Kidney cancer recurrence is a malignant tumor that occurs some time after radical treatment of oncological kidney damage. The cause of the development is insufficient radicality of the operation or undiagnosed metastases in lymph nodes and distant organs. Pathology are often asymptomatic. There may also be pain, hematuria, increased blood pressure, nausea, vomiting, swelling and enlargement of the subcutaneous veins of the lower extremities, hypercalcemia, coagulopathy, anemia, weakness, weight loss and hyperthermia. The diagnosis is made on the basis of blood and urine tests, urography, MRI, ultrasound and other studies. The main method of treatment is surgical intervention.
Meaning
Kidney cancer recurrence is the repeated development of a malignant neoplasm in the area of a previously removed primary tumor, treated or undiagnosed metastases. According to various data, it is diagnosed in 1.4-3% of patients who have previously undergone radical surgery for kidney cancer. The average age of patients is 50-55 years, men and women suffer equally often. Symptoms of recurrent kidney cancer can appear in a period of several months to several years.
There is an approximately equal distribution between three types of lesion: local relapses, distant metastases and a combination of local recurrence and distant metastasis. Local recurrences of kidney cancer in the area of the renal bed in 40% of cases have an asymptomatic course and are detected during the next preventive examination, which determines the importance of regular follow-up of patients with a history of kidney cancer. The treatment is carried out by specialists in the field of oncology, nephrology and urology.
Causes
The cause of relapse in the area of remote neoplasia, lymph node or distant organ are undetected or undiagnosed clusters of “dormant” malignant cells, which may be inactive for months or years, and then begin to divide, forming a new focus with the same histological structure as the primary tumor. Sometimes the time interval between the removal of the primary neoplasm and the development of a kidney cancer recurrence is 10 years or more.
The probability of recurrence is determined by the histological type of neoplasm, the level of cell differentiation and the stage of the disease. Most often, relapses of the most common epithelial neoplasia of the kidneys are detected – renal cell carcinoma, which accounts for 85% of the total number of oncological lesions of this organ. The lower the level of cell differentiation, the higher the probability of a kidney cancer recurrence after radical treatment. The risk of recurrence increases significantly in patients with metastases to regional lymph nodes.
Symptoms
Clinical symptoms are determined by the localization and size of recurrent neoplasia. Neoplasia located in the area of the bed of the removed kidney is often asymptomatic, due to the presence of a large amount of loose fiber in this anatomical zone. With a kidney cancer recurrence with a lesion of the paired organ (the second kidney), hematuria, pain in the lumbar region, instability of blood pressure with a tendency to increase, nausea, vomiting, blood clotting disorders and hypercalcemia are detected.
With a sufficient increase in the kidney cancer recurrence located in the area of the kidney bed or in the remaining kidney, compression of blood and lymphatic vessels occurs, manifested by swelling of the lower half of the body, varicose veins of the lower extremities and varicocele. Relapses in regional lymph nodes are also accompanied by edema and varicose veins. The symptoms of distant kidney cancer recurrence depend on the location of the lesion. With the progression of the oncological process, there is an increase in general symptoms: exhaustion, weakness, apathy, emotional lability, tendency to depression, anemia, hyperthermia and cancer intoxication.
Diagnostics
The diagnosis of a kidney cancer recurrence is established taking into account anamnesis (the presence of a radically treated oncological disease), complaints, physical examination data and additional diagnostic procedures. When palpating the lumbar region, in some cases it is possible to detect a tumor-like formation. The probability of palpatory detection of a kidney cancer recurrence with a large node, asthenic physique or exhaustion of the patient. To assess the condition of the kidneys and detect anemia, a urine test, a biochemical blood test and a general blood test are prescribed.
To determine the localization, diameter and prevalence of kidney cancer recurrence, as well as to assess the degree of involvement of neighboring anatomical formations, intravenous urography, ultrasound of the kidneys and MRI of the kidneys are prescribed. The final diagnosis is made taking into account the biopsy data and subsequent histological examination. Bone scintigraphy, liver ultrasound, chest X-ray and other studies are performed to detect distant metastases in systemic recurrences of kidney cancer.
Treatment
A distinctive feature of kidney cancer is the insensitivity of the tumor to chemotherapy and radiation therapy. This significantly limits the capabilities of oncologists in the treatment of this pathology and makes surgical interventions the main way to save patients’ lives. With small local recurrences of kidney cancer, isolated surgery or surgery with subsequent immunotherapy is possible. Experts consider isolated local relapses to be promising enough for a successful operation.
With the kidney cancer recurrence with lymphogenic metastases, the situation worsens, the volume of surgical intervention increases. Satisfactory general condition of the patient, absence of severe somatic pathology and a time interval of at least a year from the moment of the first operation are considered as necessary conditions for repeated resection. With relapses of kidney cancer with metastases to the lungs, a significant increase in life expectancy is noted after resection of the affected area, however, this method of treatment is not always applicable due to disseminated lung tissue damage or unfavorable prospects due to the removal of a significant part of the organ and the subsequent development of respiratory failure.
A promising method of treating long–term relapses of kidney cancer is radiofrequency ablation, a minimally invasive intervention during which a special device is injected into the patient’s body through the skin, and then targeted at the area of kidney cancer recurrence with thermal energy. This technique is under development and is used for lung metastases. A prerequisite for use is the absence of coagulopathy. With distant solitary metastases of other localizations, surgical resection is performed if possible. Treatment of multiple metastatic lesions with recurrent kidney cancer is problematic due to the inability to remove all neoplasia foci. In such cases, immunochemotherapy and symptomatic agents are used.
Forecast
The prognosis for recurrent kidney cancer is determined by localization (local tumor, foci in lymph nodes or distant organs), the size of the neoplasm, the number of metastatic recurrent lesions and the time of recurrence. As prognostically favorable factors in the kidney cancer recurrence, experts indicate the solitary nature of the tumor, surgical treatment and the occurrence of a relapse a year or more after the removal of the primary tumor. The average five–year survival rate after radical removal of local kidney cancer recurrence is 55%, after adjuvant therapy – 18%, in the absence of treatment – 13%. Resection of solitary metastasis provides five-year survival in 44% of patients. With incomplete surgical removal of secondary foci, 14% of patients manage to survive up to 5 years from the moment of detection of metastases, while using non–surgical methods of treatment – 11% of patients with recurrent kidney cancer.