A Simple Guide to Kidney Cancer

A Simple Guide to Kidney Cancer
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What is Kidney Cancer?
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Kidney Cancer is a malignant disease of the kidney.

What are the causes of Kidney Cancer?
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1.Hereditary- hereditary kidney cancer is related to the Von Lindau syndrome.

2.Smoking. cigarettes smoke chemicals has been known to damage the Kidney cells

3.Uncontrolled hypertension-damage to kidney cells may contribute to Kidney cancer

4.Obesity has been found to have some causal effect

5.Age - more common in in 50-70 age group

6.Long term dialysis for kidney failure.

What are the symptoms and signs of Kidney Cancer?
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Symptoms - non-specific and silent.

In the early stage there is no symptoms.

By the the time the symptoms appeared, the cancer is usually in the advanced stage.

1.painless hematuria or blood in urine

2.pain in the renal flanks

3.Fever

4.weight loss

Signs:

1.tenderness in renal area of backs

2.palpable mass in the side of abdomen

How do you diagnose Kidney Cancer?
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Diagnosis can usually be made by :

History
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1.hematuria

2.Renal flank pain

3.Weight loss

Liver function tests
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may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels) in the absence of liver disease.

Ultrasound or abdominal CT
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may be used to identify tumors.

Kidney Biopsy
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biopsy of kidney may be done to determine types of Kidney cancer:

Clear Cell Type: 75%
Papillary type: 20%
Chromophole type: 4%
Others: 1%

What is the treatment of Kidney Cancer?
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Treatment of Kidney cancer can be
surgery
chemotherapy
radiotherapy
immunotherapy
biological targeted therapy
depending on the stage of the cancer.

Surgery
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If the cancer is localized within the kidney , then it is surgically resectable and curable.

No treatment after surgery has been proven to prevent recurrence.

Depending on the size of the cancer, the recurrence rate varies from
10% in Stage I
60% in Stage III

Once recurrence occur then the cancer is considered as a Stage IV cancer and therefore incurable.

The aim of treatment then is palliative with emphasis to improve overall survival rates and quality of life.

Immunotherapy
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High dose immunotherapy such as interleukin may be able to cure less than 5% of the kidney cancer patients.

It is however toxic and potentially life threatening and is used for patients not suitable for surgery.

Low dose immunotherapy such as interferon is better in that it can relieve symptoms and improve quality of life for an average of 3-6 month in 15% of cases treated.

Despite its low dose the side effects can also affects the treatment of the patients such as fever, chills and loss of appetite.

Biological targeted therapy
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These drugs target the growth of the cancer cells by suppressing the cellular pathways which stimulates the growth of the abnormal tumor blood vessels and the tumor cells .

These treatments have been proven to better in terms of better response and length of the disease control compared to interferon and interleukin.

There has also being an improved overall survival rate with a reduced risk of death by 28%.

Side effects are hypertension, ischemia of heart, fatigue, loss of appetite, diarrhea and loss of weight.

The approved drugs are sorafenib, sumitinib and tensirolimus.

Chemotherapy and radiotherapy
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Chemotherapy and radiotherapy have been found to be ineffective for renal cancer treatment.

What is the Prognosis of Kidney cancer?
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The prognosis of Kidney cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 1 year

3.5-year survival is lower than 5%.

4.Kidney cancer has one of the highest mortality of all the cancers.

How to prevent Kidney cancer?
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Avoid smoking

Reduce weight in obese patients

Control high blood pressure to prevent damage to the kidney

Avoid taking toxic substances which may damage or injure the cells of the kidney.

A Simple Guide to Pancreatic Cancer

A Simple Guide to Pancreatic Cancer
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What is Pancreatic Cancer?
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Pancreatic Cancer is a malignant disease of the exocrine pancreas. 90% are adenocarcinomas.

What are the causes of Pancreatic Cancer?
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1.Smoking. cigarettes smoke chemicals has been known to damage the pancreatic cells

2.Diets rich in red meat- high protein tends to stmulate more enzymes frm pancreas and cause dysfunction in the cells

3.Diabetes mellitus -damage to islets in pancreas may contribute to pancreatic cancer

4.Chronic pancreatitis has been found to have some causal effect

5.Helicobacter pylori infection -known to cause stomach cancer and also pancreatic cancer

6.Occupational exposure to certain chemicals including insecticides

7.Family history -there is a family history in 5-10% of pancreatic cancer patients

8.Obesity - the high fat diet may induce more disease of bile system with blockage of its tract

What are the symptoms and signs of Pancreatic Cancer?
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Symptoms - non-specific and varied.

1.pain in the upper abdomen that typically radiates to the back

2.pain relieved by leaning forward

3.painless jaundice related to bile duct obstruction (carcinoma of the head of the pancreas)

4.depression is sometimes associated with pancreatic cancer


Signs:

1.tenderness in upper abdomen

2.mass in the abdomen

3.Trousseau sign- Spontaneous blood clots in veins of extremities, or the superficial veins may indicate presence of pancreatic cancer.


How do you diagnose Pancreatic Cancer?
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Diagnosis can usually be made by :

History
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1.pain in upper abdomen radiating straight to the back, worse on eating

2.Weight loss severe with anorexia, early satiety, diarrhea, or steatorrhea.

3.Jaundice -initially painless, itchy with dark urine.
Painful jaundice occurs later

4.onset of atypical diabetes mellitus

5.unexplained recent thrombophlebitis

6.past history of pancreatitis

Location of cancer
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1.Tumors in the pancreatic body or tail usually present with pain and weight loss

2.Tumors in the head of the gland typically present with steatorrhea, weight loss, and jaundice.

Courvoisier sign
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presence of jaundice and a painlessly distended gallbladder is suggestive of pancreatic cancer

Liver function tests
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may show a combination of results indicative of bile duct obstruction (raised conjugated bilirubin, SGGT and alkaline phosphatase levels).

CA19-9 (carbohydrate antigen 19.9)
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is a tumor marker that is frequently elevated in pancreatic cancer.

Ultrasound or abdominal CT
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may be used to identify tumors.

Endoscopic ultrasound (EUS) is another procedure that can help visualize the tumor and obtain tissue to establish the diagnosis.

What is the treatment of Pancreatic Cancer?
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Treatment of pancreatic cancer can be surgery or chemotherapy depending on the stage of the cancer.

Surgery
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1.Where the head of the pancreas is involved, the Whipple procedure is the most common surgical treatment for pancreatic cancers.
It is a major surgery involving the the resection of the head of pancreas and requres the patient to be fit for the surgery and the tumor to be localised without metastases. Only in small number of cases can the surgery be done.

2.Cancers of the tail of the pancreas can be removes by a technique called distal pancreatectomy

3.localized tumors of the pancreas have been surgically removed using laparoscopy.

4.Surgery may be performed for relief of symptoms especially if the cancer is invading or pressing on the duodenum or colon.

5.Bypass surgery may prevent the obstruction of the pancreatic ducts and improve quality of life.

Chemotherapy
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is used for patients not suitable for surgery. It can relieve symptoms and improve quality of life

Gemcitabine was approved by the US FDA after a clinical trial reported improvements in quality of life in patients with advanced pancreatic cancer

Gemcitabine may used after surgery to remove tumor tissue remaining in the body. As a result 5-year survival rates has improved.

Other drugs such as oxaliplatin and fluorouracil have also beneficial effect.

Radiation therapy
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The use of additional radiation therapy follwing surgery has been used in USA while rejected by most doctors in Europe.

What is the Prognosis of pancreatic cancer?
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The prognosis of pancreatic cancer is poor

1.because the cancer usually causes no early symptoms resulting in advanced or metastatic disease at the time of diagnosis.

2.Median survival from diagnosis is around 3-4 months;

3.5-year survival is lower than 5%.

4.Pancreatic cancer has the highest mortality of all the cancers.

5.Pancreatic cancer may sometimes cause diabetes.

How to prevent Pancreatic Cancer?
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1.a healthy lifesyle

2.increase consumption of fruits, vegetables

3.reduce red meat intake

4.Vitamin D can reduce the risk of pancreatic cancer

5.B vitamins such as B12, B6, and folate in food but not in tablets may reduce the risk of pancreatic cancer

6.Avoid smoking and drinking of alcohol