kidneys

kidney cancer

Kidneys, vital organs in the human body, are bean-shaped structures located on either side of the spine, just below the ribcage. Serving as a crucial component of the urinary system, kidneys play a pivotal role in maintaining homeostasis by filtering waste products, excess fluids, and electrolytes from the blood, producing urine as a result.

Various factors can impact renal function, including high blood pressure, diabetes, and certain medications. Adequate hydration, a balanced diet, and regular exercise contribute to kidney health, supporting efficient filtration processes. Ensuring optimal kidney function is essential for overall well-being, as these organs regulate fluid balance and help manage blood pressure, produce red blood cells, and activate vitamin D, emphasizing the significance of proactive measures to preserve kidney health.

kidney cancer

Kidney cancer, also known as renal cell carcinoma, is a type of cancer that originates in the kidneys, the vital organs responsible for filtering waste and excess fluids from the blood. Renal cell carcinoma accounts for the majority of kidney cancers, with clear cell renal cell carcinoma being the most common subtype. Other less common types include papillary renal and chromophobe renal cell carcinoma.

The exact cause of kidney cancer is often unclear. Still, certain risk factors such as smoking, obesity, high blood pressure, and a family history of the disease may increase the likelihood of its development. Early detection of kidney cancer is crucial for effective treatment. The prognosis for kidney cancer depends on various factors, including the stage at which it is diagnosed and the specific characteristics of the tumour. Regular medical check-ups and awareness of potential risk factors are essential for timely intervention and improved outcomes in cases of kidney cancer.

the symptoms

Most kidney cancers are asymptomatic and often detected incidentally, meaning they are found unintentionally during medical imaging or tests conducted for unrelated health concerns. Despite this asymptomatic nature, in many cases, certain signs and symptoms may manifest, alerting individuals and healthcare professionals to the potential presence of kidney cancer.

• Blood in the urine (haematuria): One of the primary symptoms of kidney cancer is the presence of blood in the urine, which may be visible or detected through laboratory tests.

• Persistent pain: Individuals with kidney cancer may experience persistent pain in the lower back or side, often on the same side as the affected kidney.

• Unexplained weight loss: Sudden and unexplained weight loss can be a symptom of various cancers, including kidney cancer.

• Fatigue: Kidney cancer can lead to a persistent feeling of tiredness or weakness, impacting the overall energy levels of the individual.

• Anemia: As kidney cancer progresses, it may cause a decrease in the production of red blood cells, leading to anemia, which can result in weakness and paleness.

• Swelling or lumps: In some cases, kidney tumors may cause noticeable swelling or the development of palpable lumps in the abdomen, indicating the presence of a mass.

How is kidney cancer diagnosed?

The diagnosis of a kidney mass is nearly always made with abdominal imaging. Depending on the initial imaging, further imaging in the form of a CT scan or MRI is required to further characterize the mass. The majority of such kidney lesions are cancerous (up to 80% depending on the size), but apart from special situations; the imaging cannot differentiate benign from malignant tumors. Depending on the appearance, size, location of the tumor, and certain patient characteristics, your surgeon might advocate further assessment of the lesion through needle biopsy before discussing further treatment.

What happens after referral

After receiving your referral, our practice nurse will triage your case, and you'll be promptly contacted for a brief overview of your condition. Preceding your visit, several diagnostic tests, urine analysis, urine cytology ultrasound, and CT scan are arranged to enhance the evaluation. At your appointment, A/Prof Homi Zargar will engage with you, conduct a thorough assessment, and review the gathered information.

Treatment

What are the treatment options?

Treatment differs based on the type and size of tumour, as well as the clinical contexts:

· Surveillance:  As a general rule, small tumours typically do not grow rapidly, and while small (< 4cm), the risk of spreading is very low (<5% over 3 years). It is not uncommon to observe the tumour with regular scans (every 6-9 months), especially if other medical conditions are present.  Definitive treatments can be offered if during the period of surveillance, the tumour grows rapidly. As a general rule, in many instances, the tumour can be observed for an extended period without any need for treatment or any harm to the patient.

· Surgery:  Complete removal of the cancerous tumour is the treatment of choice for kidney tumours. For tumours less than 4 cm the standard of care is partial nephrectomy. The kidney lesion is removed during this process, but the rest of the kidney is preserved. Depending on the size and location of the lesion, 80-90% of the affected kidney can be preserved. For larger or more complex tumours, the entire kidney may need to be removed (radical nephrectomy). In most instances, kidney surgery can be carried out via the laparoscopic (keyhole) route. Robotic surgery allows the surgeon to perform more complex surgery using the keyhole approach. This will allow for less pain, less blood loss, shorter hospital stays, and earlier returns to daily activities.

· Ablation:  Depending on the size and location of the tumour, it may be possible to destroy the tumour by passing a probe through the skin into the tumour and ablating it with various forms of energy (heat or cold). This approach has an extremely low risk of complication, but the risk of cancer recurrence is somewhat higher than surgery. Furthermore, this approach is not suitable for all tumour locations. 

Surgery for kidney cancer

Partial nephrectomy

The goal of partial nephrectomy is to excise the portion of the kidney containing a suspected cancerous tumour. This procedure can be carried out via the open incision or keyhole approach. The decision is based on a variety of factors. In most cases, the procedure would be carried out in a minimally invasive approach using a robotic platform.

• Utilizing small robotic instruments, precise surgery is conducted through tiny keyhole incisions in the abdomen.

• Enlargement of one of the keyhole incisions may be necessary to remove the resected part of the kidney.

• Successful completion of the procedure often results in better kidney function preservation than complete kidney removal.

• In instances where partial removal is deemed impractical or unsafe, the alternative may involve a complete removal of the kidney.

• Potential major side effects include bleeding, incomplete tumour clearance, and urine leakage from the cut edge of the kidney.

• Read more about partial nephrectomy.

Radical nephrectomy

The objective of nephrectomy is to eliminate a kidney bearing a tumour. The procedure often employs a telescopic (keyhole) technique through multiple small incisions in the abdomen.

• In certain cases, the procedure may include the removal of the adrenal gland and adjacent lymph nodes.

• Enlargement of one of the keyhole incisions is often necessary to extract the kidney.

• The procedure is generally well-tolerated, with an average hospital stay of approximately three days.

• Recovery typically spans four to six weeks, although individual variations may extend the timeline.

• After the removal of a kidney tumour, regular and long-term follow-up with scans is imperative for comprehensive monitoring and assessment.

• Read more about radical nephrectomy.