[칼럼] How to treat ‘kidney cancer’ that is difficult to detect and has no symptoms?

The kidney is located at the back of the abdomen, on both sides of the spine, and is about 10 cm in size and weighs about 150 g. Inside the kidneys, small blood vessels are clustered together, called glomeruli, which filter out wastes. In addition, it is an essential organ that regulates the amount of water and salt in our body, is responsible for blood pressure control, and helps hematopoiesis by secreting hormones that stimulate the formation of red blood cells.

Cancer occurring in the kidney, an important organ, develops in more than 70,000 people and kills about 15,000 people every year, so the importance of active treatment is emerging. With the development of early diagnosis, kidney cancer has become so common that it is the fourth most common cancer among men in their 40s, and the survival rate is increasing with appropriate surgery and other treatment. About 30% of renal cell carcinomas are found to be metastatic at the time of diagnosis, and more than 25% of patients undergoing surgery for regional renal cell carcinoma show recurrence and progression during follow-up. These advanced or metastatic renal cell carcinomas do not respond well to general chemotherapy or radiation therapy. In addition, kidney cancer has few initial symptoms, so when symptoms such as weight loss, hematuria, and flank pain appear, it is highly likely that the disease has already metastasized.

Many patients discover kidney tumors through imaging tests such as abdominal ultrasound or CT scan through physical examination. In this case, additional tests can be performed to confirm kidney cancer, and when surgical treatment is The patient’s underlying disease and risk factors must be considered. Active monitoring is also being implemented to prevent overdiagnosis and oversurgery. It is a method that is being followed a lot recently as a customized treatment for a very small kidney tumor, old age, many underlying diseases, or after sufficient consultation with the patient. to be.

As a model that can predict the prognosis of kidney cancer, the RENAL nephrometry score is applied, and when the tumor is small in size, far from the renal blood vessel, and protruding outward, a better prognosis can be obtained, and a biopsy can be performed if necessary. . Biopsy can be performed at an advanced age or when imaging is ambiguous, or for diagnostic purposes, and can provide the basis for determining confirmation and active monitoring.

For local lesions outside the renal parenchyma less than 4 cm, partial nephrectomy is possible. If the renal function of both sides is normal, even if one side is removed, there is no big problem in daily life. In the case of metastasis, nephrectomy and immunotherapeutic agents are used if indications are available, and the recent development of targeted and immunotherapeutic agents is of great help in reducing metastatic cancer after surgery. Recently, as an immunotherapeutic agent, there is PD-L1 called a checkpoint inhibitor, which blocks the binding of PD-1 and T cells and instructs the immune system to attack the cancer, effectively preventing the progression of cancer.

After treatment, regular check-ups are required to check for cancer recurrence. In general, blood and imaging tests are performed, and it is necessary to observe if there are any symptoms of the aforementioned kidney cancer, because if there are symptoms, it may mean that the cancer has recurred.

Risk factors include smoking, obesity, high blood pressure, and genetic factors, so diet management is important. It is helpful to reduce the intake of saturated fat and burnt foods, and to exercise regularly, such as controlling blood pressure and weight. Smoking is a risk factor for renal cell cancer, so it is strongly recommended to quit smoking. In addition, the kidney is a silent organ and has few initial symptoms, so it is best to receive an early examination such as periodic abdominal ultrasound after the age of 40.


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