Kidney cancer . Etiology . Signs and symptoms . Treatment includes surgical , non surgical . By Abhijit Gaikwad , Saakshi For educational purpose .

1. Kidney Cancer
By Abhijit Gaikwad
Subject : Pharmacotherapeutic

2. • Kidney cancer is cancer that begins in the kidneys. Your kidneys are two bean-shaped
organs, each about the size of your fist. They're located behind your abdominal organs,
with one kidney on each side of your spine.
• In adults, renal cell carcinoma is the most common type of kidney cancer. Other less
common types of kidney cancer can occur. Young children are more likely to develop a
kind of kidney cancer called Wilms' tumor.
• The incidence of kidney cancer seems to be increasing. One reason for this may be the
fact that imaging techniques such as computerized tomography (CT) scans are being
used more often. These tests may lead to the accidental discovery of more kidney cancers.
Kidney cancer is often discovered at an early stage, when the cancer is small and
confined to the kidney.
 Kidney Cancer

3.  Kidney cancer usually doesn't have signs or symptoms in its early stages. In time, signs
and symptoms may develop, including:
 Blood in your urine, which may appear pink, red or cola colored
 Pain in your back or side that doesn't go away
 Loss of appetite
 Unexplained weight loss
 Tiredness
 Fever
 Sign and Symptoms

4. • It's not clear what causes most kidney cancers.
• Doctors know that kidney cancer begins when some kidney cells
develop changes (mutations) in their DNA. A cell's DNA contains the
instructions that tell a cell what to do. The changes tell the cells to
grow and divide rapidly. The accumulating abnormal cells form a
tumor that can extend beyond the kidney. Some cells can break off
and spread (metastasize) to distant parts of the body.
 Etiology

5.  Factors that can increase the risk of kidney cancer include:
 Older age: Your risk of kidney cancer increases as you age.
 Smoking: Smokers have a greater risk of kidney cancer than nonsmokers do. The risk
decreases after you quit.
 Obesity :People who are obese have a higher risk of kidney cancer than people who are
considered to have a healthy weight.
 High blood pressure (hypertension) : High blood pressure increases your risk of kidney
cancer.
 Certain inherited syndromes: People who are born with certain inherited syndromes may
have an increased risk of kidney cancer, such as those who have von Hippel-Lindau
disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal
cell carcinoma or familial renal cancer.
 Family history of kidney cancer :The risk of kidney cancer is higher if close family members
have had the disease.
 Risk Factors

6.  Tests and procedures used to diagnose kidney cancer include:
 Blood and urine tests :Tests of your blood and your urine may give
your doctor clues about what's causing your signs and symptoms.
 Imaging tests : Imaging tests allow your doctor to visualize a kidney
tumor or abnormality. Imaging tests might include ultrasound, X-ray,
CT or MRI.
 Removing a sample of kidney tissue (biopsy) : In some situations, your
doctor may recommend a procedure to remove a small sample of cells
(biopsy) from a suspicious area of your kidney. The sample is tested in
a lab to look for signs of cancer. This procedure isn't always needed.
 Diagnosis

7.  Previous treatment used :
Pharmacological drugs ( common drugs used are):
 Pazopanib – taken at a dose of 400-800mg
OD(orally).
 Axitinib – taken at a dose of 2-10mg BID (orally).
 Temsirolimus – taken 25-50mg q.wk (IV)
 Sunitinib – 50 mg PO q4weeks
 Treatment

8.  For most kidney cancers, surgery is the initial treatment. The goal of surgery is
to remove the cancer while preserving normal kidney function, when possible.
Operations used to treat kidney cancer include:
 Removing the affected kidney (nephrectomy) : A complete (radical)
nephrectomy involves removing the entire kidney, a border of healthy tissue
and occasionally additional nearby tissues such as the lymph nodes, adrenal
gland or other structure.
 Removing the tumor from the kidney (partial nephrectomy) : Also called kidney-
sparing or nephron-sparing surgery, the surgeon removes the cancer and a
small margin of healthy tissue that surrounds it rather than the entire kidney.
 Kidney-sparing surgery is a common treatment for small kidney cancers and it
may be an option if you have only one kidney. When possible, kidney-sparing
surgery is generally preferred over a complete nephrectomy to preserve kidney
function and reduce risk
 Surgical Treatment

9.  Targeted therapy. Targeted drug treatments focus on specific abnormalities
present within cancer cells. By blocking these abnormalities, targeted drug
treatments can cause cancer cells to die. Your doctor may recommend testing
your cancer cells to see which targeted drugs may be most likely to be
effective.
 Immunotherapy. Immunotherapy uses your immune system to fight cancer.
Your body's disease-fighting immune system may not attack your cancer
because the cancer cells produce proteins that help them hide from the
immune system cells. Immunotherapy works by interfering with that process.
 Radiation therapy. Radiation therapy uses high-powered energy beams from
sources such as X-rays and protons to kill cancer cells. Radiation therapy is
sometimes used to control or reduce symptoms of kidney cancer that has
spread to other areas of the body, such as the bones and brain.
 Non Surgical Treatment

10. • In 2019, the FDA approved two new combinations of drugs that are being used to
right kidney cancer: axitinib and pembrolizumab, and a combination of axinitib
and avelumab.
• Pembrolizumab was approved for use in combination with axitinib for the first-line
treatment of patients with advanced renal cell carcinoma.
• In renal cell carcinoma, the recommended dose of pembrolizumab is 200 mg via
intravenous infusion over 30 minutes every 3 weeks in combination with 5 mg of
oral axitinib twice daily.
• Avelumab was approved for use in combination with axitinib for the first-line
treatment of patients with advanced renal cell carcinoma.
• The recommended dose of avelumab in renal cell carcinoma is 800 mg via
intravenous infusion over 60 minutes every 2 weeks in combination with oral
axitinib at 5 mg twice daily until disease progression or unacceptable toxicity.
 New Drugs

11. Thank You