Pathophysiology
- Renal cell carcinoma (RCC): Arises from epithelial cells of renal tubules. Accounts for 80-90% of kidney cancers. Notably resistant to traditional chemotherapy and radiation
- Bladder cancer: 90% are transitional cell (urothelial) carcinoma of the superficial epithelium
- Renal metastatic pathways: Readily metastasizes to lungs, bones, and liver
- Bladder metastatic pathways: Spreads to rectum, pelvic lymph nodes, and bones
- Gerota fascia: Dense connective tissue enclosing kidneys. Staging depends on whether growth has penetrated this fascia
- The classic renal "silent triad" (hematuria, flank pain, palpable mass) is actually an indicator of advanced disease, found in only ~10% of cases
Signs and Symptoms
Hallmark Indicators
- Painless hematuria (most dependable early sign of bladder cancer)
- Visibly red or rust-colored urine
- Unintended weight loss, persistent fatigue, low-grade fever
- Palpable mass in flank or abdomen (advanced kidney cancer)
- Deep, aching bone pain in pelvis or spine (indicates metastasis)
- Persistent urgency, frequency, or dysuria (bladder irritability)
Red Flags and Rule-Outs
- Painless hematuria: Most dependable early sign of bladder cancer — immediate referral
- Classic renal "silent triad" (hematuria, flank pain, palpable mass): Indicates advanced disease
- Murphy's percussion: Back/flank pain elicited by percussive thump over costovertebral angle differentiates renal from MSK back pain
- Deep bone pain in pelvis or spine: Indicates metastatic spread with fracture risk
- Many kidney cancers are discovered incidentally during imaging for other reasons
MT Considerations
- Goal: Palliative care to alleviate pain, anxiety, nausea, and depression
- Medical equipment: Be mindful of catheters, dialysis ports, and stomas
- Bone fragility: If metastasis is present, conservative pressure to avoid pathologic fractures
- Renal compromise: Avoid vigorous circulatory massage for clients with significant renal loss
- Analgesic masking: Conservative pressure if client is on strong analgesics
- Hand-Foot Syndrome: Some aggressive renal cancer drugs cause redness, peeling, and sensitivity on palms and soles. Massage to these areas must be avoided or highly modified
- Lymphedema risk: Pelvic lymph node removal during bladder cancer surgery creates lifelong lower extremity lymphedema risk
- Treatment side effects: See chemotherapy and radiation-therapy
CMTO Exam Relevance
- Painless hematuria is the most dependable early sign of bladder cancer
- The classic renal "silent triad" actually indicates advanced disease
- Murphy's percussion differentiates renal from MSK back pain
- RCC is notably resistant to traditional chemotherapy and radiation
- Gerota fascia penetration is a key staging criterion for renal cancer
Key Takeaways
- Painless hematuria is the most dependable early sign of bladder cancer. The classic renal "silent triad" indicates advanced disease
- Cigarette smoking is a major risk factor for both kidney and bladder cancers
- RCC is notably resistant to traditional chemotherapy and radiation. Surgery is the primary treatment
- Murphy's percussion differentiates renal pathology from MSK back pain
- Watch for Hand-Foot Syndrome from renal cancer drugs and accommodate medical devices