Is surgery the only cure for kidney cancer? What can be the consequences of difficulty urinating in men around the age of 60? These are the questions that our readers often ask us. Today, Dr. Vasil Vassilev, MD, answers these and other questions on the topic. - chief assistant at the Clinic of Urology at the University Hospital "Alexandrovska" in Sofia. He is a consultant in urology in two more Sofia hospitals, he is also the author of a Bulgarian urology portal. Dr. Vassilev is a specialist in diagnosis, treatment and breaking up of kidney stones, in laser and bloodless operations for enlarged prostate, treatment of prostate cancer, as well as in diseases of the male reproductive system.
Dr. Vassilev, what is the frequency of kidney cancer in Bulgaria and what is characteristic of this disease?
- Kidney cancer or renal cell carcinoma accounts for 2 to 3 percent of all cancers. It is the most common tumor of the kidney and accounts for 85 to 90 percent of all malignant kidney tumors. It is more common in men, and the risk to their he alth is greatest between the ages of 60 and 70. Smoking, obesity and arterial hypertension can increase the risk of developing a tumor in the kidney. Usually, this formation has a relatively slow development, initially limited to the kidney itself and can reach very large sizes - over 15-20 cm. Kidney tumors are characterized by early metastasis through the blood - initially in the renal vein, but in more advanced stage, it is possible for the "tumor thrombus" to reach the right heart atrium. For this reason, the most common distant metastases are in the lung. There is a classification that defines the different stages of a kidney tumor.
What are the symptoms of kidney tumors?
- Kidney tumors have a slow development, during this time the patient has no specific complaints. Or if there are, they are very weak. The most common symptoms are: blood in the urine - hematuria, pain in the lumbar region and a palpable tumor mass. It is important to note that with the development and spread of imaging studies, mainly ultrasound, in the last decade more and more kidney tumors are discovered incidentally. Patients have almost no complaints and the tumor is detected during an examination for some other disease. And unfortunately – at an advanced stage. 30 percent of patients may experience weight loss, anemia, prolonged high fever, increased ESR, etc.
Dr. Vassilev, our readers are mostly interested in the treatment of kidney tumors. What does it mean?
- The treatment of kidney cancer is mainly surgical - the entire kidney is removed together with the tumor mass, the so-called radical nephrectomy. In the case of small tumors under 7 cm, which are localized in the kidney, it is possible to do the so-called partial kidney resection. In these cases, only the tumor formation is removed and the rest of the organ is preserved. Unfortunately, however, even at similar sizes it is
impossible to save the kidney
Chemotherapy, radiation therapy or hormone therapy are not effective in this disease. In patients whose general condition and comorbidities do not allow surgical intervention or in cases of very advanced and inoperable tumors, renal artery embolization can be used as a palliative method. In this way, the blood flow to the kidney and also to the tumor itself is cut off, which significantly slows down its development. I want to say that in recent years, endoscopic methods have also been increasingly successfully applied - i.e.so-called laparoscopic or robot-assisted nephrectomy, or partial resection. In addition, renal cell carcinoma is among those cancers that are sensitive to treatment with drugs that stimulate the immune system. Such are interferon and interleukin-2. But their application must be well thought out and refined because it can lead to risky side effects.
And lastly on this topic: what is the prognosis for kidney cancer?
- There are many factors that affect after kidney cancer treatment. However, the two most important prognostic factors are the stage of the disease and the degree of malignancy. The basic concept is that the larger the tumor, the less likely a radical cure is. Higher malignancy rate too
assumes a lower chance of healing
The highest chance of cure with long-term follow-up gives the radical open and partial nephrectomy. In addition, in the long term, the results of laparoscopic radical nephrectomy are similar to those of classical open surgery.
Now let's move on to the second topic of today's conversation: difficulty urinating in men over a certain age. What does it express, how does it manifest itself?
- Difficulty urinating, also called dysuria, is a symptom that can manifest itself in different forms: decrease in the strength of the stream, difficult initiation and difficult initiation of urination, slower and prolonged urination, the need to strain when urinating. Difficulty urinating can appear alone or be accompanied by frequent urination during the day and night, as well as imperative urges to urinate, which are very distressing for patients. The consequences of difficulty urinating can be severe, as it develops slowly over years. Therefore, patients tolerate it and do not seek medical help. But in the advanced stages, dysuria can lead to serious disturbances in the functions of both the bladder and the kidneys.
What is the treatment of difficulty urinating? Moreover, you mentioned that it is not only the enlarged prostate that causes it?
- See, the purpose of the examination is not only to determine the size of the prostate, but rather the ability of the bladder to empty itself without difficulty, because although an enlarged prostate is the most common cause of difficulty urinating men over 50, she is not alone. Therefore, if the prescribed drug treatment for uncomplicated benign hyperplasia does not improve the condition, other causes of the disease are sought, and this requires appropriate treatment.