The simplest division of tumors of the kidney is into benign and malignant. The benign are again, divided into fibroma, lipoma, lymphadenoma, angionoma, and adenoma. These grow in the cortex of the kidney, forming small nodular masses, and unless they become very large, an exception, they do not produce any definite symptoms. They may be congenital or develop later in life.
The malignant tumors are sarcoma and carcinoma, and may be primary or secondary. While sarcoma may occur in the adult, it is more frequently found in young children, often being congenital. The most common form is the small-celled variety, while a rare form, and one generally congenital, is a mixture of sarcoma and striped muscular fiber, the rhabdomyoma.
Sarcomas develop very rapidly, are vascular, and may attain large size, almost filling the abdomen.
Carcinoma is not so common as sarcoma, and generally is found in the adult, though it may occur in children. It is usually soft, encephaloid, and may reach an enormous development. Primary cancer rarely occurs in early life, and is more common in males than in females. Heredity is a strong predisposing cause.
Secondary carcinoma is found in connection with cancer of the testicle, rectum, uterus, stomach, or liver.
Symptoms.—The characteristic symptoms are pain, hematuria, cancerous cachexia, and the presence of the tumor mass.
Pain is not always present, and therefore more or less uncertain as a diagnostic aid. When present, it is located in the affected flank, and extends down the ureter and along the inner side of the thigh. It may be more or less constant, of a dragging character, or occur at intervals, and be sharp and lancinating. Hemorrhage occurs in about half the cases, and though it is usually but small in quantity, it may be severe and exhausting. At times it will be in clots, there will be casts of the pelvis of the kidney and ureter, and when thus passed are characteristic of a malignant tumor; often, however, they are mixed with the urine and perfectly soluble.
Where the hemorrhage is large, anemia rapidly develops. As long as the tumor retains the position and outline of the kidney it is an important symptom; but as it leaves the flank and encroaches upon the abdomen, and adhesions form, it may be impossible to distinguish it from other tumors of the abdomen, though the cancerous cachexia would help in the differential diagnosis. As the disease advances, the appetite fails, nausea and vomiting are frequently present, and the emaciation becomes marked.
Diagnosis.—The diagnosis will be made by the symptoms already given,—pain, hemorrhage, cachexia, and the presence of a tumor mass, being the most pronounced.
Prognosis.—The prognosis is almost always unfavorable, the rare cases of recovery being where an early and successful nephrectomy has been performed. The duration of the disease is from a few weeks in congenital cases, to a few years in the adult.
Treatment.—While we have no specifics for malignant growths, there are two remedies that should be given persistently, with the hope of at least staying somewhat the destructive character of the disease. They are echinacea and hydrastis. When severe, the pain will be controlled by morphia. Extirpation may prolong life if resorted to early, though the diagnosis is usually only made after the system has become so thoroughly infected with the malignant poison, that successful nephrectomies are very rare.
The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.