Kidney tumours and kidney cancer – symptoms and modern treatment

A kidney tumour is something most people learn about unexpectedly – during an ultrasound scan done for a completely different reason. Today roughly half of all kidney tumours are found by chance, while they are still small and cause no symptoms at all.

Kidney cancer is not one of the most common cancers. It mainly affects people between 60 and 70 and is more common in men. When it is found early, the outlook is usually good, and treatment often consists of surgery alone, with no further therapy. So a mass found by chance is not a reason to panic, but a reason for a calm, methodical assessment by a urologist.

What kidney cancer is

The kidneys filter the blood, produce urine and help regulate blood pressure. A tumour is a growth made of cells that divide uncontrollably, and it can be benign (not cancer) or malignant (cancer).

The most common malignant form in adults is renal cell carcinoma – it starts in the cells of the kidney tubules and accounts for roughly nine out of ten cases. There are several subtypes that behave differently and have a different outlook. Less often, the tumour starts in the lining of the renal pelvis (the part of the kidney that collects urine), and it is then treated along the same lines as bladder cancer.

Some masses are benign (oncocytoma, angiomyolipoma), but they cannot always be told apart from cancer on imaging alone.

Symptoms

Small tumours usually cause no symptoms – which is why they are found by chance. Symptoms appear when the mass grows or affects nearby structures:

• blood in the urine – the most common warning sign, often painless and coming and going;
• a dull, constant ache in the lower back on one side, not related to movement;
• a lump you can feel in the side of your abdomen – rare, with large tumours;
• unexplained weight loss, a prolonged fever, tiredness, anaemia, newly developed high blood pressure;
• in men – suddenly swollen veins in the scrotum around the testicle that do not go down when lying down.

The classic triad – blood in the urine, pain and a lump you can feel – is rare today and points to advanced disease.

When it is urgent. If you are passing blood clots and cannot urinate, if the bleeding is heavy and comes with weakness or dizziness, or if severe lower back pain is combined with a high temperature, do not wait for a booked appointment – go to an emergency department or call 112 (the European emergency number).

Causes and risk factors

The exact cause is not known, but certain factors have been shown to raise the risk:

• smoking – the risk grows with how long and how much you smoke;
• excess weight and high blood pressure, especially if it has been poorly controlled for a long time;
• chronic kidney disease and dialysis – cysts form in the damaged kidney, and tumours develop in them more often;
• heredity – a small proportion of cases are linked to syndromes that cause tumours at a young age, often in both kidneys;
• exposure to certain industrial chemicals;
• being male and over 60.

Diagnosis

The consultation starts with a conversation about your symptoms, other illnesses, medicines and family history, after which Dr Penev examines your abdomen and lower back.

The first imaging test is usually an ultrasound scan of the kidneys – painless, without radiation and available at the practice in Plovdiv during the consultation itself. It distinguishes a solid mass from a simple kidney cyst, which in most cases is harmless.

If a tumour is suspected, the next step is a CT (computed tomography) scan with contrast – it shows the size, position, relationship to the blood vessels and the state of the lymph nodes and the other kidney. Blood tests (kidney function, haemoglobin, calcium) and a urine test are done, and the chest is also examined to determine the stage.

A biopsy is not always needed – when the scan shows a typical picture, treatment often goes straight to surgery; a biopsy is recommended when its result would change the plan.

Treatment

The choice depends on the size and stage of the tumour, on your kidney function and on your general health. The decision is made by a team – a urologist, an oncologist, a radiologist and a pathologist.

Kidney-sparing surgery (partial nephrectomy). For small tumours, only the mass is removed together with a thin rim of healthy tissue, and the kidney is preserved. This is preferred whenever it is technically possible, because it preserves kidney function.

Radical nephrectomy. For large or centrally placed tumours, the whole kidney is removed together with the fatty tissue around it. The remaining healthy kidney takes over the work completely.

Minimally invasive approach. Dr Penev has trained in laparoscopic urology and uro-oncology and is certified to work with a robotic surgical system. Operations are performed at the Department of Urology at Kaspela University Hospital (UMBAL Kaspela), Plovdiv, and the approach – laparoscopic or open, or robotic where the equipment is available – is chosen individually for each patient. Laparoscopic uro-oncology surgery means small incisions, less pain and a faster recovery.

Active surveillance and ablation. For very small tumours (up to roughly 3–4 cm) in elderly or seriously ill patients, it is acceptable to monitor the tumour with scans and intervene only if it grows; an alternative is to destroy the tumour by freezing or heat through the skin.

Advanced disease. If the cancer has spread (metastases), systemic therapy is used – immunotherapy and targeted drugs, prescribed by a medical oncologist. Conventional chemotherapy and radiotherapy play a limited role in this type of cancer.

After treatment, you will have follow-up scans and kidney function checks on a schedule that depends on your risk.

When to see a urologist

Book a consultation without delay if:

• you notice blood in your urine, even once and without pain;
• you have a constant ache or heaviness in your lower back on one side;
• a test report describes a mass in the kidney;
• you are losing weight for no reason or have a prolonged fever with no clear infection;
• you have close relatives who had a kidney tumour at a young age.

Prevention

There is no sure way to prevent it, but you can lower the risk: stop smoking, keep a healthy weight, control your blood pressure and stay physically active. There is no generally accepted screening programme for kidney cancer, but a kidney ultrasound as part of a preventive urology check-up after the age of 40–50 often finds the mass while it is still small.

A kidney mass found by chance deserves a calm, expert assessment, not delay. Book an appointment with Dr Penev in Plovdiv or Karlovo and bring your previous test results so that you get a clear plan at the very first consultation.