Kidney Cancer – also known as Renal Cancer, is one of the most common cancers of the urinary system. About 2 in every 100,000 males and 1/1,00,000 of the population are usually affected. This cancer affects adults above 60 years of age and is rare in people under 50 years An effective cure is possible with an early and accurate diagnosis and the right treatment.
Types of Renal Tumours
There are several types of kidney cancer:
- Renal cell carcinoma. It is the commonest type of kidney cancer in adults and constitutes about 85% of diagnoses. It develops in the kidney’s filtration system
- Urothelial carcinoma. Also called transitional cell carcinoma, they account for 5% to 10% of the kidney cancers diagnosed in adults. This carcinoma begins in the kidney area where urine collects known as the renal pelvis.
- Sarcoma This type of cancer develops in the soft tissue of the kidney called the capsule or fat.
- Wilms tumour is most common in children and makes up about 1% of kidney cancers.
- Lymphoma. Lymphoma may be associated with enlarged lymph nodes, called lymphadenopathy, in other parts of the body, including the neck, chest or abdominal cavity.
Surgery for Renal Tumour
Usually, surgery is a recommended choice of treatment for renal tumours. The types of surgeries carried out include:
- In this type of surgery, the surgeon will remove your whole kidney, the attached adrenal gland, nearby lymph nodes, and the fatty tissue around the kidney. Most people have a good quality of life with only one working kidney.
- Sometimes, the surgeon may be able to leave the adrenal gland when the cancer is in the lower part of the kidney and is not close from the adrenal gland.
- If the surrounding tissues tissue and surrounding lymph nodes are infiltrated, a lymph node dissection is also performed.
- A radical nephrectomy is usually recommended to remove a large tumour
In experienced hands, the technique is as effective as an open radical nephrectomy and usually results in a shorter hospital stay, a faster recovery, and less pain after surgery. This approach may not be an option for tumours larger than about 7 cm (3 inches) across or tumours that have grown into the renal vein or spread to lymph nodes around the kidney.
Partial Nephrectomy (Nephron-Sparing Surgery)
- In a partial nephrectomy, the surgeon removes only that part of the kidney that contains the tumour, leaving the rest intact
- Partial nephrectomy is a preferred treatment for those with early-stage kidney cancer.
- It is performed to remove small tumours (less than 4 cm or 1½ inches wide), and can also be done to remove larger tumours (up to 7 cm or 3 inches wide).
- Long-term results show that the prognosis is about the same as a radical nephrectomy
- The benefit for the patient is that more kidney function is retained
Laparoscopic Partial Nephrectomy and Robotic-Assisted Laparoscopic Partial Nephrectomy
- In this type of surgery, special instruments are inserted through the incisions, to remove the kidney.
- One of the instruments, the laparoscope, is a long tube with a small video camera on the end.
- The surgeon also uses telescoping equipment into the small keyhole incisions to completely remove the kidney or perform a partial nephrectomy.
- Sometimes, the surgeon may resort to robotic instruments to perform the surgery. This surgery may take longer but is less painful and has a faster recovery
- Robotic-assisted laparoscopic approach uses a robotic system to do the laparoscopic surgery remotely.
- The surgeon is next to a panel and controls robotic arms to operate.
- This allows the surgeon to move the instruments more easily and with more precision than during standard laparoscopic surgery
Regional Lymphadenectomy (Lymph Node Dissection)
- This procedure removes the lymph nodes in proximity to determine if they have been infiltrated
- Sometimes, this is done when doing a radical nephrectomy. The lymph nodes may be removed if the tumour has features that cause it to spread rapidly
- If the lymph nodes feel abnormal during the operation or on imaging, then they are removed
- Sometimes, the surgeon removes the lymph nodes to test them for cancer spread and stage the cancer
- A cytoreductive nephrectomy is the surgical removal of the primary renal tumour along with the whole kidney
- It is performed in patients where the disease has spread beyond the kidney.
- This may be recommended by the surgeon after the diagnosis or after other systemic treatments have been initiated
- Metastasectomy is the surgical removal of a single area of disease, such as the lung, pancreas, liver etc.
- This surgery is recommended for people who will be relieved of symptoms from having a single site of renal tumour removed.
- In about 1 in 3 people with kidney cancer, cancer will already have metastasised to other parts of the body when it is diagnosed