians/Alaska Natives than for Caucasians.
Other risk factors include:
- Exposure to certain substances in the workplace
- High blood pressure
- Certain genetic and hereditary conditions (such as von Hippel-Lindau disease, hereditary papillary renal cell carcinoma, and others)
- Family history of the disease
- Advanced kidney disease
Symptoms of Kidney Cancer
Early kidney cancers do not usually cause any signs or symptoms, but larger ones may. Some possible signs and symptoms of kidney cancer include:
- Stomach pain
- Lower back pain on one side
- Blood in the urine
- Loss of appetite
These symptoms, however, can be caused by other benign diseases.
Kidney Cancer Staging
Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because the stage determines the most appropriate course of treatment options. The stages of kidney cancer range from Stage I (the least severe stage) to Stage IV. When patients are confirmed to have kidney cancer, the doctor will discuss the staging.
Stage I The tumor is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
Stage II The tumor is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs.
Stage III Either of these conditions:
- A tumor of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body.
- The tumor has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body.
Stage IV Either of these conditions:
- The tumor has spread to areas beyond Gerota's fascia—the layer of connective tissue compressing the kidneys and the adrenal glands—and extends into the adrenal gland—small glands located on top of each kidney that produce hormones—on the same side of the body as the tumor, possibly to lymph nodes, but not to other parts of the body.
- The tumor has spread to any other organ, such as the lungs, bones, or the brain.
Treatments & Services
Kidney Cancer Treatments by Stage
Stage IA: Usually requires surgery with a partial nephrectomy (generally through robotic or laparoscopic partial nephrectomy) being performed. Active surveillance with serial imaging is performed in select patients, and radiofrequency ablation is performed for nonsurgical candidates who require treatment.
Radiofrequency Ablation for Cancer
Radiofrequency ablation (RFA) is a cancer treatment in which radiofrequency energy—derived from electric and magnetic energy—is sent by means of a narrow probe that is placed in the center of a lung tumor. Surgical incisions are not required, and the probes are placed into tumors using CT scan to guide the physician. RFA is a newer method of treating lung cancer, as well as cancers of the liver, kidney, and bone. RFA can target and kill cancerous cells sparing healthy tissues that are close to the cancer. Systemic treatments such as chemotherapy and certain types of radiation are absorbed into both healthy and diseased tissue, whereas RFA is delivered directly into a tumor.
Cryotherapy is the use of freezing diseased tissue or cells inside the body to eliminate those cells so the body can grow new, healthy ones.
For patients with advanced-stage melanoma, immunotherapy may improve the body’s natural immune response to cancer. Immunotherapy recruits the body’s own immune system and uses it to fight cancer all over the body, making it difficult for cancer cells to hide or develop defenses against it. Immunotherapy has the potential to keep working even after the patient has completed treatment.
Chemotherapy is a medication or combination of medications used to treat cancer. Chemotherapy can be given orally (as a pill) or injected intravenously (IV).
Radiation uses special equipment to deliver high-energy particles, such as x-rays, gamma rays, electron beams or protons, to kill or damage cancer cells. Radiation (also called radiotherapy, irradiation, or x-ray therapy) can be delivered internally through seed implantation or externally using linear accelerators (called external beam radiotherapy, or EBRT).
For this procedure, your surgeon guides robotic instruments to perform the surgery while sitting at computer console a few feet away. His or her natural hand movements are conveyed to the robotic instruments, which enables precise control during your operation.
Diagnostics and Tests
Because kidney cancer is usually asymptomatic, the tumor is usually found when a patient undergoes a medical test for another reason. Still, a doctor may order the following tests to confirm the diagnosis.
Computed Tomography (CT) Scan
CT scans use x-ray equipment and computer processing to produce 2-dimensional images of the body. The patient lies on a table and passes through a machine that looks like a large, squared-off donut.
An MRI is a non-invasive diagnostic imaging that doesn't use ionizing radiation. It is painless and a harmless way of looking inside the body without using X-rays. Instead it uses a large magnet and computer to scan the body. This provides the doctor with information not available from other scans.
Associate Professor, Boston University School of Medicine
Kidney Cancer Clinical Trials
Boston Medical Center has a wide variety of clinical trials mainly funded by the National Cancer Institute (NCI). NCI is coming up with new and innovative clinical trials for kidney cancers that are, or will be, available at Boston Medical Center.
CIRB #H-35254/SWOG #S1500 (PAPMET): A Randomized, Phase II Efficacy Assessment of Multiple MET Kinase Inhibitors (Cabozantinib, Crizotinib, Savolitinib, and Sunitinib) in Metastatic Papillary Renal Carcinoma
HIRB #2016-19/Janssen RIVA STM4001: Efficacy and Safety of Rivaroxaban Prophylaxis Compared with Placebo in Ambulatory Cancer Patients Initiating Systemic Cancer Therapy and at High Risk for Venous Thromboembolism