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1. Mr. Abhijit Bhoyar
Lecturer
M. sc. Nursing

2. What is kidney cancer?
• DEFINITION
• Kidney cancer is a disease that starts in the kidneys. It
happens when healthy cells in one or both kidneys
grow out of control and form a lump (called a tumor).

3. OVERVIEW
• 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

4. Causes & Risk Factors
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 . 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
risk of kidney cancer.

5.  Treatment for kidney failure. People who receive long-term dialysis
to treat chronic kidney failure have a greater risk of developing
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.

6.  Occupational exposure to toxic compounds – Risk of kidney cancer
increases in workers exposed to asbestos, cadmium, petrolium
products, dry cleaning solvents, as well as those who work in the iron
& steel factories.
 Childhood chemotherapy – Chemotherapy given during childhood to
treat cancer or for bone marrow transplantation has been associate
with kidney cancer caused by the treatment.

7. STAGES OF KIDNEY CANCER
The TNM System
The most common staging method, known as the TNM system, relies on
three pieces of information:
 T is for the size of the tumor: Doctor will note the size of the tumor
in centimeters, and whether it has grown into nearby areas.
 N is for nodes: This refers to lymph nodes, which are small bean-
shaped filters throughout body that help protect you from germs.
Doctor will note whether the cancer has spread to patients lymph
nodes.
 M is for metastasis: That means your kidney cancer has spread, or
“metastasized” to other parts of the body. It can spread anywhere,
but the brain, bones, liver, and lungs are the most common places.

8. Once the doctor has this
information, they can use it to
find the overall stage. There are
four stages of kidney cancer
• Stage I: You have a cancerous
growth inside your kidney that’s
up to 7 centimeters across. It
hasn’t spread to your lymph
nodes or other organs

9. • Stage II: if You have a tumor in
your kidney that’s bigger than
7 centimeters across. It hasn’t
spread to lymph nodes or
other organs.

10. • Stage III: There are several
combinations of tumor sizes and
locations that could make up this
stage. For example, if a tumor of
any size has started to grow into a
major vein (renal or vena cava, for
example) or into tissue around the
kidney, or has spread to nearby
lymph nodes, your cancer is in stage
III.

11. • Stage IV: There are several
combinations of tumor sizes and
locations that could make up this
stage. Cancer that has spread to any
organs other than nearby lymph
nodes is stage IV, no matter how
small the tumor is. Stage IV cancer
can also spread to other organs
without affecting nearby lymph
nodes. Or a stage IV tumor could
push into the adrenal gland just
above your kidney, or past the thin
sac that contains each kidney

12. CLINICAL MANIFESTATION
 Abnormal urine color due to
blood in urine
 Flank pain and back pain
 Hydronephrosis
 Abdominal mass or lump
 Fever
 Hypertension resulting from
secretion of rennin by the tumor
 Malaise
 Weight loss/ anorexia
A wide range of symptoms can be present with renal carcinoma
depending on which areas of the body have been affected. The majority
of symptoms are asymptomatic and are detected incidentally on
imaging, usually for an unrelated cause.

13. Cont..
Polycythemia
Anemia resulting from
depression of
erythropoietin
Cold intolerance
Chronic fatigue
Leg and ankle swelling
Night sweat
Vision abnormalities
Elevated calcium level in
blood

14. DIAGNOSTIC EVALUATION
• History & physical examination
• Blood and urine tests. Tests of blood and urine may give clues about
what's causing signs and symptoms.
• Imaging tests. Imaging tests allow doctor to visualize a kidney tumor
or abnormality. Imaging tests might include ultrasound, X-
ray, CT or MRI.

15. Cont..
• 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.
• Cystoscopy - a long, thin, rigid or flexible optical scope is inserted
through the urethra and into the bladder. The practitioner then
makes the visual examination of that area.

16. MANAGEMENT
• Kidney cancer treatment usually begins with surgery to remove the
cancer. For cancers confined to the kidney, this may be the only
treatment needed. If the cancer has spread beyond the kidney,
additional treatments may be recommended.
• Together, you and your treatment team can discuss your kidney
cancer treatment options. The best approach for you may depend on
a number of factors, including your general health, the kind of kidney
cancer you have, whether the cancer has spread and your
preferences for treatment.

17. SURGERY

18. • NEPHRECTOMY (Removing the affected kidney) - 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 structures.
• The surgeon may perform a nephrectomy through a single incision in
the abdomen or side (open nephrectomy) or through a series of small
incisions in the abdomen (laparoscopic or robotic-assisted
laparoscopic nephrectomy).

19. • 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. It can be done as an open
procedure, or laparoscopically or with robotic assistance.
• 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 the
risk of later complications, such as kidney disease and the need for
dialysis

20. Nonsurgical treatments
• Small kidney cancers are sometimes destroyed using nonsurgical treatments, such
as heat and cold. These procedures may be an option in certain situations, such as
in people with other health problems that make surgery risky
• Treatment to freeze cancer cells (cryoablation). During cryoablation, a special
hollow needle is inserted through your skin and into the kidney tumor using
ultrasound or other image guidance. Cold gas in the needle is used to freeze the
cancer cells.
• Treatment to heat cancer cells (radiofrequency ablation). During radiofrequency
ablation, a special probe is inserted through your skin and into the kidney tumor
using ultrasound or other imaging to guide placement of the probe. An electrical
current is run through the needle and into the cancer cells, causing the cells to heat
up or burn

21. • 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.

22. Integrative medicine treatments may also help you feel better,
including:
• Art therapy
• Exercise
• Massage therapy
• Meditation
• Music therapy
• Relaxation exercises
• Spirituality

23. CHEMOTHERAPY
• Clear cell carcinomas do not respond to
traditional chemotherapy. Some non clear cell
carcinomas may respond to chemotherapy In
a minority of cases, combination of platinum
agents.

24. COMPLICATIONS
• Metastasis to the lung,
bone, liver, brain, and
other areas

25. NURSING ASSESSMENT
1. Assess for clinical manifestations of systemic disease”fatigue,
anorexia, weight loss, pallor, fever”as well as evidence of metastasis.
2. Assess cardiopulmonary and nutritional status before surgery.
3. Monitor for adverse effects and complications of diagnostic tests
and treatment.
4. Assess pain control and coping ability.

26. NURSING DIAGNOSES
1. Anxiety related to diagnosis of cancer and possibility of
metastatic disease
2. Acute Pain and Hyperthermia related to post-infarction
syndrome

27. NURSING INTERVENTIONS
Reducing Anxiety
• Explain each diagnostic test, its purpose, and possible adverse
reactions. Ensure that informed consent has been obtained as
indicated.
• Assess patient's understanding about diagnosis and treatment
options. Answer questions, and encourage more thorough discussion
with health care provider as needed.
• Encourage patient to discuss fears and feelings; involve family and
significant others in teaching

28. NURSING INTERVENTIONS
Controlling Symptoms of Post-infarction Syndrome
• Administer analgesics as prescribed to control flank and abdominal
pain.
• Encourage rest, and assist with positioning for 2 to 3 days until
syndrome subsides.
• Obtain temperature every 4 hours, and administer antipyretics as
indicated.
• Restrict oral intake and provide I.V. fluids while patient is nauseated.
• Administer antiemetics as ordered

29. PREVENTION
Taking steps to improve your health may help reduce your risk of kidney
cancer. To reduce your risk, try to:
• Quit smoking. If you smoke, quit. Many options for quitting exist, including
support programs, medications and nicotine replacement products. Tell
your doctor you want to quit, and discuss your options together.
• Maintain a healthy weight. Work to maintain a healthy weight. If you're
overweight or obese, reduce the number of calories you consume each day
and try to be physically active most days of the week. Ask your doctor about
other healthy strategies to help you lose weight.

30. • Control high blood pressure. Ask your doctor to check your
blood pressure at your next appointment. If your blood
pressure is high, you can discuss options for lowering your
numbers. Lifestyle measures such as exercise, weight loss and
diet changes can help. Some people may need to add
medications to lower their blood pressure. Discuss your
options with your doctor.