Kidney cancer begins in the cells of the kidney and can spread to other parts of the body if not treated promptly. The most common type is renal cell carcinoma (RCC), accounting for about 90% of all kidney cancer cases. Other less common types include transitional cell carcinoma and Wilms tumor, which primarily affects children.
Kidney cancer exhibits several differences between men and women in terms of incidence, risk factors, and biological characteristics. Here are some key differences:
INCIDENCE OF KIDNEY CANCER
Higher Incidence in Men:
Men are twice as likely to develop kidney cancer compared to women. This disparity is partly attributed to lifestyle factors like higher rates of smoking and occupational exposure to toxins, as well as biological differences such as hormonal influences. Men also tend to present with larger tumors and more advanced disease at diagnosis, which may contribute to poorer outcomes.
Lower Incidence but Worse Prognosis in Women:
Although women have a lower incidence of kidney cancer, they often experience worse outcomes due to delayed diagnosis or more aggressive tumor biology at later stages34. Hormonal fluctuations during pregnancy or menopause may also play a role in tumor progression6.
KEY RISK FACTORS AND GENDER-SPECIFIC IMPACTS
1) Hormonal Differences:
Men: Higher levels of testosterone may contribute to faster kidney function decline and increased tumor growth. The lack of protective estrogen, which is higher in premenopausal women, may also increase men’s susceptibility to kidney cancer.
Women: Estrogen appears to have a protective effect against kidney cancer. However, after menopause, the risk increases due to declining estrogen levels. Pregnancy-related conditions like preeclampsia can also elevate the risk of chronic kidney disease (CKD), which is a precursor for kidney cancer.
2) Smoking:
Smoking is a major risk factor for kidney cancer in both genders but has a stronger association with men due to historically higher smoking rates among males. Women smokers may still face significant risks due to biological differences in how their bodies process carcinogens.
3) Obesity:
In men, obesity is linked to increased insulin resistance and chronic inflammation. In women, obesity-related hormonal imbalances (e.g., elevated estrogen) contribute more significantly.
4) Hypertension:
Men: Men with hypertension are more likely to develop aggressive forms of kidney cancer due to chronic renal damage caused by high blood pressure.
Women: Women with hypertension may experience delayed onset but are still at risk, especially if hypertension occurs during pregnancy (e.g., preeclampsia).
5) Occupational Exposures:
Men are more likely to work in industries with exposure to carcinogens like cadmium or asbestos, increasing their risk of kidney cancer.
TUMOR BIOLOGY AND GENDER-BASED DIFFERENCES
Tumor Characteristics:
- Men tend to have larger tumors with higher grades and stages at the time of diagnosis compared to women.
- Women’s tumors often show distinct hormonal receptor expressions that could influence treatment responses.
Immune Response:
- Men often exhibit weaker immune responses against tumors.
- Women’s immune systems are generally more active but can sometimes lead to autoimmune complications during treatment.
HYPERTENSION AND KIDNEY CANCER RISK
Risk Increase:
Men: Studies show that men with hypertension have a higher risk of kidney cancer, with a relative risk (RR) of approximately 1.29 compared to those without hypertension.
Women: Women also experience an increased risk, but it is higher than in men, with an relative risk (RR) of about 1.63. This suggests that hypertension may have a more pronounced effect on kidney cancer risk in women.
Dose-Dependent Relationship:
Both men and women experience a dose-dependent increase in kidney cancer risk with higher systolic and diastolic blood pressure levels. For every 10 mmHg increase in systolic blood pressure, there is a 5% higher risk of kidney cancer, and for diastolic blood pressure, a 7% higher risk.
OUTCOMES AND SURVIVAL RATES
Men:
Men generally have worse survival rates due to more aggressive disease presentation and lifestyle factors like smoking and poor diet. They are also more likely to undergo dialysis or kidney transplants earlier than women if CKD progresses rapidly.
Women:
Women diagnosed at later stages face poorer outcomes despite having smaller tumors on average. This could be due to delays in diagnosis or differences in tumor biology that make treatment less effective in advanced cases.
PREVENTION STRATEGIES FOR MEN AND WOMEN
For Men:
1) Quit smoking and limit exposure to occupational carcinogens.
2) Manage hypertension through regular check-ups and lifestyle changes.
3) Maintain a healthy weight through diet and exercise.
For Women:
1) Treat urinary tract infections promptly to prevent long-term kidney damage.
2) Monitor blood pressure closely during pregnancy.
3) Post-menopausal women should discuss hormone replacement therapy (HRT) risks with their healthcare providers.
CONCLUSION:
Kidney cancer affects men and women differently, yet both face significant risks that demand urgent attention. Dr. M.G. Giriyappagoudar, a senior radiation oncologist of North Karnataka and head of TumorBoard.Care emphasizes that men are more prone due to smoking, occupational exposures, and aggressive tumor growth, while women may experience delayed diagnosis and hormonal influences post-menopause. The differences in risk factors, tumor biology, and survival rates highlight the need for gender-specific prevention and early detection strategies. Quitting smoking, managing hypertension, and maintaining a healthy lifestyle are essential for both men and women. Raising awareness, timely screenings, and proactive medical care can significantly reduce the burden of kidney cancer in both genders.
DR. M G GIRIYAPPAGOUDAR
DMRT, MDRT (CMC Vellore, TN)
Consultant Radiation Oncologist, Hubli