What is a Renal Neoplasm?

A renal neoplasm is a collection of abnormal cells or tissues originating within the kidney. The formation of a renal neoplasm may contribute to the development of a benign cyst or malignant tumor. Extensive testing is essential for determining the composition of a neoplastic growth. If the neoplasm is determined to be malignant, a diagnosis of kidney cancer is confirmed. Treatment for a malignant neoplasm is dependent on several factors, including the staging and type of neoplasm and the individual’s overall health.

It is unknown what initiates and promotes the abnormal cell development associated with the formation of a renal neoplasm. Research has demonstrated that the process may begin with a mutation that occurs during cell development that causes rapid cell division and maturation. As the cells divide and grow, they may accumulate together to form a neoplasm, or tumor. With time, some cells may break off from the group to travel to other parts of the body spreading their virulence, or metastasize.

Individuals with a renal neoplasm may not experience any symptoms during the early stages of neoplastic growth. As the tumor matures, individuals may begin to exhibit a variety of signs that may include unintended weight loss, lower back pain, and bloody urine. Additional generalized signs may include fatigue and fever.

There are several diagnostic tests that may be administered to confirm the presence of a renal neoplasm. Symptomatic individuals may undergo urine and blood analysis to check for the presence of markers indicative of cancer, and evaluate calcium, white and red blood cell, and hemoglobin levels. Imaging testing, including a computerized tomography (CT) scan and ultrasound, of the abdominal and kidney areas may also be conducted. Since treatment for kidney cancer generally involves surgery, kidney biopsies are usually reserved for individuals whose neoplasm is likely to be benign. A biopsy procedure carries a significant risk for providing false negative results, therefore, only those unable to undergo surgery or are diagnosed with a benign growth may undergo the procedure.

A benign neoplasm may not progress to become cancerous nor may it spread beyond the confines of the kidney. Normally, benign neoplasms do not require any treatment and may dissolve independently. Symptomatic individuals who are diagnosed with a benign neoplasm may decline treatment to alleviate discomfort unless it becomes absolutely necessary, at which point the growth may be surgically removed.

Renal neoplasms that are malignant in composition generally undergo a staging process during which the tumor is assigned a number based on its maturity and characteristics. Tumors that remain confined to the kidney area and are less than 3 inches (about 8 cm) in diameter are assigned a staging of one. Those that are larger than a stage one tumor in size and have not spread beyond the kidney are considered a stage two. When the neoplasm spreads beyond the kidney and is invasive to surrounding tissues, glands, or lymph nodes it is given a staging of three. Malignant renal neoplasms that spread beyond the kidney to other parts of the body possess advanced maturity and are stage four.

Surgery is the first approach utilized to treat kidney cancer. The procedure may be conducted one of two ways depending on the extent of the malignancy and condition of the kidney. The affected kidney may be either partially or completely removed. A nephron-sparing surgery may be conducted laparoscopically or as an open procedure, requiring a single large incision, and involves the removal of the neoplasm and a small portion of the surrounding, healthy tissue. When the entire kidney is removed, the procedure is known as a nephrectomy, necessitating not only the removal of the kidney, but a moderate portion of surrounding healthy tissue and nearby lymph nodes.

When surgery is not possible due to the health of the individual, non-surgical options may be utilized that involve the use of embolization, radiofrequency ablation, or cryoablation. Embolization is a procedure where the tumor's blood supply is cut off with the aid of a unique material injected into the main blood vessel. Conducted with the aid of imaging technology, radiofrequency ablation utilizes the application of an electrical current via a needle to target and eradicate cancerous cells with heat. Cryoablation also utilizes imaging technology and involves the freezing of cancerous cells through the use of a gas-delivering needle.

Additional treatment may include the use of chemo and immunotherapies. Chemotherapy involves the oral or intravenous administration of drugs to target and eradicate cancerous cells. Individuals who undergo chemo often experience side effects that may include fatigue and nausea. Immunotherapy utilizes the body's natural immune system to fight the cancerous cells and may be supplemented by the use of drugs such as interferon and interleukin-2. Side effects associated with immunotherapy may include loss of appetite, fatigue, and nausea.