Kidney Cancer

Kidney Cancer

Kidney tumours may be benign or malignant. The most common types of malignant kidney tumours are renal cell cancers or transitional cell carcinomas. There are several types of benign tumours including oncocytoma and angiomyolipomas. About 80% of kidney tumours are malignant.

The kidneys primary function is to filter the blood to produce urine which is composed of water, mineral salts and waste products with a secondary function to produce the hormone erythropoietin which helps to produce red blood cells.

Renal cell cancers are also known as renal cell carcinoma or renal adenocarcinoma. These are the most common type of kidney cancers and make up about 90% of all malignant kidney tumours.

Transitional cell carcinomas arise from the tubules draining the urine from the kidney to the bladder. These are most commonly associated with smoking.

A/Prof Peter Royce and Mr Dennis King perform the treatments for kidney cancer below at Cabrini Hospital Malvern and Epworth Eastern Hospital Box Hill, Melbourne Australia.

How Does It Spread ?

Kidney cancers may either spread locally through the kidney capsule into surrounding fat and adjacent structures or into the renal vein. They can also metastasize away from the kidney to the lungs, liver, bone, lymph nodes, adrenal gland and the opposite kidney.

Assessment of a kidney mass is performed with a variety of tests including blood tests and radiology (x-rays) that help to determine whether the mass is likely to be cancerous and whether there is evidence of spread.

CT scanning is the primary technique of examining the kidney mass and determining whether there is any evidence of spread.

Ultrasound is a noninvasive tests that gives information as to whether a renal mass is solid (more likely to represent a cancer) or cystic (unlikely to represent a cancer).

Bone scans are a nuclear medicine scan which are used to determine whether there is spread to bones.

Up to 20% of renal masses may be benign rather than malignant tumours. This can be difficult to determine preoperatively and in select situations a biopsy of the renal mass may be performed. However this is a controversial area as there may be inaccuracies in the sample taken or it is not always possible to be sure of the diagnosis and there are potential complications from a biopsy.

What Are The Symptoms ?

Kidney cancers often have no symptoms and are discovered incidentally on an ultrasound or CT scan performed for other reasons.

15% of kidney cancers present with haematuria (blood in the urine) flank pain or a palpable mass.

Kidneys with metastatic disease may present with symptoms from the site of spread.

What Are The Treatment Options ?

Treatment is based on the staging of the cancer and the general health of the patient. Localised kidney cancer is most effectively treated with surgical removal of the kidney (nephrectomy).

The renal cancer may be removed either with the remainder of the kidney or in some situations the cancer may be removed with preservation of the remainder of the kidney (Partial Nephrectomy). 15% of kidney cancers present with haematuria (blood in the urine) flank pain or a palpable mass.

Although our kidneys are very important it is possible to live with less than one kidney.

Laparoscopic Nephrectomy(Surgical removal of the kidney)

This operation is performed using laparoscopic (key hole) surgery with significant benefits, patient recovery, return to normal activities, reduced hospital stay, less post-operative pain and less intra-operative bleeding compared with open surgery.

Certain circumstances such as marked enlargement of adjacent lymph nodes, very large cancers or involvement of the inferior vena cava may mean that an open rather than laparoscopic approach is required.

Partial Nephrectomy

Laparoscopic or open partial nephrectomy involves removal of the cancer with an adequate margin of tissue but preservation of the rest of the kidney. This technique is used in patients with bilateral renal cancers, cancer in a single kidney or in those with medical diseases affecting kidney function.

Steps During Laparoscopic Partial Nephrectomyy

Renal Tumour Clamping Renal Artery Excision Renal Mass Floseal Application