Bilateral Kidney Cancer: Causes, Outlook, and Treatment Options
Understanding bilateral kidney cancer: prognosis, symptoms, treatment strategies, and important information for patients and caregivers.
Bilateral kidney cancer is a rare but significant medical condition where cancer develops in both kidneys. Understanding this diagnosis is critical for patients, caregivers, and healthcare professionals, as it involves distinct considerations regarding treatment, prognosis, and quality of life. This article provides a comprehensive overview of bilateral kidney cancer, including explanations of its types, possible causes, survival rates, treatment options, and answers to frequently asked questions.
What is Bilateral Kidney Cancer?
Bilateral kidney cancer is defined as the presence of cancerous tumors in both kidneys. Typically, kidney cancer only affects one kidney (unilateral), but in rare cases, both organs develop malignant growths. Bilateral cases require special attention, as treatment strategies aim to manage cancer while preserving as much kidney function as possible.
There are two main forms of bilateral kidney cancer:
- Synchronous: Cancer is present in both kidneys at the initial time of diagnosis or both kidneys develop cancer within a short timeframe.
- Metachronous: Cancer appears in one kidney first and then develops in the other kidney months or years after the first diagnosis.
This distinction has important implications for prognosis, treatment planning, and patient follow-up.
How Common is Bilateral Kidney Cancer?
While kidney cancer is among the ten most common cancers globally, bilateral kidney cancer accounts for only a small proportion of these cases. Most kidney cancer cases affect a single kidney. According to large epidemiological studies, the increased risk for bilateral disease is more significant in individuals diagnosed with kidney cancer at a younger age, suggesting possible genetic components.
Some key facts include:
- Most people develop kidney cancer in only one kidney.
- The incidence of bilateral cases is rare but higher among those with inherited risk factors.
- The likelihood of developing bilateral kidney cancer increases in patients diagnosed before age 40.
Symptoms of Bilateral Kidney Cancer
Symptoms of bilateral kidney cancer are usually similar to those experienced in unilateral cases. In the early stages, kidney cancer may not cause any noticeable symptoms, making early detection challenging. However, as the disease progresses, some patients may experience the following:
- Blood in the urine (hematuria) – often painless and may come and go.
- Flank pain or a persistent ache on one or both sides of the lower back.
- A mass or fullness in the side or abdomen.
- Unintentional weight loss.
- Fatigue and loss of appetite.
- Fever and night sweats (in some cases).
If bilateral kidney cancer spreads (metastasizes) to other parts of the body, additional symptoms may develop depending on the organs involved.
What Causes Bilateral Kidney Cancer?
The exact causes of bilateral kidney cancer remain under investigation, although both genetic and environmental factors are believed to play roles. Some cases occur spontaneously, while others are linked to inherited genetic syndromes.
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Key factors and syndromes associated with increased risk include:
- Genetic predisposition, including inherited syndromes such as:
- Tuberous sclerosis complex
- Von Hippel-Lindau syndrome
- Birt-Hogg-Dubé syndrome
- Hereditary papillary renal carcinoma
- Family history of kidney cancer
- Diagnosis of kidney cancer at a young age (less than 40 years)
- Lifestyle and health factors:
- Cigarette smoking
- Obesity
- High blood pressure
- Certain racial/ethnic backgrounds (increased rates in African American, American Indian, and Alaska Native individuals)
- Male sex
It is important to note that not all individuals with these risk factors will develop bilateral kidney cancer, and some cases arise with no identifiable risk factor.
Diagnosis of Bilateral Kidney Cancer
The diagnostic process for bilateral kidney cancer typically involves:
- Medical history and physical examination, focusing on symptoms and family history of cancer.
- Laboratory tests, including blood and urine analyses to assess kidney function and detect abnormalities.
- Imaging studies:
- Ultrasound: to detect tumors in the kidneys.
- CT or MRI scans: to assess tumor size, location, and potential spread.
- Biopsy, if needed, to confirm cancer diagnosis and determine cell type.
Survival Rates and Prognosis for Bilateral Kidney Cancer
The prognosis for bilateral kidney cancer depends on several factors:
- The stage of the cancer at diagnosis
- The aggressiveness or grade of the cancer
- The treatment used and its effectiveness
- The level of kidney function that can be preserved
- The person’s age and overall health status
Types of Bilateral Kidney Cancer and Survival Outcomes
- Synchronous bilateral kidney cancer: Cancer present in both kidneys at (or soon after) the initial diagnosis.
- Metachronous bilateral kidney cancer: The second kidney is affected months or years after the first diagnosis.
A 2019 study found the 5-year cancer-specific survival rate was 93.6% for metachronous cases, compared to 51.5% for synchronous cases. This suggests that earlier onset and metachronous development are linked to better outcomes.
Overall Survival Rates in Kidney Cancer
| SEER Stage | 5-Year Survival Rate |
|---|---|
| Local (confined to kidneys) | 92.9% |
| Regional (spread to nearby tissues) | 73.8% |
| Distant (spread to distant organs) | 17.4% |
| Overall | 77.6% |
This table summarizes overall survival rates for all kidney cancers (bilateral and unilateral). Early detection greatly improves the likelihood of positive outcomes.
A 2016 study found that people with bilateral kidney cancer had a 5-year survival rate of 89.4%, comparable to those with unilateral, non-metastatic kidney cancer. However, higher grade (more aggressive) tumors increase the risk for recurrence.
Treatment Options for Bilateral Kidney Cancer
The foremost goal in treating bilateral kidney cancer is to effectively remove or control the cancer while preserving as much kidney function as possible. This ensures the best possible long-term outcomes and quality of life.
Surgical Approaches
Surgery is the primary treatment and is customized according to the tumor’s characteristics:
- Partial Nephrectomy (PN): Removes only the part of the kidney containing the tumor, sparing healthy tissue. Usually done when cancer is localized and feasible, this approach helps retain maximum kidney function.
- Radical Nephrectomy (RN): Involves removal of the entire kidney, and sometimes surrounding tissues. Indicated when:
- The tumor is large
- There are multiple tumors
- The tumor’s location prevents partial removal
- The cancer has already spread to nearby tissues
Surgical strategies for bilateral cases include:
- Partial nephrectomy (PN) on both kidneys (when possible)
- PN on one kidney and RN on the other
- RN on both kidneys, followed by dialysis or eventual kidney transplantation (if necessary)
Surgery can sometimes be done in staged procedures, meaning one kidney is treated first, followed by surgery on the other kidney after the patient has recovered.
Other Treatment Modalities
In cases where surgery cannot be performed or additional therapy is needed after surgery, other treatments may be utilized:
- Targeted therapy: These drugs inhibit specific molecules involved in cancer growth.
- Immunotherapy: Approaches that stimulate the patient’s immune system to fight cancer cells.
- Radiation therapy: Employs high-powered energy beams to destroy cancer cells. Rarely a primary treatment for kidney tumors but may be used to control symptoms if cancer has spread.
- Ablation therapy: Techniques such as radiofrequency ablation or cryoablation use heat or cold to destroy cancer tissue, typically for small tumors.
The precise treatment plan depends on the cancer’s stage, patient health, and patient preferences.
Impact on Kidney Function
Many treatments for bilateral kidney cancer focus on sparing as much healthy kidney tissue as possible. Preserving kidney function is essential to avoid long-term dialysis or dependence on a transplant. After significant kidney tissue removal, kidney function is carefully monitored and, if necessary, managed with dialysis or transplantation.
Living with Bilateral Kidney Cancer
Receiving a diagnosis of bilateral kidney cancer affects many aspects of a person’s life. Living with reduced kidney function (especially after major surgery) may necessitate lifestyle modifications, dietary changes, and regular follow-up appointments to monitor for recurrence and ensure optimal health.
- Maintain regular kidney function tests as advised by your healthcare provider.
- Dietary adjustments may be needed to reduce load on the kidneys.
- Monitor and control blood pressure and blood sugar levels.
- Be aware of symptoms like swelling, fatigue, and shortness of breath, which may indicate reduced kidney function.
Prevention and Risk Reduction
While not all cases are preventable, certain steps may reduce the risk of developing kidney cancer (and secondary cancers in the remaining kidney):
- Avoid tobacco use
- Maintain a healthy weight
- Control blood pressure
- Be physically active and eat a balanced diet
- Know your family history and discuss genetic counseling if needed
Frequently Asked Questions (FAQs)
Q: How do doctors differentiate between synchronous and metachronous bilateral kidney cancer?
A: Synchronous bilateral kidney cancer is diagnosed when both kidneys are found to have cancer during the initial evaluation or within a short period of time after the first diagnosis. Metachronous cases are identified when cancer develops in the second kidney months or years after an initial unilateral diagnosis.
Q: What is the prognosis for people with cancer in both kidneys?
A: Prognosis depends on factors such as the stage of cancer, tumor grade, patient age, kidney function, and treatments used. Generally, metachronous bilateral cancer has a better 5-year survival rate compared to synchronous cases. Early and effective treatment offers the best outcomes.
Q: Are both kidneys always removed when someone has bilateral kidney cancer?
A: Not always. Whenever possible, surgeons aim for partial nephrectomies to remove only the cancerous portions and leave as much healthy tissue as possible. Removal of both kidneys is considered only when necessary; in such cases, dialysis or kidney transplantation may be needed.
Q: Can bilateral kidney cancer be inherited?
A: Some cases of bilateral kidney cancer are associated with inherited genetic syndromes, such as Von Hippel-Lindau syndrome or hereditary papillary renal carcinoma. In these situations, proper genetic counseling and screening may benefit family members.
Q: Is dialysis always required after bilateral nephrectomy?
A: Yes. If both kidneys are removed and no transplant has yet occurred, the patient requires long-term dialysis to filter waste products from the blood until a donor kidney becomes available for transplantation.
Q: What lifestyle changes should be made following a diagnosis?
A: Maintaining blood pressure control, quitting smoking, adjusting diet for reduced kidney workload, staying physically active, and following the care plan recommended by your medical team are essential for long-term health.
For more information, support, and counseling, patients are encouraged to consult with their healthcare providers and connect with reputable cancer organizations and support groups.
References
- https://www.healthline.com/health/kidney-cancer/bilateral-kidney-cancer
- https://www.medicalnewstoday.com/articles/bilateral-kidney-cancer
- https://pubmed.ncbi.nlm.nih.gov/19597028/
- https://www.healthline.com/health/kidney-cancer
- https://www.healthline.com/health/renal-cell-carcinoma
- https://www.youtube.com/watch?v=oZP1MwIifpU
- https://www.healthline.com/health/kidney-cancer/kidney-cancer-types
- https://actionkidneycancer.org/wp-content/uploads/2022/03/Essential-Guide-Papillary-RCC.pdf
- https://www.healthline.com/health/video/home-remedies-for-kidney-stones
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