The two well perfused kidneys are located in the upper posterior abdomen, below the diaphragm. The kidney capsule surrounds the kidney and two other sheaths additionally surround the adrenal gland, a hormonal gland located at the upper end of each kidney. Below the kidney capsule is the renal cortex, in which the renal marrow is embedded. The centre of the kidney is the renal pelvis, which merges into the ureter, which in turn is connected to the bladder. As the central filtering and purification station for the blood, the kidneys detoxify the body: no longer needed degradation products and foreign substances (including drugs) are filtered out of the blood and discharged to the outside via the urine. In contrast, important substances remain in the blood and thus in the body. In addition, the kidneys produce the hormone erythropoietin (EPO), which stimulates the formation of red blood cells in the bone marrow; they are important for the regulation of water and salt levels and thus also blood pressure and play an important role in vitamin D metabolism.
The experts for kidney cancer treat all malignant tumors of the kidney that can develop from different areas or cell types of the kidneys. These include
- The renal cell carcinoma, also known as renal carcinoma or adenocarcinoma of the kidney, is by far the most common kidney cancer, accounting for 95% of all tumors, and usually develops from cells of the urinary tract.
- The Wilms tumor, also known as nephroblastoma, is a rare tumor in children.
- The malignant renal sarcoma is also rare and usually develops from cells of the kidney capsule or other cell types.
- Kidney lymphoma
- Kidney metastases are colonizations of malignant tumors of other organs (lungs, chest, intestines and stomach, skin, etc.) in the kidney.
In addition to these malignant tumors, the kidney cancer experts also treat benign tumors such as oncocytoma and angiomyolipoma.
The kidney cancer specialists also treat the symptoms and side effects of kidney cancer and the treatment itself. These include, among other things:
- Treatment of fatigue and permanent tiredness (fatigue)
- Treatment of pain
- Treatment of bone metastases
- Treatment of brain metastases
- Treatment of anaemia
- Treatment of side effects of therapy
Since kidney cancer does not cause any symptoms in its early stages, it is usually found by chance during an ultrasound examination (sonography). If blood is found in the urine during a laboratory examination or if pain occurs in the lateral back area, this can be, but does not necessarily indicate kidney cancer.
First, the doctor will ask the patient (anamnesis) which pre-existing conditions, habits and complaints exist and which medications are taken. As a rule, urine and blood are examined in the laboratory. The physical examination consists, among other things, of palpating the upper abdomen.
If a kidney tumor is suspected after these examinations, the renal cancer specialist has various imaging methods at his disposal to determine whether there is a tumor at all and how large it is, whether it is malignant or benign, whether lymph nodes are affected, whether a malignant tumor has already spread to neighboring organs or even to other organs, i.e. metastasized. The following diagnostic methods are used:
- Ultrasound examination (sonography) is often used as a routine examination. It can be used to detect changes in the kidney.
- The standard procedure is computed tomography (CT). It can be used to determine the extent to which the kidney cancer has spread within the kidney and into the surrounding area.
- Contrast-enhanced computed tomography can be used to better assess smaller tumors and metastases as well as the extent of the tumor and any infestation of lymph nodes.
- Magnetic resonance imaging (MRI) is often used to determine whether tumor tissue has grown into the vena cava.
- The biopsy involves removing suspicious kidney tissue from the abdominal wall and examining it in the laboratory to determine whether it is cancerous.
- In the course of the spread diagnosis, it is clarified whether the kidney cancer has already spread into the lung, brain or bone. Lung metastases can best be detected with CT and bone metastases with CT or MRT. In some cases, however, skeletal scintigraphy is also used. MRI is also used for brain metastases.
- CT and MRT are also used to check the effectiveness of a therapy.
- Excretion urogram (urography) to represent the kidneys and the urinary tract.
- Angiography to visualize blood vessels.
Also important for the planning of the therapy are:
- Determination of the tumor stage (tumor staging) on the basis of spread diagnostics
- Estimation of the course of the disease using various questionnaires
The range of services of a specialist for kidney cancer includes the following treatment methods:
- Partial nephrectomy: Removal of kidney cancer by removing only part of the kidney (so-called kidney-preserving surgery)
- Radical nephrectomy: Removal of kidney cancer by removing the entire kidney.
- Open kidney cancer operation in which the abdominal cavity is opened
- Minimally invasive renal cancer surgery (keyhole surgery, laparoscopic surgery, laparoscopy)
- Removal of infected lymph nodes
- Destruction of the tumor by radiofrequency ablation (application of heat)
- Destruction of the tumor by cryoablation (application of cold)
- Waiting behaviour in certain patient groups with smaller tumors: so-called Active Surveillance
- Surgical removal of kidney cancer metastases, i.e. secondary tumors in other organs
- Irradiation of renal cancer metastases
- Administration of targeted drugs that act on metastases throughout the body
- Treatment with new drugs or methods within the framework of clinical studies
- After-care treatments
- Psycho-oncological care
Kidney cancer specialists from a wide range of medical backgrounds work together in a tumor conference in which each individual patient is discussed and a treatment strategy suitable for the patient is developed. Tumor conferences are often attended by experts from the fields of urology, oncology, radiotherapy, radiology, surgery and pathology. Kidney cancer specialists have extensive experience in the recommended diagnostic and therapeutic procedures. Oncological centers are usually certified by the German Cancer Society - this ensures a permanent high quality in the care of patients with kidney cancer.
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2017) S3-Leitlinie Diagnostik, Therapie und Nachsorge des Nierenzellkarzinoms, Langversion 1.2, AWMF Registrierungsnummer: 043/017-OL
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2016) Nierenkrebs im frühen und lokal fortgeschrittenen Stadium. Patientenleitlinie zur Behandlung des nicht metastasierten Nierenzellkarzinoms
- Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2016) Nierenkrebs im metastasierten Stadium. Patientenleitlinie zur Behandlung des metastasierten Nierenzellkarzinoms
- Manski D (2018) Urologielehrbuch.de
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