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Kidney cancer (also known as a malignant kidney tumor) is a common urologic malignancy. In fact, over 25,000 patients will be diagnosed in the U.S. with kidney cancer this year alone and the incidences seem to be on the rise. Fortunately, if detected early and before the cancer has spread, it is a highly curable disease. The most common type of kidney cancer is called Renal Cell Carcinoma or RCC.
Symptoms of kidney cancer can include blood in the urine, flank or abdominal pain, weight loss, and bone pain. Most commonly, some kidney cancers have no symptoms. Fortunately, due to the increased use of imaging techniques (ultrasounds, CT scans, and MRIs) in medical care, a significant number of these tumors are being diagnosed by chance before they have grown to larger sizes, and before they have had a chance to spread to other places. The result of earlier detection of such tumors translates into much better overall prognosis and high chance of a cure. In fact, the majority of patients with early stage kidney cancers are CURED with surgery alone.
Staging of Kidney Cancers
Kidney cancer can be divided into two categories: Early stage or Advanced Stage. Early stage kidney cancer are limited to the kidney and its surrounding enveloping fatty tissue but has not spread elsewhere in the body such as to the lymph nodes or other organs such as the liver or the lungs. Early stage kidney cancers are highly curable and, in most cases, this 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 was removed surgically (total or radical nephrectomy) in order to remove the cancer.
However, more recent studies have clearly shown that in most cases (depending on the size and location of the tumor in the kidney) the entire kidney does not have to be removed. In fact, if the tumor is removed in its entirety along with a small margin of kidney tissue while preserving the rest of the kidney that does not have cancer in it (partial nephrectomy), one can achieve the same excellent cure rates.
The advantage of preserving the rest of the kidney is that our patients will have better kidney function long term and will have a much lower chance of developing kidney failure.
The steps to performing a partial nephrectomy
1. Exposing the kidney tumor
2. Controlling the blood vessels that supply blood flow to the kidney
3. 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
Performing a partial nephrectomy is technically more challenging and is best performed by experienced urologists who have expertise in cancer operations (urologic oncological surgeons).
Our urologists will determine the size and location of the kidney tumor as well as the patient’s overall clinical status, and then will assess 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 (remember, not all patients or tumors are suitable for a partial nephrectomy procedure). Given that our urologists are highly skilled minimally invasive surgeons (i.e. laparoscopic and robotic surgery) such procedures can often be performed with small incisions while utilizing the most advanced surgical tools and techniques to provide the best outcomes for our patients with the least amount of discomfort and risk.
Kidney Cancer Treatment
At Comprehensive Urology, we employ a variety of treatment options when dealing with kidney cancer. Depending on the stage and grade of the cancer, our doctors have many options when determining the proper course of treatment for kidney cancer.
In most cases, kidney cancer treatment consists of the surgical removal of the kidney. When the whole kidney is removed, the process is referred to as a radical nephrectomy. However, recent studies have shown that partial nephrectomies (in which only the tumor and a small margin of the healthy kidney is removed) are equally, effective when treating kidney cancer.
Minimally Invasive Robotic Partial Nephrectomy
In suitable candidates, rather than making a large surgical incision, a kidney cancer surgeon can perform the partial nephrectomy by making a few small incisions and using specialized instruments utilizing the daVinci surgical system. 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 who need a kidney tumor removal. Given that our surgeons are well adept at both traditional open operations as well as minimally invasive robotic surgery, we 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 lower 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.
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 radical nephrectomy is performed whereby the entire kidney is removed along with the tumor. Typically a radical 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 allow the removal of the entire kidney from the body. Excellent cancer cure rates can be achieved with a radical 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 indicates that the cancer has spread beyond the kidney and has 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 that even with metastic kidney cancer, removing the main kidney tumor to decrease the overall burden of disease (i.e. “cytoreductive nephrectomy” followed by medical treatments (chemotherapy, etc.) will result in better outcomes and survival for the patient. Our physicians at Comprehensive Urology work closely with the medical oncology doctors in order to develop the optimal treatment plan for each individual.
There are certain situations when a person may not be healthy enough to be a good surgical candidate. In such cases, or even in healthy adults with a small tumor, percutaneous ablation techniques can be helpful and provide a cure. These can include killing the tumors by freezing them via a prove inserted through a small incision in the skin (cryotherapy/cryoablation) or by heating and burning the tumor with a different probe (radiofrequency thermal ablation). The literal meaning of the term “percutaneous” means “through the skin.” This procedure does not involve large incisions. Rather, large needles (probes) are precisely placed through the skin and into the tumor with the help of imaging devices, such as a CT scanner, MRI or ultrasound targeting. Since this is a very particular procedure, only some forms of kidney cancer are treatable through this method. For instance, if the cancer is located too close to the body structures, such as the bowel or ureter, percutaneaous ablation is not recommended as it may damage nearby organs
These techniques are performed by placing a needle into the tumor and ablating them after a biopsy, rather than removing the entire kidney by surgery. There is some promise as to the short-term efficacy of these treatments; however, there is little data available regarding long-term cancer control.