Kidneys are the bean-shaped pair of organs located on the either side of the spine in the abdomen. The major function of the kidneys are to clean or filter the blood, and remove waste products and extra water in the form of urine.
Renal cell carcinoma (RCC) is the most common kidney cancer in adults. Men are more predisposed to kidney cancer than women and it appears mostly between the ages of 50 to 70.
The exact cause of kidney cancer is unknown. There are certain factors that may increase the risk of kidney cancer. These include:
Sometimes occupational exposure to certain substances and chemicals may also increase the risk of certain types of kidney cancer.
The majority of kidney cancers are now detected incidentally when an ultrasound or CT scan of the abdomen is performed for other reasons. That is, most kidney cancers are asymptomatic.
However, larger or more aggressive forms of kidney cancer can present with:
The diagnosis is usually confirmed on a CT scan of the abdomen although ultrasound and MRI may also be useful. A biopsy usually is not required if the mass has a typical appearance of a kidney cancer as false negatives can occur and although rare, there is the risk of spreading cancer along the needle track of the biopsy.
Further imaging such as a bone scan and chest X-ray may also be performed to determine if there is spread of the tumour.
From the diagnostic tests, Dr Louie-Johnsun will be able to determine the stage of the kidney cancer and recommend an appropriate treatment plan to manage the disease.
The severity of kidney cancer is characterised into 4 stages:
Stage 1: Cancer is completely embedded in the kidney and is less than 7 cm across
Stage 2: Cancer is more than 7 cm and is completely embedded in the kidney
Stage 3: Cancer has spread into the adrenal gland present above the kidney or into one of the nearby major veins, and a few cancer cells are present in the lymph node
Stage 4: Cancer has spread into surrounding tissues or another part of the body, and cancer cells are found in more than one lymph node.
Surgical removal of the kidney cancer is the gold standard curative approach.
This is often achieved with keyhole / laparoscopic minimally invasive techniques unless the tumour is very large or locally advanced and involves adjacent organs or major veins. The operations include radical or partial nephrectomy.
In most cases NO further adjunctive treatment such as chemotherapy or radiotherapy will be required after surgery.
Laparoscopic Radical Nephrectomy:
This is a keyhole surgery to remove the entire kidney because of a cancerous growth and involves the removal of one kidney together with the adjacent tissues, usually fat, lymph nodes and adrenal gland.
Traditionally this operation is performed through a large incision either at the front of the abdomen or alternatively at the side of the rib cage. Whilst this approach provides good access to the kidney it is associated with greater post operative pain, slower recovery and a prolonged convalescence period with higher wound complication rate.
Laparoscopic nephrectomy, in contrast to open is performed through small incisions in the skin and small tubes called ports are then placed into the abdominal wall allowing access to the kidney. Specialised instruments including telescopic cameras are then used to allow improved, magnified vision and precise surgery. Tumours up to 10-12cm can often be treated laparoscopically although this does depend on the actual position of the tumour and if there is any evidence of local extension of the cancer.
The operation is performed under general anaesthesia and most patients spend 2 nights in hospital before returning home with usual resumption of normal activities within 4-6 weeks.
Laparoscopic Partial Nephrectomy:
If you need surgery for an abnormal presumed cancerous growth in the kidney, your entire kidney may not need to be removed. Depending on location and size of the growth, you may be able to undergo surgery to remove the growth itself surrounded by a small rim of normal kidney tissue whilst preserving as much normal healthy kidney tissue as possible. This surgery is called a partial nephrectomy or kidney (nephron) sparing surgery.
Why Have a Partial Nephrectomy?
Studies have shown that when patients have their whole kidney removed they are more likely to develop chronic kidney disease after surgery compared to patients who have a partial nephrectomy. Kidneys play a major role in maintaining good health, in essence they are the body’s filter, and those with chronic kidney disease may need dialysis (or help with external filtration) to remove waste and excess water from the blood in the years to come especially if the remaining kidney becomes diseased.
Who is Laparoscopic Partial Nephrectomy Suitable for?
This is technically a much more challenging operation than a complete laparoscopic nephrectomy and not all patients will be suitable for this approach. A laparoscopic partial nephrectomy is suitable for those individuals with a small renal lesion which is in a favourable position that can be readily accessed. A radical nephrectomy is the standard approach for renal tumours which are larger or centrally placed within the kidney.
The added potential risks of having a laparoscopic partial nephrectomy include bleeding, urine leaks, incomplete cancer removal and conversion to open surgery. You should discuss your individual risk based on your clinical scenario with Dr Louie-Johnsun when considering these treatment options.
Active Surveillance of Kidney Cancer
In some situations, especially in older patients with small cancers eg <3cm the risks of surgery must be balanced with the natural history of the cancer. There is now good evidence that some small kidney cancers grow very slowly and may not cause problems for many years. As such Dr Louie-Johnsun may recommend active surveillance whereby regular CT or ultrasound imaging will be performed and surgical intervention considered only if there is evidence of the cancer increasing in size.
If surgical treatment is not possible, non-surgical treatment may be performed. This may include: