Renal Cell Carcinoma Treatment in Delhi, India

There are different subtypes of renal cell carcinomas. Identifying the sub-type helps to decide the best treatment and to identify if the cancer is caused by the inherited genetic syndrome.

The different types of renal cell carcinomas are as follows:

1. Clear cell carcinoma

   Also known as clear cell adenocarcinoma, is the most common type of renal cell carcinoma. The cancer cells of clear cell carcinoma look clear and pale under the microscope. It is commonly caused by smoking, obesity, and hereditary genetic conditions. About 70% of people with RCC have clear cell carcinoma.

2. Chromophobe RCC

   This cancer forms in the cells lining the tubules in the kidney. It accounts for 5% of renal cell carcinomas. These cells look clear and pale but are much larger in size. It has a low rate of somatic mutations compared to other RCCs.

   Females are at higher risk of chromophobe RCC. Cancer can be caused by genetic and environmental factors. Smoking, high blood pressure, and exposure to toxins may increase the risk for chromophobe renal cell carcinomas.

3. Papillary RCC

   It is the second most common type of RCC in which the tumour has finger-like growth. Only 1 in 10 RCCs is this type of cancer. Papillary RCC is a cancer of tubes that filter waste from the blood. There are two types of papillary RCC, type 1 is common and grows slowly, whereas type 2 is aggressive, and cancer grows rapidly.

4. Collecting duct Carcinoma

   This is a rare and aggressive type of renal cell carcinoma that forms in the principal cells of distal collecting ducts. Many people have no signs and symptoms in the early stage; the symptoms are mostly visible only in the advanced stage CDC. This cancer is highly malignant and has a poor diagnosis.

5. Unclassified carcinoma

   This category of RCC does not fit into any type, as there is more than one type of cancer cell present.

Renal cell carcinomas in their early stage may not cause any symptoms. In an advanced stage, its symptoms may include:

• A lump in the abdomen
• Extreme weight loss
• Fatigue and loss of appetite
• Blood in the urine
• Persistent back pain or flank pain
• Anaemia
• Fever and tiredness

Consult the doctor immediately in case of persistent symptoms or blood in the urine.

The exact cause of RCC is unknown. It is commonly found between 50 and 70 years of age. There are no exact causes that can cause RCC. However, some factors may increase the risk for the disease, such as:

• Older age
• Hypertension or dialysis treatment
• Obesity
• Smoking
• Polycystic kidney disease 
• Familial syndromes such as Von Hippel-Lindau disease. Tumours may be multiple and occur at an early age and in both kidneys. Patients usually have tumours in other organs and have a strong family history of cancers.
• Over intake of some medications/Analgesic abuse

The diagnosis for RCC includes a physical examination and checking personal and family medical history. The doctor may recommend the following test to diagnose RCC:

• Blood test - A blood test is conducted to examine the complete blood count (CBC). The blood count can show possible signs of kidney cancer.

• Urine test - This test checks the colour of urine and the presence of sugar, protein, and white blood cells in red blood cells in the urine.

• Imaging tests - Imaging tests such as CT scan, MRI, and the x-ray doctor to take a close look at the kidney to detect any abnormal growth. These tests are also used to find out if cancer has spread to other body parts.

• Biopsy - Biopsy is a procedure of removing a small piece of kidney tissue using a needle. The collected sample is checked for the presence of cancer.

• Ultrasound test - This method uses high-energy sound waves to bounce off the internal organs to form a picture of body tissues called a sonogram.

Renal cell carcinoma is relatively radioresistant and chemoresistant. Surgery is the mainstay of treatment.

Surgery

Surgery for RCC includes different types of procedures depending on the spread of cancer. In Partial Nephrectomy, a small invocancerlved part of the kidney is removed. In Radical Nephrectomy, the entire kidney with surrounding fat is removed.

In an otherwise healthy person with adequate functioning of the other kidney, one kidney is sufficient to carry out all physiological functions of the body and lead a normal life. Surgery can be done in a minimally invasive manner (laparoscopic/robotic) or by the conventional open method.

If cancer has spread outside the kidney, then systemic treatment such as targeted therapy or immunotherapy is required.

Robotic (da Vinci) Surgery for kidney tumour:

The da Vinci Surgical System enables your surgeon to operate through a few small incisions, like traditional laparoscopy. The da Vinci System features special surgical instruments that bend and rotate far greater than the human hand. It also has a magnified vision system that gives your surgeon a 3D HD view inside your body. Da Vinci technology enables your surgeon to operate with enhanced vision, precision, and control.

Targeted therapy

The therapy uses drugs to attack the cancer cells by blocking signals to proliferate without causing any damage to surrounding healthy cells.

Immunotherapy

This is a type of biological therapy that helps the immune system attack and fight cancer cells.

Radiation Therapy

Sometimes used to control or palliate symptoms when the disease has spread to other areas such as bones

Reviewed by Dr. Puneet Ahluwalia, Director - (Urological Oncology & Robotic Surgery), Cancer Care / Oncology, Uro-Oncology, Surgical Oncology on 19-July-2022

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