The kidneys are two bean-shaped organs in the back of the abdomen which filter blood and produce urine. They are also important in regulating blood pressure, the production of blood cells, and maintaining health of bones.
Kidney tumour is a growth in the kidney. Kidney tumours can be malignant (cancerous) or benign. Malignant kidney tumours are also called renal cell carcinoma.
Number of people diagnosed with kidney cancer has increased, but the survival rates have improved. More kidney tumours are diagnosed at an early stage due to increasing use of imaging techniques such as ultrasound and CT.
Risk Factors (causes):
The exact cause of kidney cancer is unknown but risk factors include smoking and obesity. Other potential risk factors are family history (first-degree relative with kidney cancer) and high blood pressure.
In most cases kidney cancer is asymptomatic, which means that there are no symptoms attributable to it. This is because most kidney tumours are found during a routine scanning for other symptoms such as abdominal pain or back pain. However, some patients (about 10% of patients) with kidney tumour present with one or more of the following symptoms:
- loin pain
- haematuria (blood in urine)
- palpable lump in abdomen
- general symptoms: high blood pressure, weight loss, fever, anaemia, muscle mass loss, and loss of appetite
- bone pain
The most important tests are radiological (imaging), however, some other tests are also performed:
- Blood tests: to look at blood count and kidney function and liver function
- Imaging: ultrasound, CT and/or MRI
- Nuclear imaging to assess relative function of each kidney
The imaging is usually done using contrast (a special chemical administered through an IV). The CT and/or MRI scan not only helps to diagnose the tumour, but also can help to reveal:
- The location and size of the tumour
- Any enlarged lymph nodes
- Whether or not the tumour has spread to neighbouring organs, such as the adrenal gland, liver, spleen or pancreas
The results of such scan(s) can help to guide the treatment.
Biopsy: Biopsying of the renal tumour is being used more often specially a) if the results of the scans are not conclusive, b) the tumour is small and difficult to characterise or monitoring rather than treatment is contemplated c) if minimally invasive technique, such as cryotherapy, is considered as a treatment option.
Biopsy is usually done under local anaesthetic using imaging techniques such as ultrasound or CT.
Treatment of renal cancer
Majority of the renal cancers at diagnose are confined to the kidney. The treatment of choice for such tumours is surgical excision. The treatment option for localised renal cancer will depend on the size and position of the tumour as well as patient’s medical situation and choice.
Common treatment options for localised kidney cancer are:
- Partial nephrectomy (done robotically, open or laparoscopically)
- Radical nephrectomy (laparoscopic, robotic or open).
- Non-surgical ablation techniques, such as radiofrequency ablation or cryotherapy.
- Active surveillance
However, the best treatment option for tumours that are confined to kidney is surgical removal.
This form of surgical treatment is recommended whenever possible. The whole purpose of this type of surgery is to remove the tumour and leave as much as possible the healthy tissue of kidney.
This surgical treatment can be performed open, laparoscopically or robotically assisted. The advantage of minimally invasive techniques is faster recovery which means quicker discharge from hospital and return to normal activities.
The advantage of robotic surgery over laparoscopic partial nephrectomy is the ability to perform the suturing of the kidney following removal of kidney tumour more quickly and more precisely. This technique is fast becoming the gold standard for partial nephrectomy.
Mr Khoubehi has been performing this surgery since 2007 and his group published the first series in UK.
This type of surgery is done when a partial nephrectomy cannot be performed. During this type of surgery, the whole kidney (including the tumour) as well as the surrounding fatty tissue is removed. The surgery may also involve removal of adrenal glands and lymph nodes near the kidney.
Radical nephrectomy can be done open, laparoscopic or robotically.
Mr Khoubehi is recognised expert in this type of surgery.
Non-surgical treatments: Radiofrequency ablation/Cryotherapy
These types of therapy are usually recommended for small kidney tumour when surgery is not advisable due patient’s age, medical conditions or if surgery is thought to be too dangerous.
During these procedures needle(s) are put through the skin to tumour and the cancer cells are killed either using heat (radiofrequency ablation) or by freezing (cryoablation).