Kidney cancer occurs when cancer cells and/or tumors are found in one or both kidneys. Generally, there are no symptoms for kidney cancer. However, tumors are often identified during routine X-rays or scans, so many kidney cancers are diagnosed in very early stages when the amount of cancer cells or the tumors are very small.
Surgery is generally the main, and often the only, treatment for localized kidney cancers (cancer that appears only in the kidney). Removing the tumor and the cancer cells is generally very effective at curing small localized cancers, especially if the cancer is caught and treated before it advances.
One form of advanced kidney cancer, called Inferior Vena Cava (IVC) occurs when the tumor spreads into the main vein that the kidney drains from. When IVC occurs, this is considered to be stage III kidney cancer. Once cancer cells infiltrate the vein, they can begin to grow there and may spread through the vein and progress towards the heart. This tumor, which grows in the veins, is referred to as a "tumor thrombus" because it is similar to a blood clot, which flows in the direction of the vein and reaches the heart as well. Although this is far more serious and difficult to treat than localized stage I or stage II kidney cancer, removal of the tumor is nearly always an option, even if the tumor has reached the heart, and the clot in the vein generally does not cause severe problems or symptoms.
While those with IVC surgeries may have to have a graft inserted, generally for most localized kidney cancers, surgery can remove the tumor without hindering the function of the affected kidney. This allows for a faster recovery and return to a normal life once the cancer enters remission or disappears.
Goal of Treatment
Surgery designed to cure kidney cancer has two purposes: to remove the tumor and all cancer cells while still preserving the health and normal function of the kidney. With a qualified surgeon, both of these goals can generally be achieved as long as the cancer has not spread or become too large, and as long as the cancer is localized within the kidney itself.
Nephrectomy
Traditionally, open nephrectomy was the recommended treatment for kidney tumors and cancer cells. Nephrectomy involves opening and operating on the kidney to remove cancer cells. However, new techniques in science have allowed for another option. In many cases, surgery can be done laparoscopically--with a laser instead of opening the kidney. This new surgery has a faster recovery time and less scarring.
Open Nephrectomy
Open nephrectomy involves opening the kidney and removing the cancer cells and tumors. Depending on the extent of the cancer, either the kidney and/or the lymph nodes may be removed. If the cancer is more advanced, a radical nephrectomy may be performed. Radical nephrectomies involve removal of the entire kidney, the lymph nodes surrounding the kidney and the adrenal gland attached to the kidney. This radical procedure is done to remove any cancer cells that may have spread to the lymph nodes and/or the adrenal gland, as this is generally the first place cancer cells spread as the kidney tumor grows.
Patients with smaller tumors rarely have radical nephrectomies. If the tumor is localized to the lower portion of the kidney, generally the adrenal gland does not need to be removed. Further, lymph nodes are only removed if there is reason to suspect that the cancer has begun to spread to the lymph nodes. When an open nephrectomy is performed and the adrenal gland and lymph nodes are left in place, normal kidney function can be preserved.
Laparoscopic Nephrectomy
Laparoscopic nephrectomy involves the removal of cancer cells/tumors in the kidney using a laser procedure instead of opening the kidney. Laproscopic nephrectomy provides a faster recovery time and minimizes scarring.
Generally laparoscopic nephrectomy is the treatment of choice for small or medium-size tumors--8 cm in diameter or less. Laparoscopic nephrectomies are not generally recommended for large tumors or tumors that have spread into surrounding veins or another organ. In addition, if there is a reason to suspect that cancer cells have spread into the lymph nodes, laparoscopic surgery is not recommended.
Because both open nephrectomies and laproscopic nephrectomies can preserve kidney function, it is the patient's choice which type of surgery to have. Often, surgeons have more experience with open nephrectomies because the procedure has been around longer, so this may be a factor in a patient's choice. However, a patient who is elderly or frail may benefit from the shorter and easier recovery period involved in a laparoscopic nephrectomy.
Partial Nephrectomy
Partial nephrectomies, as opposed to radical nephrectomies, may be possible to preserve kidney function. Partial nephrectomies are only an option for those with small, localized tumors (those approximately 4 cm in diameter or smaller) in certain areas of the kidney. Tumors at the center or top of the kidney are generally not recommended for partial nephrectomies. Tumors in the center of the kidney are difficult to access with the laser, and when a tumor is at the top of the kidney, there is a higher chance that the adrenal gland has become affected by cancer cells.
Because the majority of people can live a normal life with only one functioning kidney, often it is best to err on the side of caution and have a radical nephrectomy. However, there are cases in which a partial nephrectomy is preferable: if the patient already has only one kidney or has reduced kidney function due to disease; if he is likely to develop reduced kidney function because of diabetes or high blood pressure; if both kidneys have tumors; or if the cancer is hereditary and it is likely that both kidneys will eventually develop tumors.
Because there is a risk of localized recurrence, partial nephrectomy is recommended only for those with very small tumors or those who will have to be on dialysis if the kidney is removed because of a problem or potential problem with the remaining kidney.
Energy Based Ablation and Cryablation
Ablation is an alternative to surgery which involves destroying the tumor through the use of energy. Electronic imaging devices, such as CAT scans, MRI's, or ultrasounds, are used to identify the appropriate location. Then a probe is inserted into the tumor. Depending on the type of ablation used, the tumor is either destroyed by heat (Radiofrequency Ablation) or by being frozen (Cryoablation).
While these techniques are minimally invasive, and may not even require general anaesthesia, they are limited to use on small tumors (4 cms or less) that are not located near the center of the kidney or close to any vital organs. Furthermore, these techniques are still considered by most to be experimental.
Tags: cancer cells, lymph nodes, adrenal gland, kidney cancer, kidney function