RENAL CANCER
So what is Renal Cancer? This is a malignant tumor
that arises from the cortex, pelvis, or calyces of the
kidney.
The most common type of kidney cancer is RENAL
CELL CARCINOMA or RCC. This is considered a
SILENT TUMOR because the symptoms don’t
typically get noticed until the tumor has grown
pretty large.
Where does RCC occur? So within the cortex and
medulla, there are millions of tiny functional units
called the NEPHRONS (the mechanism is for
filtration, reabsorption, secretion, and excretion)
and it consists of the RENAL CORPUSCLE
(filtration of blood happens) and RENAL
TUBULES (returns needed substances to the blood
and removes wastes). So here, the RCC originates
in the lining of the RENAL TUBULES especially
in the PROXIMAL CONVOLUTED TUBULE
(where in it reabsorbed sodium, water, glucose,
amino acid (tyrosine, cysteine), and secretes
ammonia and creatinine), LOOP OF HENLE (it
reabsorbed water), and DISTAL CONVOLUTED
TUBULES (to balance electrolyte (sodium,
calcium, potassium) and regulate extracellular
fluid). The COLLECTING DUCTS (drains the
urine). An imbalance in the electrolyte can lead to
dehydration, edematous, and water retention.
However the cause of RCC is UNKNOWN, but
RCC occurs when something triggers genetic
mutation (rapid change or transformation) within
the cells in the kidney like a mutation of the VON
HIPPEL-LINDAU or VHL because this is a tumor
suppressor it means that this helps control cell
growth and cell division, so if there is a mutation in
the VHL then it may increase the growth of cells
including abnormal cells that causes forming of
tumor or mass. This can be hereditary or non-
hereditary.
RCC often starts as a single mass of a tumor but can
also grow in one or in both kidneys.
For the RCC we have 4 stages that vary based on
the size and location of the tumor, the STAGE 1-4.
For STAGE 1 the diameter is 7cm or smaller and
hasn’t spread anywhere else. For STAGE 2, the
tumor is larger than 7cm. For STAGE 3, the tumor
spreads nearby lymph nodes but does not involve
distant organs. And for STAGE 4, cancer has spread
to both near and distant lymph nodes and to other
organs in the body such as the brain and lungs.
So what are the RISK FACTORS, for modifiable
we have here the exposure to toxins such as
tobacco, asbestos, cadmium, and gasoline (they
have toxic effectsthat causes inflammation and
scarring that damages DNA that turns normal cell to
cancer cells)
OBESITY (carrying too much body fat increases
levels of insulin and cancer cells loves glucose
because they grow quickly and multiply fast which
takes a lot of energy)
HYPERTENSION (this can constrict and narrow
the blood vessels in the kidney that reduce blood
flow and stops kidney from working well)
UNOPPOSED ESTROGEN USE (it inhibits a
protein called MLK3 that causes normal cell death
that leads to uncontrolled growth of cancer cells)
ACQUIRED CYSTIC KDNEY DISEASE
For non-modifiable
AGE 45 years and above
Mostly in MEN (more likely to smoke and have
hypertension)
FAMILY HISTORY of RENAL CANCER
Now for the SIGNS AND SYMPTOMS, So
initially client are asymptomatic but as the disease
progresses then client will develop palpable mass
in abdomen or lower back, and can experience
symptoms like unintentional weight loss, fever,
malaise, nausea and vomiting.
If the tumor grows enough to physically obstruct
urinary flow then it can cause urine to build up
inside the ureter and this is what we called the
hydroureter.
As the tumor invades the tissue and breaks through
the basement membrane then clients will experience
hematuria (blood in the urine)
While compression of nearby nerves can cause pain
in the flank or near the hipbone.
We also have here the paraneoplastic syndromes
where in when the tumor cells generate a hormone
that causes its own set of symptoms.
For example , the tumor can release erythropoietin
that increase the production of new RBC that can
lead to polycythemia or too much RBC that can
cause blood to start slowing down to its normal
flow.
Next is the release of renin which causes
hypertension (it works together with angiotensin
and aldosterone to accomplish this. Angiotensin
narrows your blood vessels and aldosterone causes
your kidneys to retain water and salt. This increases
the amount of fluid in your body and raises your
blood pressure)
Another one is the release of parathyroid hormone
related peptide or PTHrP that mimics PTH causing
hypercalcemia, fatigue, and ,muscle weakness
Lastly the adrenocorticotropic hormone or ACTH
results in cushing syndrome which can cause
hyperglycemia, hypertension, skin
hyperpigmentation, osteoporosis and weight gain
easy bruising and frequent infections from a
weakened immune system.
For the diagnosis of RRC, it starts with the clients
HISTORY AND PHYSICAL ASSESSMENT.
Additionally, Laboratory studies include a CBC
which may show anemia and increased electrolyte
sedimentation rate (m-0-22, f-0-29). When the
tumor secretes erythropoietin then clients can have
an increased haematocrit and low ESR. If the tumor
secretes PTHrP then calcium levels are also
elevated. Next is the KIDNEY FUNCTION TEST
can show elevated serum creatinine and blood urea
nitrogen, or BUN. Then URINALYSIS to look for
red blood cells in the urine.
AND RADIATION THERAPY to kill the
remaining cancer cells. Now for the client with
unresectable metastatic tumor as well as those
who cant have surgery . The treatment choice is the
MICROWAVE ABLATION or MWA, and
CRYOABLATION, which can slow tumor growth.
Next is the BIOLOGIC RESPONSE MODIFIER
including interleukin 2 (cytokines- proliferation,
activation, maturation of immune cells) , interferon
(glycoproteins)-response to infection), and tumor
necrosis factor have also been shown to increase
survival time . Lastly the TARGETED THERAPY
or medications that targeted specific molecules
involved in the growth of cancer cells. Like tyrosine
kinase inhibitors (TKIs) (such as sorafenib,
sunitinib, erlotinib) and mTOR inhibitors (such as
sirolimus, everolimus, and temsirolimus). These
drugs can get inside cancer cells and block certain
enzymes and proteins that tell cancer cells to grow,
multiply and spread.
For the NURSING RESPINSIBILITES, we have to
assess baseline V/S as well as their pain level, fluid
balance,and intake and output. Also review most
recent lab test results including kidney function test
CBC, electrolytes, and urinalysis. Importantly be
alert for complications including paraneoplastic
syndromes. Report to the HCP if there are problems
like hypertension,hyperglycemia, or hypercalcemia.
And administer medications as prescribed.

For the IMAGING TEST like the PELVIC OR

ABDOMINAL CT SCAN can be used to stage the
tumor using the TNM classification by defining the
location and looking for lymph node involvement or
metastasis. Another is the RENAL
ULTRASOUND,AND A KIDNEY, URETER,
AND A BLADDER X-RAY, OR KUB. Once a
suspicious lesion is found on imaging test, a
RENAL BIOPSY is performed where multiple
core specimens are obtained to confirm the
diagnosis.

The TREATMENT for RRC depends on

aggressiveness and extension. Where in if the tumor
is small and localized, this can be treated with
PARTIAL NEPHRECTOMY, where in the only
affected part of the kidney is removed. On the other
hand for clients with larger tumors, the treatment
choice is RADICAL NEPHRECTOMY or the
removal of the entire kidney. This Surgical
procedure is followed by CHEMOTHERAPY