Kidney cancer

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1. Mr. Abhijit Bhoyar Lecturer M. sc. Nursing Kidney cancer

2. What is kidney cancer? DEFINITION Kidney cancer is a disease that starts in the kidneys. It happens when healthy cells in one or both kidneys grow out of control and form a lump (called a  tumor ).  

3. OVERVIEW In adults, renal cell carcinoma is the most common type of kidney cancer. Other less common types of kidney cancer can occur. Young children are more likely to develop a kind of kidney cancer called Wilms ' tumor

4. Causes & Risk Factors Factors that can increase the risk of kidney cancer include Older age.  Your risk of kidney cancer increases as you age. Smoking.  Smokers have a greater risk of kidney cancer than nonsmokers . The risk decreases after you quit. Obesity.  People who are obese have a higher risk of kidney cancer than people who are considered to have a healthy weight. High blood pressure (hypertension).  High blood pressure increases risk of kidney cancer.

5. Treatment for kidney failure.  People who receive long-term dialysis to treat chronic kidney failure have a greater risk of developing kidney cancer. Certain inherited syndromes.  People who are born with certain inherited syndromes may have an increased risk of kidney cancer, such as those who have von Hippel-Lindau disease, Birt -Hogg- Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma or familial renal cancer. Family history of kidney cancer.  The risk of kidney cancer is higher if close family members have had the disease.

6. Occupational exposure to toxic compounds – Risk of kidney cancer increases in workers exposed to asbestos, cadmium, petrolium products, dry cleaning solvents, as well as those who work in the iron & steel factories. Childhood chemotherapy – Chemotherapy given during childhood to treat cancer or for bone marrow transplantation has been associate with kidney cancer caused by the treatment .

7. STAGES OF KIDNEY CANCER The TNM System The most common staging method, known as the TNM system, relies on three pieces of information: T is for the size of the tumor:  Doctor will note the size of the tumor in centimeters, and whether it has grown into nearby areas. N is for nodes:  This refers to lymph nodes, which are small bean-shaped filters throughout body that help protect you from germs. Doctor will note whether the cancer has spread to patients lymph nodes. M is for metastasis:  That means your kidney cancer has spread, or “metastasized” to other parts of the body. It can spread anywhere, but the brain, bones,  liver , and  lungs  are the most common places.

8. Once the doctor has this information, they can use it to find the overall stage. There are four stages of kidney cancer Stage I:  You have a cancerous growth inside your kidney that’s up to 7 centimeters across. It hasn’t spread to your  lymph nodes  or other organs

9. Stage II:  if You have a tumor in your kidney that’s bigger than 7 centimeters across. It hasn’t spread to lymph nodes or other organs.

10. Stage III:  There are several combinations of tumor sizes and locations that could make up this stage. For example, if a tumor of any size has started to grow into a major vein (renal or vena cava, for example) or into tissue around the kidney, or has spread to nearby lymph nodes, your cancer is in stage III.

11. Stage IV:  There are several combinations of tumor sizes and locations that could make up this stage. Cancer that has spread to any organs other than nearby lymph nodes is stage IV, no matter how small the tumor is. Stage IV cancer can also spread to other organs without affecting nearby lymph nodes. Or a stage IV tumor could push into the adrenal gland just above your kidney, or past the thin sac that contains each kidney

12. CLINICAL MANIFESTATION Abnormal urine color due to blood in urine Flank pain and back pain Hydronephrosis Abdominal mass or lump Fever Hypertension resulting from secretion of rennin by the tumor Malaise Weight loss/ anorexia A wide range of symptoms can be present with renal carcinoma depending on which areas of the body have been affected. The majority of symptoms are asymptomatic and are detected incidentally on imaging, usually for an unrelated cause.

13. Cont.. Polycythemia Anemia resulting from depression of erythropoietin Cold intolerance Chronic fatigue Leg and ankle swelling Night sweat Vision abnormalities Elevated calcium level in blood

14. DIAGNOSTIC EVALUATION History & physical examination Blood and urine tests.  Tests of blood and urine may give clues about what's causing signs and symptoms. Imaging tests.  Imaging tests allow doctor to visualize a kidney tumor or abnormality. Imaging tests might include ultrasound, X-ray, CT or MRI .

15. Cont.. Removing a sample of kidney tissue (biopsy).  In some situations, your doctor may recommend a procedure to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer. Cystoscopy - a long, thin, rigid or flexible optical scope is inserted through the urethra and into the bladder. The practitioner then makes the visual examination of that area.

16. MANAGEMENT Kidney cancer treatment usually begins with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney, additional treatments may be recommended. Together, you and your treatment team can discuss your kidney cancer treatment options. The best approach for you may depend on a number of factors, including your general health, the kind of kidney cancer you have, whether the cancer has spread and your preferences for treatment .

17. SURGERY

18. NEPHRECTOMY (Removing the affected kidney) -   A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures. The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy ) or through a series of small incisions in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy ).

19. Removing the tumor from the kidney (partial nephrectomy ).  Also called kidney-sparing or nephron -sparing surgery, the surgeon removes the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. It can be done as an open procedure, or laparoscopically or with robotic assistance. Kidney-sparing surgery is a common treatment for small kidney cancers and it may be an option if you have only one kidney. When possible, kidney-sparing surgery is generally preferred over a complete nephrectomy to preserve kidney function and reduce the risk of later complications, such as kidney disease and the need for dialysis

20. Nonsurgical treatments Small kidney cancers are sometimes destroyed using nonsurgical treatments, such as heat and cold. These procedures may be an option in certain situations, such as in people with other health problems that make surgery risky Treatment to freeze cancer cells ( cryoablation ).  During cryoablation , a special hollow needle is inserted through your skin and into the kidney tumor using ultrasound or other image guidance. Cold gas in the needle is used to freeze the cancer cells. Treatment to heat cancer cells (radiofrequency ablation).  During radiofrequency ablation, a special probe is inserted through your skin and into the kidney tumor using ultrasound or other imaging to guide placement of the probe. An electrical current is run through the needle and into the cancer cells, causing the cells to heat up or burn

21. Immunotherapy.  Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process . Radiation therapy.  Radiation therapy uses high-powered energy beams from sources such as X-rays and protons to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain .

22. Integrative medicine treatments may also help you feel better, including: Art therapy Exercise Massage therapy Meditation Music therapy Relaxation exercises Spirituality

23. CHEMOTHERAPY Clear cell carcinomas do not respond to traditional chemotherapy. Some non clear cell carcinomas may respond to chemotherapy In a minority of cases, combination of platinum agents.

24. COMPLICATIONS Metastasis to the lung, bone, liver, brain, and other areas

25. NURSING ASSESSMENT Assess for clinical manifestations of systemic disease”fatigue , anorexia, weight loss, pallor, fever”as well as evidence of metastasis. Assess cardiopulmonary and nutritional status before surgery. Monitor for adverse effects and complications of diagnostic tests and treatment. Assess pain control and coping ability.

26. NURSING DIAGNOSES Anxiety related to diagnosis of cancer and possibility of metastatic disease Acute Pain and Hyperthermia related to post-infarction syndrome

27. NURSING INTERVENTIONS Reducing Anxiety Explain each diagnostic test, its purpose, and possible adverse reactions. Ensure that informed consent has been obtained as indicated. Assess patient's understanding about diagnosis and treatment options. Answer questions, and encourage more thorough discussion with health care provider as needed. Encourage patient to discuss fears and feelings; involve family and significant others in teaching

28. NURSING INTERVENTIONS Controlling Symptoms of Post-infarction Syndrome Administer analgesics as prescribed to control flank and abdominal pain. Encourage rest, and assist with positioning for 2 to 3 days until syndrome subsides. Obtain temperature every 4 hours, and administer antipyretics as indicated. Restrict oral intake and provide I.V. fluids while patient is nauseated. Administer antiemetics as ordered

29. PREVENTION Taking steps to improve your health may help reduce your risk of kidney cancer. To reduce your risk, try to: Quit smoking.  If you smoke, quit. Many options for quitting exist, including support programs, medications and nicotine replacement products. Tell your doctor you want to quit, and discuss your options together. Maintain a healthy weight.  Work to maintain a healthy weight. If you're overweight or obese, reduce the number of calories you consume each day and try to be physically active most days of the week. Ask your doctor about other healthy strategies to help you lose weight .

30. Control high blood pressure.  Ask your doctor to check your blood pressure at your next appointment. If your blood pressure is high, you can discuss options for lowering your numbers. Lifestyle measures such as exercise, weight loss and diet changes can help. Some people may need to add medications to lower their blood pressure. Discuss your options with your doctor .

31. Thank you