Kidney Cancer Treatment Melbourne
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 provide assessment and treatment for kidney cancer in Melbourne, including kidney-sparing partial nephrectomy, laparoscopic nephrectomy and robotic nephrectomy where clinically appropriate. Procedures are performed at Cabrini Hospital Malvern and Epworth Eastern Hospital Box Hill.
How Does Kidney Cancer 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 Of Kidney Cancer?
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.
Kidney Cancer Treatment Options
Treatment is based on the stage and position of the cancer, kidney function, the patient's general health and whether the tumour is suitable for kidney-sparing surgery. Localised kidney cancer is commonly treated with surgery to remove either the tumour-bearing part of the kidney or, when required, the whole kidney.
The renal cancer may be removed with the whole kidney, known as radical nephrectomy, or in selected cases the cancer can be removed while preserving the remainder of the kidney, known as partial nephrectomy.
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, robotic 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 may be used for smaller or favourably positioned kidney cancers, patients with bilateral renal cancers, cancer in a single kidney or those with medical diseases affecting kidney function.
Robotic Nephrectomy
Robotic nephrectomy is a minimally invasive form of keyhole kidney surgery. Rather than making a large open incision, the surgeon operates through several small incisions and controls fine robotic instruments from a surgical console with a magnified three-dimensional view.
For selected patients with kidney cancer, robotic surgery may be used for either partial nephrectomy, where only the tumour and a margin of surrounding tissue are removed, or radical nephrectomy, where the entire kidney is removed. The most suitable approach depends on the size and position of the tumour, whether it is close to important blood vessels or the collecting system, the patient's kidney function and overall health.
Potential advantages of a robotic or laparoscopic approach may include smaller incisions, less post-operative pain, reduced blood loss, a shorter hospital stay and a faster return to usual activities compared with open surgery. Open surgery may still be recommended for very large or complex kidney cancers, cancers involving major veins, or where it is considered the safest oncological approach.
The decision between observation, biopsy, partial nephrectomy, radical nephrectomy, laparoscopic surgery, robotic surgery or open surgery is made after review of imaging, blood tests, kidney function and the patient's individual circumstances.
Steps During Laparoscopic Partial Nephrectomy
