Metastases in the kidneys to the lungs in cancer: symptoms, causes, treatment, prognosis, how long they live

Kidney tumors can spread to other organs or distant lymph nodes. This is called metastatic disease. In metastatic disease, the tumor in the kidney is called the primary tumor, and tumors in other organs are called metastases. Your doctor may recommend treating metastatic disease with surgery in combination with antiangiogenic therapy, also known as targeted therapy (uncovered radionuclide therapy). In rare cases, immunotherapy is used. Radiation therapy may be recommended to treat metastases.

Treatment of metastatic disease is aimed at reducing the size of the primary tumor and metastases. This will give you the opportunity to live longer and with fewer symptoms.

When kidney cancer metastasizes, it usually spreads to the lungs, bones, distant lymph nodes, or brain (Figure 1). Metastases can be seen on computed tomography. They can also be detected by the symptoms they cause. Metastatic disease may be asymptomatic or cause various symptoms, depending on where the cancer has spread. The most common symptoms are a persistent cough if the cancer has spread to the lungs or bone pain if the cancer has spread to the bones.

Rice. 1 Metastatic kidney cancer can spread to the lungs, bones, or brain.

Causes

Kidney cancer is one of the most common cancer pathologies. The structural features and functional load contribute to an increased risk of degeneration of normal cellular structures under unfavorable conditions. The increased risk of detecting cancer at later stages is associated with the erased symptoms of the pathological process over a long period of time. A person may live with kidney cancer and not suspect the existence of the disease until a disappointing diagnosis is made during a random examination or when typical symptoms appear.

The causes of the occurrence are considered not fully understood. A large role in the development of diseases related to oncology is played by genes, or more precisely, their mutations under the influence of unfavorable external conditions or with a burdened heredity. When analyzing cases of occurrence, it was found that more than 40% of cases are associated with the presence of cancer in the family.

Kidney cancer

The structure and functions of cells are laid down during intrauterine development, specification and integration into tissues occurs, and the whole process is regulated at the gene level. A violation in the genetic code under unfavorable conditions leads to the launch of a pathological mechanism in which cells actively divide and grow, but stop working and performing their functions. The failure is inherent in genes, but does not occur immediately. Oncology can manifest itself throughout life when the body’s defenses are weakened, or it can be transmitted to subsequent generations in the form of a pathological code. Cancer development can be triggered by harmful external influences or changes in the functioning of the immune system.

Oncological pathology affects any organs, but most often the targets are structures that are closely related to blood circulation. Important filtration processes take place in the kidneys; the blood is cleared of toxins, some of which have oncogenic properties. Excessive load leads to disruption of cellular structures, and a tumor of a benign or malignant nature develops.

Factors that may pose a threat to the development of kidney cancer:

Symptoms and signs of kidney cancer

Symptoms of this disease appear gradually. So, at stages 1 and 2 of oncology, symptoms may be completely absent. The only manifestation that may occur is discomfort in the lumbar (kidney) area. However, people do not take this symptom seriously and relieve pain with analgesics.

A little later, characteristic symptoms of kidney cancer are added.

Pain. The discomfort becomes pronounced. The pain is characterized as aching, dull, and is increasingly difficult to relieve with medications.
Hematuria (blood in the urine). This manifestation invariably accompanies many serious diseases, so at the first signs you should consult a doctor immediately.

Difficulty urinating. The growth of the tumor can partially block the ureter, which means that the flow of urine from the kidneys is impaired.

There are also a number of nonspecific signs. Symptoms of kidney cancer in women and men can be similar to those of other diseases. The list of such symptoms may include:

signs of venous thrombosis (this is possible in case of damage to the vena cava);
Kinschburg syndrome;
signs of anemia;
dyspnea;
loss of strength, increased fatigue;
low appetite or its complete absence;
sudden weight loss;
signs of apathy, lethargy;
temperature 37-38 or 38-39 degrees;

A common sign of kidney cancer in men is symptoms of varicocele (enlarged testicle). This can be explained by the fact that when the vena cava or renal vein is compressed, the veins of the spermatic cord expand. Doctors consider this manifestation to be quite serious, since it most often indicates a large size of the tumor.

Women do not take some symptoms of kidney cancer seriously. Thus, sudden weight loss, fatigue, lack of appetite and apathy are often attributed to menopause, hormonal changes and severe stressful situations. This is why many women put off seeing a doctor for a long time.

In children, the course of the disease may not be entirely typical. So, there may not be obvious symptoms until the last, 4th stage. After this, they appear immediately and very brightly. This makes diagnosis and treatment much more difficult.

Metastasis process

A cancerous tumor is a collection of pathological cells that are different in shape and size, do not have specific functions, and are in the stage of constant reproduction. An irregular growth forms within the capsule, muscle layer or at the level of nephrons. Initially, healthy cells cope with their functions, the kidneys function normally, and the body does not initiate the processes of introducing diseased structures into the general bloodstream. In medical practice, this stage is considered the stage of tumor localization; it can be treated with conservative and surgical methods.

Kidney cancer metastases

As they grow and expand, tumor cells become overgrown with a network of blood and lymphatic vessels, displace healthy tissue, and begin to penetrate through the blood and lymph into distant organs. This is how metastases form, and given the peculiarities of the blood supply to the kidneys, as well as the proximity of large lymph nodes, the process can develop rapidly.

At the site of the new habitat, the process of active growth and replacement of normal cells in another part of the body begins. The detection of metastases is accompanied by an unfavorable prognosis, and life expectancy in this case depends on the degree of activity of the oncological process.

Treatment methods

Therapy depends on a large number of circumstances: the nature of metastasis, the type and stage of the source of metastases, and the patient’s well-being. Treatment methods are practically no different from oncological processes in other organs.

Chemotherapy

The technique involves administering to the patient specific medications that affect tumor cells and inhibit their spread. Such drugs can have a strong side effect directly on the body, but their therapeutic effect fully compensates for the adverse complications.

Radiation therapy

The method involves physical influence on the tissue of the growth through gamma rays or high-frequency X-ray irradiation. Radiation therapy has a destructive effect on tumors in the kidneys, preventing their active reproduction and slowing the progress of the disease.

Surgical intervention

Surgical elimination of metastases is a radical method of treating growths in the kidneys. The operation is performed only if there are no contraindications to surgery. The purpose of the manipulation also depends on the stage of formation of the tumor in the kidney and its size.

The decision on the type of surgical intervention must be made by the specialist who performs the procedure itself. The volume is assessed before the procedure itself.

In the treatment of kidney metastasis, complex therapy (for example, chemotherapy and radiation) is mainly used. In addition, auxiliary medications play an important role in patient therapy, reducing side effects from the main treatment and improving well-being. Such drugs are classified as symptomatic drugs. Often, patients are prescribed hormonal medications that normalize the functioning of the body.

Where can they occur?

Regardless of the location of metastases, the risk of cancer at this stage is high. Predicting the site of localization is difficult, since the kidneys actively participate in the general blood flow and are penetrated by the lymphatic network. Malignant pathology is complicated by the spread of pathological tumor foci to the liver, lungs, brain and spinal cord, skin, bone structures, and adrenal glands. If at least one large lymph node is affected, then there is a high probability of development of lesions along all lymphatic tracts. The breast and prostate gland are also potential target organs. In most cases, detection of metastases occurs during diagnostic procedures or during surgery. The prognosis for a person when cancer is detected at the metastatic stage is unfavorable.

In the lungs

A large amount of venous blood enters the lungs to enrich it with oxygen, and a huge number of lymphatic vessels also pass through them. The incidence of cancer metastasis to the lungs is more than 60% of the total number of cases. Primary metastases are detected during diagnosis and are identified during plain radiography of the lungs. Secondary pathology is determined during surgical intervention associated with the need to remove a kidney affected by cancer. Symptoms of the development of metastases manifest themselves in different ways - cough, shortness of breath, pulmonary failure, bleeding. In most cases, the prognosis is unfavorable, since both organs are affected and surgery is impossible.

In the spine

Metastatic cancer can penetrate the bone structure, cerebrospinal fluid and spinal cord, affecting large nerve centers. The danger of the pathology lies in the loss of motor ability with the widespread spread of metastases. Initial symptoms are often associated with muscle weakness, numbness of the limbs, and periodic cramps. The most likely route of penetration of a malignant tumor into the spine is through the lymphatic system. Modern diagnostic methods make it possible to identify the initial stage, and then carry out complex therapy with a likely successful outcome. The prognosis depends on the location of the cancer foci in the spine; if large areas are affected, the life expectancy against the background of complete paralysis is no more than 1 year.

In the liver

Metastases from the kidney penetrate into the liver through the circulatory and lymphatic systems, and with extensive development of the initial focus, cases of tumor germination occur. Among all forms of metastasis, liver damage is in third place in terms of frequency of occurrence, but the prognosis with timely treatment is the most favorable. The symptoms resemble the course of chronic hepatitis or liver failure. A person is worried about yellowness of the skin, loss of appetite, weight loss, pain, a taste of bile in the mouth, and digestive disorders. The structure of the liver allows for extensive surgical interventions while maintaining functional ability.

In the skin

Clear cell cancer, which is diagnosed during a kidney examination, metastasizes to the skin, forming small focal lesions in the form of red stars, moles, rashes and other unusual skin lesions. Most often, metastases to the skin affect the face, abdomen and lower back, lower extremities, and scalp. Removal of single fragments is ineffective, so preference is given to complex treatment of kidney cancer with metastases to the skin using radiation techniques and chemotherapy.

Diagnosis of metastases

The danger of metastasis in the kidneys is that at this time their work is practically not disrupted, secondary foci do not manifest any symptoms. The picture of the disease is uncharacteristic; there are no risk groups and preventive measures. Diagnosis of these lesions occurs by chance or during testing for the presence of metastases.

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With extensive metastasis, in some cases hydronephrosis develops (can provoke kidney failure) and arterial hypertension (high blood pressure) due to compression of the ureter and blood vessels. Often the provoking factor of metastasis is fornical reflux. With increased blood pressure in the pelvis, all pathways for metastasis will open.

The success of therapy in all cases depends on a timely examination. Currently the following diagnostic methods are used:

Ultrasound or ultrasound sonography. The advantage of this technique is that it is highly informative, non-invasive, completely harmless and accessible. Using ultrasound, it is possible to assess the condition of the vena cava and renal veins and identify metastasis.
Biopsy. Taking a fragment of tissue from a specific organ for subsequent diagnostic purposes.
analysis . Allows you to detect changes that occur during a malfunction of the kidneys. The patient's blood protein, hemoglobin and red blood cells decrease.
CT. It is an x-ray method that allows one to diagnose the structure of the kidneys layer by layer. At this time, a contrast agent is injected into the patient’s vessels, visible on the image. Since the neoplasm contains many vessels, it is easy to identify it on a section.
MRI. It is also a layer-by-layer diagnostic method. It is generally accepted that growths in the kidneys are best seen directly during such an examination, since magnetic tomography clearly visualizes the soft tissue of the tumor.

After metastasis in the kidney is detected, the patient undergoes a full diagnosis, which is necessary to establish the original focus of the disease.

How to diagnose

Diagnosis of all forms of cancer requires a comprehensive examination:

Biopsy

Urine and blood tests reveal pathological abnormalities in the biochemical and structural composition; individual samples indicate the presence of specific markers.
Ultrasound diagnostics determines the primary focus and makes it possible to detect the presence of metastases.
Computer research methods provide a complete picture of the development and course of oncology.
A biopsy is performed to determine the form of the malignant tumor.

Based on the diagnostic results, a treatment plan is drawn up.

Embolization of arterial vessels

Insertion of a catheter into an artery located in the groin is used when it is impossible to carry out full operations, for example, in patients with severe cardiovascular diseases.

With the help of a catheter, the malignant tumor receives a special substance that disrupts its blood supply, which causes the death and destruction of tumor structures. When the patient's condition is stabilized, removal is performed - nephrectomy.

Features of therapy

A diagnosis of cancer several years ago was a death sentence. In modern medicine, thanks to new technologies and advances in treatment, treatment options for metastatic cancer are possible:

Removal of the primary lesion by surgery, followed by a course of radiation therapy to destroy malignant cells.
Targeted therapy with complex radiation, immunostimulating and chemotherapeutic effects.
Stimulation of natural immunity, increasing the activity of the body’s own defenses to fight pathological cells.

Traditional medicine methods and alternative remedies are ineffective for treating any form of cancer.

Forecast

If metastases are detected, the prognosis is unfavorable. If surgical treatment is performed, the patient’s life is extended by 5 years in slightly more than half of the cases. With metastases in the spine, despite the treatment, restrictions on motor activity remain, and life expectancy is extended by only one to one and a half years.

After radiotherapy, the probability of stopping the tumor process is one third of cases. With mild paralysis and paresis, it is possible to maintain motor activity after the use of radiation therapy.

Survival prognosis

Doctors involved in the treatment of oncological diseases prefer not to make predictions regarding further development. Much depends on the stage of the disease, the area of spread of metastases and the timeliness of the prescribed treatment. Patients are advised to prepare themselves for a long-term fight against the disease, stimulate their own defenses, follow the doctor’s recommendations, and get rid of negative thinking as much as possible. Scheduled inspections and implementation of the necessary procedures allow you to notice changes in time.

Prevention

The detection of distant metastases often indicates the neglect and inoperability of the tumor. To avoid their appearance, it is necessary to identify the tumor at an early stage, when it is possible to completely remove it and radically cure the disease.

In order to prevent a severe stage of the disease, it is necessary to visit the surgeon annually, examine the prostate through the rectum, periodically donate blood for the PSA tumor marker of prostate cancer and, if indicated, do an ultrasound examination of the prostate gland. These, albeit unpleasant, procedures must be completed annually for men over 40 years of age.

When is laparoscopic resection indicated?

For patients with stage T1 and T2 tumors (localized tumors that do not extend beyond the organ), surgery is an effective treatment, providing a five-year survival rate of approximately 95%.

Previously, resection for cancer was only indicated for patients with a solitary kidney, poor function of both kidneys, or bilateral cancer. All other patients underwent radical nephrectomy. However, since the 1990s, the indications for this procedure have expanded and partial nephrectomy has been approved for the treatment of patients with small tumors (T1 and T2).

Thus, laparoscopic resection is a breast-conserving surgical procedure approved for patients with a tumor no more than 4 cm in diameter. Although this operation is often used for large tumor sizes.

To date, the vast majority of studies have shown equivalent control in patients undergoing radical nephrectomy or partial nephrectomy.

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