Kidney Cancer

The kidneys are a pair of fist-sized organs in the back of the upper abdomen.  Kidneys remove waste and extra water from the blood and also make hormones that regulate blood pressure and the production of red blood cells. Cancer of the kidney most commonly forms in the outer portion of the kidney but can form in the inner portion where urine is collected.

Cancer can start in the kidney. This page is about renal cell cancer, the most common type of kidney cancer in adults. This type is sometimes called renal adenocarcinoma or hypernephroma. Another type of cancer, transitional cell carcinoma, affects the renal pelvis or center of the kidney (insert a kidney picture here). It is similar to bladder cancer and similar treatments are often used.

When cancer spreads outside the kidney, cancer cells are often found in nearby lymph nodes. It also may spread to the lungs, bones, liver or to the opposite kidney.

Risk factors for kidney cancer include

• Smoking
• Obesity
• High blood pressure
• Long-term dialysis
• Family History of Kidney Cancer

Common symptoms of kidney cancer can include

• Blood in the urine
• Flank pain or mass
• Weight loss
• Fever
• Fatigue

Most people with kidney cancer do not have symptoms and their tumors are found incidentally during imaging for an unrelated problem.

Evaluation and Treatment

Patients known to have a mass on their kidney or suspected of having kidney cancer should undergo a thorough physical exam and history.  Additional tests may include a chest x-ray, bone scan, CT scan of the head, chest or abdomen, MRI scan or a biopsy of the mass.
Not all patients will undergo a biopsy of a mass found on the kidney because the likelihood of the mass being cancer is greater than 90% in most cases.
Treatment of kidney cancer depends on the size and extent of the spread of the tumor as well as the general health of the patient.

Surgery is a common treatment

Surgery is the most common treatment for kidney cancer and is generally considered the most likely chance for cure. Although it is the preferred treatment for kidney cancer that has not yet spread, many patients with known spread of their kidney cancer will undergo surgery to help make the other treatments more successful.  An operation to remove the kidney is called a nephrectomy.

• Radical nephrectomy: Involves removal of the entire kidney and surrounding tissues.  This treatment is most appropriate for larger tumors or tumors that are difficult to access.  It is important that the other kidney is working well to avoid dialysis.  For more information on dialysis, please visit the following website http://www.kidney.org/atoz/content/dialysisinfo.cfm
• Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters) may have this type of surgery.

Either of these procedures can be performed using an open incision, which is large, or laparoscopically, with very small incisions using a camera to visualize the surgery and a surgical robot to perform the surgery.

Robotic Surgery

The DaVinci Surgical Robot System is a revolutionary tool that enables surgeons to have incredible visualization and precision when removing kidney tumors.  The surgical robot utilizes dual cameras to enable 3-D images and special wristed instruments to enable fine instrument control.  The robot is a tool controlled by the physician’s hands.   This tool allows for rapid control of bleeding and the removal of many tumors that could only be removed using an open approach.  However, the surgical robot is merely a tool and does not replace the skill and decision making experience of a great surgeon.  There may be instances where the surgical robot is considered unnecessary or when removing the entire kidney through a laparoscopic or open approach is considered better.

Minimally Invasive Procedures

• Arterial embolization: Refers to blocking the blood supply to a kidney tumor.  This form of therapy is not considered a way to cure cancer but can decrease symptoms of pain or bleeding and may be used pre-operatively to make kidney removal easier.
• Cryotherapy: Is a form of therapy that destroys the tumor without removing it from the body.  Special needles are inserted into the tumor and Argon gas is used to freeze the tumor with minimal damage to surrounding normal kidney tissue.  This type of treatment may be offered by a radiologist and performed using a CT scanner or ultrasound.  Not all tumors are appropriate for this form of treatment due to size, location or clinical characteristics of the patient.
• Radiofrequency: This form of treatment is very similar to cryotherapy but uses radio waves to destroy the tumor with heat.