Kidney cancer is not a common condition, but getting diagnosed more often now because of health screening. It can affect both men and women.
There are no clear risk factors for kidney cancer, although in some cases an increased risk for kidney cancer can be passed down through the genes.
In the early stages it does not cause any symptoms but later on it can cause pain, blood in the urine, anaemia and weight loss.
Ultrasound of the kidneys can show a mass suspicious of kidney cancer. CT scan of the kidneys is usually necessary to confirm the presence of the kidney cancer. A biopsy is usually not necessary unless the CT scan does not sufficient information. Ultimately, the final confirmation that the mass is a kidney cancer is by examination of the surgical specimen after surgical removal is performed.
CT scan showing a tumour in the right kidney
Kidney cancer has the tendency to spread to the lymph nodes and other organs such as the lungs. Once kidney cancer has been diagnosed, it is important to determine the extent or stage of the disease. This is important for prognosis and also to determine the type of treatment.
If the cancer is confined to the kidney, surgery is the best treatment. The surgical options are:
- Radical nephrectomy:
This procedure involves completely removing the affected kidney together with the fatty tissue covering it. Depending on the size of the tumour and complexity of the surgery, it is possible to perform this procedure laparoscopically (keyhole surgery) or by the traditional open method.
- Laparoscopic radical nephrectomy:
The surgery is performed using special instruments through small 1 cm incisions. A lower abdominal incision is made to extract the specimen, this incision can be hidden under the undergarments. Laparoscopic surgery is less painful and the recovery is faster compared to open surgery.
- Open radical nephrectomy
The surgery is performed through a large incision in the flank or upper abdomen. Usually this surgery is performed when the tumour is too large for the laparoscopic approach.
- Partial nephrectomy:
This procedure involves removing the tumour together with a small portion of the kidney around it. The rest of the kidney is preserved. This procedure is recommended for smaller kidney tumours only. It is technically more difficult than radical nephrectomy but as it avoids removing the entire kidney, the patient will do better in the long term in terms of overall health.
- Laparoscopic partial nephrectomy/Robotic assisted laparoscopic partial nephrectomy:
Performing partial nephrectomy through a laparoscopic approach reduces the amount of pain after surgery and gives faster recovery. However it is a technically demanding surgery and is best suited for small tumours which are not too deep-seated. The surgical robot makes it easier to perform the surgery.
- Open partial nephrectomy:
For tumours which are deep-seated within the kidney, this is preferred over laparoscopic partial nephrectomy.
Laparoscopic radical nephrectomy
Patient’s wounds after laparoscopic radical nephrectomy
Patient’s wound after open radical nephrectomy
Partial nephrectomy (image from Cancer Research UK)
This involves placing one or several needle probes into the kidney tumour. Once the probes are activated, the energy released within the probes destroys the tumour. This method is much less invasive compared to surgery, however there is a risk that the tumour will recur. This treatment is usually recommended for patients who are elderly or have medical problems that make them unfit for surgery.
This is an alternative approach for patients who are elderly and who have small incidentally detected kidney tumours. In some of these cases, the tumours are slow-growing and may not need treatment. The patients are followed up very closely and only treated if their tumours show signs of progression.
If the cancer has spread to the lymph nodes or distant organs, surgery alone is not sufficient. Additional medication may be needed to control the disease. A class of medications called tyrosine kinase inhibitors have been shown to control and shrink kidney cancer.