Renal Pelvis Tumors Health Article

Clinical staging, treatments, and prognosis

Clinical staging

Tumor stage and grade provide important information on how an individual patient's renal pelvis tumor (s) will be treated and on the patient's prognosis. The primary tumor is staged on the basis of whether it remains superficial or has settled into the kidney. Patients with more superficial tumors have the best prognosis. However, even these patients may develop new tumors later.

Another factor important in determining treatment and prognosis is to determine the type and character of the individual cells that make up the tumor. Cells with a well-differentiated structure are associated with longer patient survival than cells with poorly differentiated structure.

Treatments

Surgery constitutes standard treatment for renal pelvis tumors. The surgical procedure may involve removal of a portion of the bladder, as well.

Some patients should not receive surgical treatment for this cancer. Other patients should undergo a relatively more limited surgical procedure than the standard procedure—one in which less of the kidney is removed. Those who should be approached in the more limited way may include patients with only one single kidney, patients with cancer of both kidneys, and patients with Balkan nephropathy. In addition, patients who are in generally poor health may not be good candidates for surgery or may receive a limited surgical procedure.

Of course, patients with a single tumor comprised of well-differentiated cells are likely to have a better long-term outcome following a limited surgical procedure than are patients with several tumors comprised of poorly differentiated cells. It should be understood, however, that more limited procedures may involve a greater likelihood that the cancer will return.

Patients with Balkan nephropathy usually benefit from receiving the more limited procedure. These patients are at pre-existing risk of kidney failure because of the Balkan nephropathy; thus, the more of their kidneys preserved, the better for their future overall medical outcomes.

Some surgical procedures used for renal pelvis tumors are performed using a medical device that moves along the body channels used by urine. The use of this device in the treatment of renal pelvis tumors is, however, limited to extremely small tumors.

X-ray therapy may be used following a surgical pro cedure for renal pelvis tumors. In particular, it may be used if there is any evidence that tumor cells have affected any of the surrounding organs or if they are appearing in the lymph nodes. In addition, x-ray therapy may be recommended for patients who are at a higher-than-average risk for reappearance of cancer, for example, patients who are heavy smokers. Some authorities believe that additional studies are needed to clarify the effects of xray therapy for these patients.

Patients who experience pain related to renal pelvis tumors may receive x-ray treatment to control pain. Such treatment may be very effective. Patients with such pain may also benefit from chemotherapy.

The patient with advanced renal pelvis cancer does not receive treatment that attempts to cure the disease. Rather, the treatment is palliative—it is used in an attempt to make the patient feel better and to improve the patient's quality of life. Cisplatin used alone has been shown to be an effective chemotherapy medicine in this situation.

It may, however, be preferable to use combination chemotherapy rather than cisplatin alone for patients with advanced disease, as a recent study demonstrated. The combination chemotherapy used in this study is the so-called M-VAC regimen, which consists of methotrexate, vinblastine, Adriamycin (doxorubicin), and cisplatin. This combination of medicines permitted patients both to live for a longer time without return of cancer and to live for a longer time overall.

Another combination of chemotherapy medicines studied for patients with advanced disease is the so-called CMV, which consists of cisplatin, methotrexate, and vinblastine.

It is important to examine the side effects that may accompany chemotherapy in these patients. Some of these side effects are severe, and a small percentage of patients treated using this modality die. Both the M-VAC and the CMV regimens help approximately half of patients and give some patients additional months of life.

Other, newer medicines that have been tried as chemotherapy for patients with renal pelvis tumors and advanced disease are paclitaxel (Taxol) and gemcitabine (Gemzar). In 2001, it was questionable whether the use of either one of these medicines as single-drug chemotherapy produces superior results to the M-VAC or CMV regimens.