What are the other Names for this Condition? (Also known as/Synonyms)

• Adenocarcinoma of Kidney Pelvis
• ARP (Adenocarcinoma of Renal Pelvis)

What is Adenocarcinoma of Renal Pelvis? (Definition/Background Information)

• Adenocarcinoma of Renal Pelvis (ARP) is a rare type of renal cell carcinoma (kidney cancer) that develops from the renal pelvis. It is a malignant tumor that develops due to an abnormality within the tissue lining in the pelvis of the kidney
• Majority of the tumors arising from the lining of the renal pelvis are non-adenocarcinomas. ARP arises from the urothelial lining showing gland formation. Most of the cancers occurring in the lining of kidney pelvis and urinary bladder are transitional cell carcinomas
• The exact cause for the development of Adenocarcinoma of Renal Pelvis is presently unknown. It generally affects older adult males and females. The tumor can occur in the ureter and urinary bladder also
• The risk factors are also not well-established, but Adenocarcinoma of Renal Pelvis may be associated with kidney stones and hydronephrosis due to chronic inflammation. However, in general, the risk factors for kidney cancer includes smoking, exposure to toxins, high blood pressure, and obesity
• The typical signs and symptoms of Adenocarcinoma of Renal Pelvis may include blood in urine, a lump on the side of the abdomen, flank pain, unexplained fever, and unexplained weight loss. ARP may result in complications, such as spreading of cancer to other parts of the body
• The treatment options include surgery, radiation therapy, chemotherapy, and targeted drug therapy. The prognosis of Adenocarcinoma of Renal Pelvis depends on the type and size of the tumor, whether it is localized in the kidney or has metastasized to other regions, and most importantly, if ARP is in its early or advance stages, at the time of diagnosis
• Although Adenocarcinoma of Renal Pelvis might not be preventable, being aware of one’s family history and having regular medical check-ups may help diagnose the condition early. Leading a healthy lifestyle, managing an ideal body weight, controlling blood pressure, avoiding unnecessary medication, and smoking cessation can potentially help one avoid cancer formation

The main types of kidney cancers include:

• Clear cell renal cell carcinoma: This is also called conventional renal cell carcinoma. 65% of all renal cancers belong to this type
• Papillary renal cell carcinoma (PRCC): It is also called chromophil renal cell carcinoma. It constitutes 15% of all renal cancers. Some of these cancers can be seen in syndromes such as hereditary papillary renal cell carcinoma syndrome. A majority of individuals with PRCC, do not have a family history of kidney cancer
• Chromophobe renal cell carcinoma: They make up for 5% of the renal cancers. Usually, it is a slower-growing cancer when compared to other kidney cancers
• Collecting duct carcinoma of kidney: They make up for approximately 1% of the kidney cancers. The cancer arises from the collecting ducts of the kidney

There are histologically 3 types of ARP and these include:

• Mucinous Adenocarcinoma of Renal Pelvis
• Non-Mucinous Adenocarcinoma of Renal Pelvis
• Clear Cell Adenocarcinoma of Renal Pelvis

Who gets Adenocarcinoma of Renal Pelvis? (Age and Sex Distribution)

• Most Adenocarcinoma of Renal Pelvis cases occur in individuals who are older than 60 years
• ARP affects both men and women, and the cancer is not specific to any ethnic or racial group
• Adenocarcinoma of Renal Pelvis occurs in less than 1% of the kidney cancer cases and is an uncommon cancer type

What are the Risk Factors for Adenocarcinoma of Renal Pelvis? (Predisposing Factors)

In a majority of individuals, no clear-cut risk factors for Adenocarcinoma of Renal Pelvis have been established to date. However, ARP may be associated with the following conditions:

• The presence of kidney stones
• Pyelitis glandularis (pyelitis cystica) or inflammation of the renal pelvis
• Hydronephrosis due to chronic inflammation

Some studies have shown that the following factors may predispose an individual to kidney cancer development:

• Family history of kidney cancer: If the cancer is present among close family members, then the risk of developing the cancer is increased
• Obesity
• High blood pressure
• Smoking
• Exposure to toxins, such as naphthylamine dye, asbestos, lead, polycyclic aromatic hydrocarbons, cadmium, and other chemical compounds
• Continuous use of certain medications such as non-steroidal anti-inflammatory drugs (NSAIDs)
• Long-term dialysis

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one’s chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your health care provider.

What are the Causes of Adenocarcinoma of Renal Pelvis? (Etiology)

Currently, scientists do not know the definitive factor(s) causing Adenocarcinoma of Renal Pelvis.

• In general, it is known that cancers and tumors form when normal, healthy cells begin transforming into abnormal cells - these cancer cells grow and divide uncontrollably (and lose their ability to die), resulting in the formation of a mass or a tumor
• The transformation of normally healthy cells into cancerous cells may be the result of genetic mutations. Mutations allow the cancer cells to grow and multiply uncontrollably to form new cancer cells
• These tumors can invade nearby tissues and adjoining body organs, and even metastasize and spread to other regions of the body

What are the Signs and Symptoms of Adenocarcinoma of Renal Pelvis?

The signs and symptoms of Adenocarcinoma of Renal Pelvis may include the following:

• Small tumors usually do not cause any symptoms. But, occasionally they may become painful, if they compress the surrounding structure
• Blood in the urine (hematuria)
• Fatigue
• A visible lump may be seen on the side of the abdomen
• Flank pain
• Fluid accumulation in the lower legs (pedal edema)
• Night sweats, unexplained fever
• Unexplained weight loss
• Abnormal liver function test
• If the tumor is associated with paraneoplastic syndrome; then, the following may be noted:
  • Increased blood pressure (hypertension)
  • Increased calcium in blood (hypercalcemia)
  • Increased red blood cells (erythrocytosis)
  • Increased platelets (thrombocytosis)

The signs and symptoms may depend on the size of the kidney tumor.

How is Adenocarcinoma of Renal Pelvis Diagnosed?

A healthcare provider might employ one or several of the following tools to diagnose Adenocarcinoma of Renal Pelvis:

• Evaluation of the patient’s personal and family medical history
• A complete physical examination
• Blood tests such as complete blood count (CBC), serum calcium, serum albumin, liver function test (LFTs)
• Urine analysis such as albumin levels
• Plain X-ray of the abdomen
• Ultrasound scan of the abdomen
• Computed tomography (CT) scans of the kidneys
• Magnetic resonance imaging (MRI) and positron emission tomography (PET) scans may help differentiate between benign versus malignant tumors by detecting areas of metastasis (if any)

Although the above modalities can be used to make the initial diagnosis, a tissue biopsy of the tumor may be required to make a definitive diagnosis to begin treatment.

• The tissue for diagnosis can be procured in multiple different ways, and they include:
  • Fine needle aspiration (FNA) biopsy of the tumor: A FNA biopsy may not be helpful, because one may not be able to visualize the different morphological areas of the tumor. Hence, a FNA biopsy as a diagnostic tool has certain limitations, and an open surgical biopsy is preferred
  • Core biopsy of the tumor
  • Open biopsy of the tumor
• A tissue biopsy of the tumor is performed and sent to a laboratory for a pathological examination. A pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. Examination of the biopsy under a microscope by a pathologist is considered to be gold standard in arriving at a conclusive diagnosis
• Biopsy specimens are studied initially using Hematoxylin and Eosin staining. The pathologist then decides on additional studies depending on the clinical situation.
• Sometimes, the pathologist may perform special studies, which may include immunohistochemical stains, molecular testing, and very rarely electron microscopic studies to assist in the diagnosis.

Note: On examination of the tumor under the microscope by a pathologist, Adenocarcinoma of Renal Pelvis can be of mucinous, non-mucinous, or clear cell histological type.

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Adenocarcinoma of Renal Pelvis?

The complications associated with Adenocarcinoma of Renal Pelvis may include:

• Metastasis: The cancer can spread to other areas of the body
• Recurrence of the tumor due to its partial or incomplete surgical removal
• Complications due to surgery
• Side effects of chemotherapy (such as toxicity) and radiation

How is Adenocarcinoma of Renal Pelvis Treated?

The treatment measures for Adenocarcinoma of Renal Pelvis may include the following:

• Surgery:
  • In majority of individuals, surgical resection of the tumor with clear margins may result in a cure, especially if the tumor is confined to the kidney. In some cases, due to location of the tumor, a complete surgical removal may be difficult
  • Several different surgical procedures may be available, such as partial/radical nephrectomy or laparoscopic surgery, depending on the type, size, and location of the tumor
  • Post-operative care is important: One must maintain minimum activity levels, until the surgical wound heals
• Radiation therapy:
  • The tumor may respond well to radiation treatment
  • Radiotherapy can be used as primary therapy in situations where the tumor cannot be removed completely, or when the tumor reappears (recurrent Adenocarcinoma of Renal Pelvis) after surgery
  • Radiotherapy can also be used as an additional therapy after surgery, if there is a possibility of tumor recurrence after surgery, or if there are inadequate margins following surgery (possibility of tumor left behind)
• Chemotherapy can be used for treating Adenocarcinoma of Renal Pelvis under the following circumstances:
  • The tumor cannot be removed completely (incomplete surgical resection)
  • Tumors that recur after surgery (recurrent ARP)
  • Tumors that have spread to distant parts of the body (metastatic ARP)
• Immunotherapy for Adenocarcinoma of Renal Pelvis: A patient’s immune system is activated to combat the cancer in this kind of therapy
• Targeted drug therapy for Adenocarcinoma of Renal Pelvis: This kind of drug treatment targets and kills cancer cells specifically, while not harming the surrounding normal/healthy cells
• Arterial embolization of Adenocarcinoma of Renal Pelvis is a possible treatment option. Here the blood supply to the tumor is blocked resulting in tumor death

A long-term follow-up is required, because recurrence of the tumor at the site of surgery, or metastasis in distant sites have been reported many years after surgery.

How can Adenocarcinoma of Renal Pelvis be Prevented?

Current medical research has not established a method of preventing Adenocarcinoma of Renal Pelvis.

• Regular health check-ups might help those individuals with a history of the condition in the immediate family and help diagnose ARP early
• Regular medical screening at periodic intervals with blood tests, radiological scans, and physical examinations for those who have already endured the tumor are helpful

In general, preventive methods for Adenocarcinoma of Renal Pelvis may include reducing contributory risk factors, such as:

• Smoking
• Unhealthy diet and lifestyle
• Obesity
• Exposure to toxins
• Unnecessary medication

What is the prognosis of Adenocarcinoma of Renal Pelvis? (Outcomes/Resolutions)

The prognosis of Adenocarcinoma of Renal Pelvis depends on the size and number of tumors, their localization, and spread. In general, the prognosis is poor, since many have metastasis at the time of diagnosis.

• The most reliable prognostic factor of ARP is dependent on whether the tumor can be completely removed through surgery with free margins or not (no traces of the tumor in adjoining tissue)
• The prognosis also depends upon a set of several factors, which include:
  • Stage of tumor: with lower-stage tumors, when the tumor is confined to site of origin, the prognosis is usually excellent with appropriate therapy. In higher-stage tumors, such as tumors with metastasis, the prognosis is poor
  • The surgical respectability of the tumor (meaning, if the tumor can be removed completely)
  • Overall health of the individual. Individuals with overall excellent health have better prognosis compared with those with poor health
  • Age of the individual. Older individuals generally have poorer prognosis than younger individuals
  • Whether the tumor is occurring for the first time, or is a recurrent tumor. Recurring tumors have worse prognosis compared to tumors that do not recur
  • Response to treatment. Tumors that respond to treatment have better prognosis compared to tumors that do not respond to treatment
  • When ARP is diagnosed in the initial stages, the possibility of survival increases and the prognosis is considered good with treatment
  • In cases where both kidneys are affected, the prognosis is not projected to be favorable. Additionally, if the cancer has spread to other parts of the body, such as to the liver, lungs, or bone, the possibility of prolonged survival following diagnosis is limited

As with any tumor, it is important to have follow-up appointments with a physician to monitor for any returning tumors.

Additional and Relevant Useful Information for Adenocarcinoma of Renal Pelvis:

Please visit our Cancer & Benign Tumors Health Center for more physician-approved health information:

http://www.dovemed.com/diseases-conditions/cancer/