Inoperable kidney cancer

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Renal tumours are neoplasms that account for about 2% of all adult tumours. In 90% of cases, they originate in the cells on the walls of the renal tubules that make up nephrons, taking the name of renal adenocarcinomas. 

Renal cell tumours include, among others, the following histological variants:

• Clear-cell tumour
• Papillary tumour type I
• Papillary tumour type II
• Chromophobe tumour

In most cases, kidney cancer is attributable to a carcinoma. More rarely, however, kidney cancer is a sarcoma that originates in different tissues, in particular:

• Liposarcomas
• Rhabdomyosarcomas
• Angiosarcomas
• Fibrosarcomas
• Leiomyosarcomas

In children, instead, the most common renal neoplasms are nephroblastoma (also called embryonal tumour) and Wilms tumour.

Kidney cancer is almost twice more common in men than in women, with a peak incidence between 60 and 70 years old. Kidney cancer occurs bilaterally- in both kidneys- in 2% of cases.

Causes of inoperable kidney cancer

Although the causes of renal neoplasms have not yet been defined, there is a number of established risk factors that significantly increase the risk of kidney cancer, including:

• Smoking habit
• Obesity
• High blood pressure
• Alcohol abuse
• Long-term dialysis
• Chronic exposure to chemicals such as asbestos, cadmium and thorotrast
• Taking phenacetin
• Hereditary diseases such as Von Hippel-Lindau syndrome and hereditary papillary carcinoma

Symptoms of inoperable kidney cancer

In the majority of episodes, renal neoplasms are asymptomatic up to an advanced stage of the disease. This is the reason why this pathology is diagnosed 'by accident' in more than half of the cases.
When present, the symptoms of kidney cancer can be recognised in:

• Palpable mass in the abdomen
• Haematuria
• Localised lumbar pain
• Weight loss
• Cachexia
• Feeling of tiredness
• Fever
• Anaemia
• High blood pressure
• Hypercalcaemia
• Varicocele (in men)

Diagnosis of inoperable kidney cancer

In case of suspected kidney cancer, visiting a specialist is required to define a correct patient’s medical history. 

Subsequently, a number of examinations for a correct diagnosis are required, including:

• Urinalysis
• Ultrasound scan
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI) scan
• Fine-needle aspiration biopsy

Once the presence of kidney cancer has been confirmed, staging is crucial to assess the most suitable treatment. The TNM /AJCC staging system is generally used to define the kidney tumour.

Treatment of inoperable kidney cancer

The treatment of kidney cancer varies depending on the size and location of the lesion, the stage of severity found, and the patient’s general medical condition. 

Due to the high percentage of cases of kidney cancer discovered at an advanced stage, surgical resection (total or partial) is usually not a viable treatment. Therefore, hadrontherapy may represent a promising therapeutic option for cases of inoperable kidney cancer because it is high degree of effectiveness in overcoming the resistance to traditional radiation this type of cancer shows. In addition, due to the strong resistance to traditional radiation, hadrontherapy can also be used to treat unique distant metastases.