Renal pelvic carcinoma is a relatively rare tumor disease; just one percent of all tumors that form in the genitourinary system affect the renal pelvis. Prognosis depends on the detection of the tumor; surgical methods are the only way to defeat the tumor.
What is renal pelvic carcinoma?
Renal pelvic carcinoma, as mentioned in the name, refers to tumor formation directly in the renal pelvis. Renal pelvic carcinoma is a relatively rare tumor; just one percent of all genitourinary tumors are formed by renal pelvic carcinoma. The tumor forms predominantly in individuals who are over the age of 60. It should be noted that within the renal pelvic carcinoma several types of tumors are possible, which can be distinguished on the basis of histology. Ninety percent are so-called papillary eoithelial tumors; 10 percent are [[spinalioma (squamous cell carcinoma)|squamous cell carcinoma.
Causes
As part of various studies, doctors have found that renal pelvic carcinoma can sometimes be occupational. People who work primarily in mining or chemical plants are more likely to be affected than people who are not employed in those industries. Aromatic amines and nitrosmines are thought to promote tumor formation. However, there are also tumor formations that arise due to mutations in the apoptosis gene. Chronic urinary tract infections also favor tumor formation.
Symptoms, complaints, and signs
Even though hematuria (visible blood in the urine) occurs relatively early, renal pelvic carcinoma may go unnoticed for a long time. Patients also complain of recurrent pain, with blood accumulation – coagulation – being the cause here, as the patient’s urinary tract becomes obstructed. The pain is described as colicky and sometimes radiates to the back. For this reason, many physicians – at the beginning of the examination – assume urolithiasis. However, other symptoms that appear only with the later course of the disease are nausea, weight loss, fever, and night sweats or loss of appetite.
Diagnosis and course of the disease
The physician already suspects, based on the medical history as well as the complaints of his patient, that sometimes a tumor disease may be present. Initially, the focus is on the fact whether it is a renal pelvis carcinoma or a ureter or kidney tumor. By means of ultrasound examination, it is possible that the physician can detect any changes in the structures. An X-ray also provides information as to whether a tumor is present. Sometimes bone metastases can also be detected in the X-ray. If the suspicion of renal pelvic carcinoma is confirmed, further examinations are performed. These examinations serve to determine the stage or extent. Computer tomography, for example, can be used to determine whether daughter tumors (metastases) are already present. Tumor staging must be performed so that a targeted therapy can be started. In this process, the physician assesses the tumor according to the TNM classification, which is composed of the tumor size (T) the lymph node involvement (N) as well as the metastases (M):
- T1 N0 M0 = stage I. Neither metastases nor lymph node involvement are present.
- T2 N0 M0 = stage IIA. The tumor has grown into the surrounding tissue layers, but there are no metastases or lymph node involvement.
- T1-2 N1 M0 = Stage IIB. Comparable to stage IIA; the lymph nodes are already affected.
- T3-4 N1 M0 = stage III. the tumor has already grown into the organ tissue; the lymph nodes are also affected, but no metastases have formed.
- T3-4 N1 M1 = stage IV. as stage III, but metastases have formed.
The prognosis depends mainly on the stage at which the renal pelvic carcinoma was diagnosed. The chances of recovery, provided that the tumor was detected at a very early stage, are significantly better. However, early diagnosis is extremely difficult; mainly because at the beginning of the disease there are no symptoms to suggest that a tumor has formed. Only at an advanced stage do symptoms occur that clearly indicate that a carcinoma has formed.For this reason, it is essential to consult a medical professional at the very first symptoms that may indicate a tumor.
Complications
Renal pelvic carcinoma is a very serious disease. Unfortunately, in most cases, it leads to the death of the patient or to significant limitations. However, the further course of this disease depends very much on the time of diagnosis and on the spread of the tumor, so that a general prognosis cannot be given. Those affected primarily suffer from bloody urine. Blood in the urine can sometimes lead to a panic attack. Severe pain in the kidneys or flanks can also occur due to renal pelvic carcinoma and can also spread to the back. Furthermore, those affected suffer from weight loss and fever. A general feeling of illness also occurs with renal pelvic carcinoma and leads to a significantly reduced quality of life for the affected person. Patients appear fatigued and also suffer from night sweats. As a rule, renal pelvic carcinoma can be removed by surgery. However, patients are still dependent on chemotherapy or radiotherapy afterwards. This can lead to various side effects. The patient’s life expectancy is significantly reduced by renal pelvic carcinoma.
When should you see a doctor?
If there is blood in the urine, which does not occur in sexually mature women because of menstruation, there is cause for concern. A visit to the doctor should be made to determine the cause. If there is a decrease in weight, listlessness, or loss of ability to exercise, a physician should be consulted. If fever, nausea, vomiting or general weakness occurs, the individual needs help. Sweating or profuse night sweats are indications of illness. A visit to the doctor is necessary. Pain, malaise or a feeling of illness should be clarified by a doctor. Since renal pelvic carcinoma takes a fatal course if left untreated, a visit to the doctor is urgently recommended at the first sign of an irregularity. The prognosis depends on the timing of the initiated treatment. Therefore, participation in regular cancer screening examinations is generally recommended in adulthood. In this way, early detection is possible even before symptoms have manifested themselves. In case of complaints such as loss of appetite, back pain or colic, these should be presented to a doctor. If the affected person suffers from abnormalities in urination, a change in urine or odor, the observations should be further investigated by a physician. If participation in leisure activities decreases, behavioral changes occur, or mood swings occur, there should be increased vigilance. Often, these are the first signs of an illness.
Treatment and therapy
Therapy focuses primarily on surgical removal of renal pelvic carcinoma, whereby – since the entire kidney is usually affected – it must be removed in its entirety. However, not only the kidney but also the bladder and the ureter are surgically removed. In individual cases, i.e. when only a very small tumor is present, a partial resection or partial removal of the renal pelvis is sufficient. Chemotherapy is then prescribed. The aim of chemotherapy is to give the patient a drug that inhibits cell growth. This involves inserting a fairly thin catheter directly into the area near the tumor. Radiation therapy is also recommended – but after surgical removal of the renal pelvic carcinoma. It is important that the radiation therapy only “irradiates” the affected area; in this way, any damage to the surrounding organs can be prevented. If metastases have been detected, the patient’s entire body must be treated with systemic chemotherapy. In this case, the drug is administered directly via the bloodstream. The goal here should be to rid the affected regions of daughter tumors.
Outlook and prognosis
In patients with renal pelvic carcinoma, the further outlook depends on the stage of the disease when the tumor was discovered and treated. In addition, it must be clarified whether the tumor is malignant or benign. If the diagnosis is made early, the patient has a good chance of recovery.The later the undesirable tissue changes are noticed and the more intensive the growth of the tumor, the less favorable the further course of the disease. When determining the prognosis, it must be taken into account that renal pelvic carcinoma usually occurs in people over the age of 60. In many of those affected, the organism is weakened at an advanced age. In addition, there are often other diseases that can have an effect on further development. The general state of health of the patient is therefore a decisive factor in the further course of the disease. To alleviate the symptoms, surgical intervention and tumor treatment are necessary. The carcinoma must be completely removed in order to have a prospect of relief. The operation and subsequent therapy are associated with numerous side effects and physical as well as emotional stress. There is a possibility of secondary diseases. If the patient has a fundamentally healthy immune system and is in good health, the prospects are significantly improved. If no further complications occur during the surgical procedure, freedom from symptoms is possible.
Prevention
It is important that renal pelvic carcinoma is prevented in the way that the patient can have any urinary stones and urinary tract infections treated quickly. If those diseases are not treated, chronic irritation will result, which can also promote tumor formation.
Follow-up
If renal pelvic carcinoma could be treated successfully, aftercare takes place afterwards. Follow-up treatment in a rehabilitation or spa clinic is considered helpful. There, the patient also receives psychological support as well as valuable insights into a conscious and healthy lifestyle. One of the most important aspects of aftercare is preventing the recurrence of renal pelvic carcinoma. To this end, a follow-up examination is performed every three months for the first two years after therapy. The physician inquires about the patient’s condition and performs a physical examination. The controls include examinations of urine and blood. A sonography (ultrasound examination) is also performed. A check of the abdominal region can be performed with the help of a computer tomography (CT) or magnetic resonance imaging (MRI). In order to exclude possible metastases in other regions of the body, such as the lungs, X-rays of the chest are taken. From the 3rd year after the end of renal pelvic carcinoma treatment, check-ups take place every six months. From the 5th year onwards, only one examination per year is necessary. The examinations are performed by the family doctor, a urologist or in the clinic where the therapy took place. However, the number of examinations also depends on the course of the disease and the individual’s state of health. If cancer recurrences, sequelae or concomitant diseases show up, these are treated immediately.
What you can do yourself
After being diagnosed with renal pelvic carcinoma, those affected need the support of friends and family. Doctors, psychologists and counseling centers are also available with tips to make everyday life easier. Above all, it is important to return to work. Vocational rehabilitation succeeds with the help of various counseling services, about which the family doctor can provide information. Since renal pelvic carcinoma is usually treated with chemotherapy or radiotherapy, patients suffer side effects that affect both their internal organs and their appearance. Problems such as hair loss or scars can be treated with both medical preparations and natural remedies. In the area of sexuality, sufferers can also turn to a specialist to effectively treat typical problems such as erectile dysfunction. Last but not least, dealing with the diagnosis of cancer is also important. Particularly in the early days, those affected have many questions and fears. These can be worked through in a self-help group or in discussions with a psychologist. Through all these measures, the quality of life can gradually be improved again. In conjunction with comprehensive medical therapy, the self-help measures mentioned above offer a perspective for patients to maintain a higher standard of living despite the serious diagnosis.
