KIDNEY CANCER

A type of cancer that starts in kidneys is called kidney cancer. It can occur in people of all ages. The most common type of cancerous growths in kidneys is called renal cell carcinoma. Kidney cancer symptoms rarely appear on early stages letting the tumor grow unnoticed. Kidney cancer treatment usually starts with a surgery (e.g. nephron sparing surgery) followed by some other options (radiation, targeted therapy), if needed. Below we are going to review this condition, its symptoms, diagnostic services and kidney cancer treatment options in more detail.

The kidneys are two bean-shaped organs that are each about the size of your fist. They are located on either sides of your spine behind your abdominal organs. The kidneys play an important role in helping to remove waste products from your body.
Kidney cancer means there is an uncontrolled growth of abnormal cells within the kidneys.

KIDNEY CANCER SYMPTOMS

In the early stages of kidney cancer, there are rarely any signs or symptoms. However, in the later stages, these signs and symptoms may appear:

  • Presence of blood in urine (may be pink, red or cola coloured)
  • Constant pain in the back just below the ribs
  • Weight loss
  • Fatigue
  • Intermittent fever

KIDNEY CANCER TREATMENT OPTIONS

Your doctor may recommend treatment if you have experienced any of the signs and symptoms mentioned above. Treatment options include:

Laparoscopic Surgery (Keyhole Surgery)

This approach is minimally invasive where surgery on the affected kidney is performed through small incisions (less than 1.5m) in the abdominal cavity using specialized instruments and a video camera system instead of large incisions. In most cases, keyhole surgery is always preferred as there are more advantages compared to conventional open kidney surgery. Patient experience less pain after the surgery and less intraoperative bleeding, shorter hospital stay and they are able to return to work and normal activities sooner. On the other hand, many patients complain about chronic pain or numbness overlarge incisions in open surgery.

Having that said, keyhole surgery may not always be the best approach in certain rare cases. For example:

  • Patients who have very large or locally advanced kidney cancer
  • Patients who become very sick from severe kidney infection with haemodynamic instability
  • Unstable patients with life-threatening trauma to the kidneys and abdominal organs causing constant bleeding.

Nephron Sparing Surgery (NSS)

This procedure is normally preferred to radical nephrectomy where the entire kidney has to be removed. Several studies have shown that NSS patients live longer and have significantly lower risks of developing hypertension ischaemic heart disease or strokes in the long-run compared to patients who had their entire kidney removed.

Surgery that is minimally invasive, with or without robotic instrumentations provides more advantages over traditional open surgery. Small incisions mean that there is less pain, quicker recovery; shorter hospital stay and you will be able to return to daily activities much faster. Patients who have undergone open surgery complain of chronic pain or numbness over the large incision.

NSS involves:

  • Tumor identification in affected kidney
  • Clamping of the blood vessels, which supply the affected kidney to minimize bleeding
  • Tumor removal with a 1cm-rim of healthy tissue around it to avoid leaving any cancer cells behind
  • Closing the defect left in the kidney tissue
  • Removal of clamps in the blood vessels and checking for bleeding before closing up

It may be performed in three different approaches:

  • Traditional open surgery: This involves a fifteen to twenty cm incision in your abdomen or flank
  • Laparoscopic surgery: Performed through small incisions in your abdomen
  • Robotic surgery: Tumour removal and sew up in the affected kidney are performed with the da Vinci® surgical robot.

Minimising the clamp time on the vessels to the kidney is a surgical challenge in NSS. The longer the clamp time is needed, the longer the kidneys are starved of oxygen that results in occurrence of warm ischaemia. Irreversible loss of kidney function has been found to be associated with warm ischaemic clamp times of longer than thirty minutes.

The da Vinci® robot gives surgeons enhanced clarity of vision and dexterity to achieve the same goals of tumor removal and kidney reconstruction and at the same times helps to significantly reduce the clamp time and incidences of post-operative complications compared to conventional laparoscopic instruments. A few published studies have now validated the superior results from the robotic approach over laparoscopic and open surgery.

Hand Assisted Laparoscopy

This is a variation of the standard laparoscopic surgery. Air is pumped into the peritoneal cavity to allow the surgeon’s hand into the operative field.

Radiotherapy

This kidney cancer treatment option involves usage of radiation to target or destroy malignant cells. In most cases, radiotherapy is not able to cure kidney cancer, but it can slow down the progress of the disease and help control the symptoms. This option may be recommended to those who have advanced kidney cancer that has spread to other parts of the body (bones or brain).

During the treatment, a large machine directs a carefully aimed beam of radiation at the tumor area. A course of radiotherapy usually takes up to several weeks with daily administration of small doses of radiation.

Side effects of radiotherapy can include:

  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin in the treatment area

Targeted therapy

The aim of targeted therapy treatment is to block the specific abnormal signals to kidney cancer cells, which allow them to grow and multiply. These drugs are used to treat kidney cancer that has already spread beyond a kidney itself and to other parts of the body. The group of targeted drugs includes: cabozantinib (CaboMetyx), axitinib (Inlyta), bevacizumab (Avastin), pazopanib (Votrient), sorafenib (Nexavar) and sunitinib (Sutent). They aim to block the signals, which induce the growth of blood vessels that nourish cancer cells and allow them to spread. The other two – Temsirolimus (Torisel) and everolimus (Afinitor) are targeted drugs that prevent cancer cells from growing and don’t allow them to survive. The only disadvantage of the targeted therapy is that it does not work for every case of kidney cancer, only tumors with specific genes may respond to treatment.

DIAGNOSING KIDNEY CANCER

  • Ultrasound: Sound waves are used to create an image of the internal organs to determine if the cancer has spread to other organs and parts of the body.
  • CT scan: A three dimensional picture of the inside of your body is created using X-rays snapped at different angles. A special dye called contrast medium is sometimes administered before a scan to produce better detail on the image. This dye is injected or given as a pill to swallow.
  • MRI scan: Images of your organs and structures inside of your body are made using powerful magnets and radio waves.
  • CT urogram: This imaging exam examines the urinary tract, including the kidneys, bladder and ureters (tubes that connect the kidneys to the bladder).