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Early Stage Kidney Cancer
Minimally Invasive Robotic Partial Nephrectomy
Open Partial Nephrectomy
Total Nephrectomy
Advanced Stage Kidney Cancer
Alternative Therapies
Kidney cancer is a common urologic malignancy. In fact, over 25,000 patients will be diagnosed with kidney cancer this year alone. Fortunately if detected early, before the cancer has spread, it is a highly curable disease.
Symptoms of kidney cancer can include blood in the urine, flank or abdominal pain, weight loss, and bony pain. Fortunately, because of the increased use of ultrasounds, CT scans, and MRIs in medical care, a significant number of these tumors are being diagnosed early before they have grown to larger sizes, before they become symptomatic and before they have had a chance to spread. The result of earlier detection of such tumors translates into better overall prognosis. In fact, the majority of patients with early stage kidney cancers are cured with surgery alone.
 ©2009 Intuitive Surgical, Inc.
Tumor shown growing from the side of a kidney.Staging of Kidney Cancers
Kidney cancer can be divided into two categories: Early stage or Advanced Stage. Early stage kidney cancer is defined by cancers that are limited to the kidney and its surrounding enveloping fat and tissue, but has not spread elsewhere in the body such as to the lymph nodes, liver or lungs. Early stage kidney cancers are highly curable and in most cases treatment can be achieved by surgery alone (without the need for chemotherapy or radiation). Advanced kidney cancers, however, are cancers that have spread beyond the kidney and have involved other structures such as the lymph nodes, liver, or the lungs. Advanced kidney cancers are less likely to be curable and have a more limited prognosis.
When a patient is diagnosed with a kidney cancer, your physician will determine if the tumor is an early stage or an advanced stage cancer by performing tests including blood work, and imaging evaluations including CT scans or MRI’s. With this approach, they can clearly locate the cancer and determine its extent of progression. The urologists at Comprehensive Urology are experts in the cancers of the urinary tract (Urologic Oncologic Surgeons) and can best determine the best course of therapy for each individual patient. Their goal is to offer the most advanced therapeutic modalities in order to offer the best cure rates while optimizing our patient’s quality of life.
Early Stage Kidney Cancer
Most early stage kidney cancer can be cured by surgical removal alone. Chemotherapy and radiation are typically not necessary and commonly are not effective. Traditionally, the entire kidney is removed surgically (total or radical nephrectomy) in order to remove the cancer. However, more recent studies have clearly shown that in most cases the entire kidney does not have to be removed. In fact, if the tumor is removed in its entirety while preserving the rest of the kidney that does not have cancer in it (termed partial nephrectomy), one can achieve the same excellent cure rates. The advantage of preserving the kidney is that our patients will have better kidney function long term and will have a much lower chance of developing kidney failure. Performing a partial nephrectomy is technically more challenging and is best performed by experienced urologists who have expertise in cancer operations (urologic oncological surgeons). Drs. Michel and Desai are urologic oncological surgeons who, after determining the size and location of the kidney cancer as well as the patient’s overall clinical status, will determine the candidacy of each patient to undergo a total or partial nephrectomy. In each case all efforts are made to perform a partial nephrectomy if suitable for the specific tumor and patient (not all patients or tumors are suitable for a partial nephrectomy procedure). Given that Dr. Desai and Dr. Michel are highly skilled minimally invasive surgeons (laparoscopic and robotic surgery), they can often perform such procedures with small incisions while utilizing the most advanced surgical tools and techniques.
The steps to performing a partial nephrectomy are similar regardless of the surgical approach. These include:
1. Exposing the kidney tumor
2. Controlling the blood vessels that supply blood flow to the tumor
3. Temporarily stopping blood flow to the area of the kidney where the tumor is located
4. Surgically removing the tumor
5. Reconstructing the kidney
6. Restoring blood flow to the kidney
Minimally Invasive Robotic Partial Nephrectomy
In suitable candidates, rather than making a large surgical incision, our surgeons can perform the partial nephrectomy by making a few small incisions and using specialized instruments utilizing the daVinci surgical system. To learn about robotic partial nephrectomy, click here. Patients who undergo robot assisted partial nephrectomy are typically in the hospital for 2 days and are able to return to most of their activities within 1-2 weeks. They are asked not to engage in heavy lifting or strenuous exercise for 4 weeks in order to allow their incisions and the kidney to heal well.
Open Partial Nephrectomy
In certain situations, minimally invasive robotic surgery is not a suitable option for patients. Given that Dr. Michel and Dr. Desai are well adept at both traditional open operations as well as minimally invasive robotic surgery, they can choose the best technique for individual patients. With the open operation, the surgery is often performed by making a flank incision and approaching the kidney by going between the ribs. This is a highly successful approach and affords great exposure to the kidney.
Patients who undergo an open partial nephrectomy are typically in the hospital for 3-5 days and are able to return to most of their normal activities within 2 weeks. They are asked not to engage in heavy lifting or exercise for approximately 4 weeks in order to allow their incision and the kidney to heal well. Excellent cancer cure rates and preservation of kidney function can be achieved with partial nephrectomy.
Total Nephrectomy
Sometimes the kidney cancer is so large that it has replaced most of the kidney; in other situations the cancer is located such that preserving the blood supply to the kidney is not possible. In such cases a partial nephrectomy cannot be performed. Instead, a total nephrectomy is performed whereby the entire kidney is removed with the cancer. Typically a total nephrectomy can be performed through a minimally invasive approach (laparoscopic or robotic nephrectomy), where several small incisions are used to perform the operation. At the end of the operation, one of the incisions is slightly lengthened to be able to remove the entire kidney from the body. Excellent cancer cure rates can be achieved with a total nephrectomy. Using a minimally invasive approach, our patients have less pain, shorter hospital stays, and quicker return to their daily activities.
Advanced Stage Kidney Cancer
Advanced stage kidney cancer are cancers that have spread beyond the kidney and have involved other structures such as the lymph nodes, liver, or the lungs. Advanced kidney cancers are less likely to be curable and have a more limited prognosis. Recent medical trials have shown more promise in the management of certain advanced kidney cancers, where surgical nephrectomy can be used in conjunction with medical treatments to help manage the disease. Our physicians at Comprehensive Urology work closely with the medical oncologist team in order to develop the optimal treatment plan for each individual.
Alternative therapies when surgery is not possible
There are certain situations when a person may not be healthy enough to be a good surgical candidate. These can include treatment to try to kill the tumor cells by freezing them (cryotherapy) or by heating and burning them (radiofrequency ablation). These techniques are performed by placing a needle into the tumor and treating them, rather than removing them. There is some promise as to the short term efficacy of these treatments, however there is very little data available regarding long term cancer control.
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