Kidney cancer (also known as a malignant kidney tumor) is a common urologic malignancy. In fact, over 25,000 patients will be diagnosed in the U.S. with kidney cancer this year alone. Fortunately, if detected early and before the cancer has spread, it is a highly curable disease. The most common type of kidney cancer is called Renal Cell Carcinoma or RCC.
Symptoms of kidney cancer can include blood in the urine, flank or abdominal pain, weight loss, and bone pain. Fortunately, because of the increased use of ultrasounds, CT scans, and MRIs in medical care, a significant number of these tumors are being diagnosed early before they have grown to larger sizes and without having any symptoms, and before they have had a chance to spread to other places. The result of earlier detection of such tumors translates into much better overall prognosis. In fact, the majority of patients with early stage kidney cancers are cured with surgery alone.
Kidney cancer can be divided into two categories: Early stage or Advanced Stage. Early stage kidney cancer is defined by cancers that are limited to the kidney and its surrounding enveloping fat and tissue but has not spread elsewhere in the body such as to the lymph nodes, liver or lungs. Early stage kidney cancers are highly curable and, in most cases, a cure can be achieved by surgery alone (without the need for chemotherapy or radiation). Advanced kidney cancers, however, are cancers that have spread beyond the kidney and have involved other structures such as the lymph nodes, liver, or the lungs. Advanced kidney cancers are less likely to be curable and have a more limited prognosis.
When a patient is diagnosed with a kidney cancer, your physician will determine if the tumor is an early stage or an advanced stage cancer by performing tests including blood work, and imaging evaluations including CT scans or MRI’s. With this approach, they can clearly locate the cancer and determine its extent of progression. The urologists at Comprehensive Urology are experts in the cancers of the urinary tract (Urologic Oncologic Surgeons) and can best determine the best course of therapy for each individual patient. Their goal is to offer the most advanced therapeutic modalities in order to offer the best cure rates while optimizing our patient’s quality of life.
Early Stage Kidney Cancer
Most early stage kidney cancer can be cured by surgical removal alone. Chemotherapy and radiation are typically not necessary and commonly are not effective. Traditionally, the entire kidney is removed surgically (total or radical nephrectomy) in order to remove the cancer. However, more recent studies have clearly shown that in most cases the entire kidney does not have to be removed. In fact, if the tumor is removed in its entirety while preserving the rest of the kidney that does not have cancer in it (termed partial nephrectomy), one can achieve the same excellent cure rates. The advantage of preserving the kidney is that our patients will have better kidney function long term and will have a much lower chance of developing kidney failure.
Performing a partial nephrectomy is technically more challenging and is best performed by experienced urologists who have expertise in cancer operations (urologic oncological surgeons). Dr. Michel is a urologic oncological surgeon who, after determining the size and location of the kidney cancer as well as the patient’s overall clinical status, will determine the candidacy of each patient to undergo a total or partial nephrectomy. In each case, all efforts are made to perform a partial nephrectomy if suitable for the specific tumor and patient (not all patients or tumors are suitable for a partial nephrectomy procedure). Given that our urologists are highly skilled minimally invasive surgeons (laparoscopic and robotic surgery) such procedures can often be performed with small incisions while utilizing the most advanced surgical tools and techniques.
The steps to performing a partial nephrectomy are similar regardless of the surgical approach. These include:
1. Exposing the kidney tumor
2. Controlling the blood vessels that supply blood flow to the tumor
3. Stopping blood flow to the area of the kidney where the tumor is located
4. Surgically removing the tumor
5. Reconstructing the kidney
6. Restoring blood flow to the kidney
At Comprehensive Urology, we employ a variety of treatment options when dealing with kidney cancer. Depending on the stage and grade of the cancer, our doctors have many options when determining the proper course of treatment for kidney cancer.
In most cases, kidney cancer treatment consists of the surgical removal of the kidney. When the whole kidney is removed, the process is referred to as a total nephrectomy. However, recent studies have shown that partial nephrectomies (in which only the cancerous part of the kidney is removed) are equally, if not more, effective when treating kidney cancer.
Aside from the obvious advantage of preserving part of the kidney, a partial nephrectomy is ideal for many reasons. Over the long term, patients who undergo a partial nephrectomy will experience better kidney function and will have a lower chance of developing kidney failure. However, a partial nephrectomy is very difficult to perform, which is why it’s critical that patient’s speak with the expert oncological surgeons at Comprehensive Urology. At our center, our doctors are experts in performing this complex and challenging procedure.
Thanks to the da Vinci surgical system, our doctors are able to perform nephrectomies with more precision and expertise than ever before. Call us today to learn more about this exciting new development in the world of kidney cancer treatment.
Minimally Invasive Robotic Partial Nephrectomy
In suitable candidates, rather than making a large surgical incision, a kidney cancer surgeon can perform the partial nephrectomy by making a few small incisions and using specialized instruments utilizing the daVinci surgical system. Patients who undergo robot-assisted partial nephrectomy are typically in the hospital for 2 days and are able to return to most of their activities within 1-2 weeks. They are asked not to engage in heavy lifting or strenuous exercise for 4 weeks in order to allow their incisions and the kidney to heal well.
Open Partial Nephrectomy
In certain situations, minimally invasive robotic surgery is not a suitable option for patients who need a kidney tumor removal. Given that Dr. Michel is well adept at both traditional open operations as well as minimally invasive robotic surgery, he can choose the best technique for individual patients. With the open operation, the surgery is often performed by making a flank incision and approaching the kidney by going between the ribs. This is a highly successful approach and affords great exposure to the kidney.
Patients who undergo an open partial nephrectomy are typically in the hospital for 3-5 days and are able to return to most of their normal activities within 2 weeks. They are asked not to engage in heavy lifting or exercise for approximately 4 weeks in order to allow their incision and the kidney to heal well. Excellent cancer cure rates and preservation of kidney function can be achieved with partial nephrectomy.
Sometimes the kidney cancer is so large that it has replaced most of the kidney; in other situations, the cancer is located such that preserving the blood supply to the kidney is not possible. In such cases, a partial nephrectomy cannot be performed. Instead, a radical nephrectomy is performed whereby the entire kidney is removed with the tumor. Typically a radical nephrectomy can be performed through a minimally invasive approach (laparoscopic or robotic nephrectomy), where several small incisions are used to perform the operation. At the end of the operation, one of the incisions is slightly lengthened to allow the removal of the entire kidney from the body. Excellent cancer cure rates can be achieved with a radical nephrectomy. Using a minimally invasive approach, our patients have less pain, shorter hospital stays, and quicker return to their daily activities.
Advanced Stage Kidney Cancer
Advanced stage indicates that the cancer has spread beyond the kidney and has involved other structures such as the lymph nodes, liver, or the lungs. Advanced kidney cancers are less likely to be curable and have a more limited prognosis. Recent medical trials have shown more promise in the management of certain advanced RCC, where surgery (nephrectomy) can be used in conjunction with medical treatments to help manage the disease. Our physicians at Comprehensive Urology work closely with the medical oncologist team in order to develop the optimal treatment plan for each individual.
Alternative Therapies When Surgery is Not Possible
There are certain situations when a person may not be healthy enough to be a good surgical candidate. These can include treatment to try to kill the tumor cells by freezing them (cryotherapy) or by heating and burning them (radiofrequency thermal ablation). These techniques are performed by placing a needle into the tumor and treating them, rather than removing them. There is some promise as to the short-term efficacy of these treatments; however, there is very little data available regarding long-term cancer control.
During a radical nephrectomy, the kidney and sometimes the adrenal gland and neighboring lymph nodes, are completely removed.
A radical nephrectomy is typically best suited for kidney cancer patients who have larger, more advanced tumors, or small tumors in a location deep within kidney close to the blood vessels that are not amenable to partial nephrectomy. Removing the entire kidney may be helpful especially if the cancer has metastasized or has already spread to other areas of the body.
How is Total Kidney Removal Performed?
At Comprehensive Urology, our expert urologists will perform a thorough evaluation of your specific condition in order to determine the best course of action for you. If it is determined that a partial nephrectomy is not a feasible option for you, the surgeon will move forward with a radical nephrectomy. This type of surgery is performed through a single incision in the abdomen or the side of the abdomen. Once the incision is made, the surgeon will mobilize the kidney from the surrounding structures, then isolate and ligate the blood supply (artery and vein) to the kidney as well as ligating the ureter (the tube that carries urine from the kidney to the bladder). Once these steps are accomplished, the kidney is removed. The incision is then closed with sutures.
Recovering from a Radical Nephrectomy
Immediately after surgery, our health care team will monitor the patient’s blood pressure, electrolytes and fluid balance closely as these are normal body functions partially controlled by the kidneys. A urinary catheter will most likely be kept in the patient’s bladder during the recovery process.
Pain relievers are typically given after the surgical procedure is complete and throughout the recovery period as well. It is also highly recommended to perform breathing exercises, despite discomfort in the incision area, to prevent fevers or pneumonia.
Most patients recovering from a total kidney removal procedure are required to remain in the hospital typically anywhere from three to five days. Once released from the hospital, it is advised to gradually return to light activities that you normally participated in. Any movements that will put a strain on your body, such as heavy lifting, should definitely be avoided for six weeks following the procedure.
Procedures Offered at Comprehensive Urology
Our experienced urologists at Comprehensive Urology are trained to perform partial nephrectomies either through a minimally invasive robotic approach or through open partial nephrectomy. Generally, each approach will require the patient to be under general anesthesia throughout the surgery. The patient is placed on the operating room bed lying on the side opposite of the diseased kidney. The surgeon’s main goal is to remove the kidney tumor the best possible way.
Minimally Invasive Robotic Partial Nephrectomy
During a minimally invasive partial nephrectomy, the surgeon will operate through a few small incisions using the da Vinci Surgical System. This platform allows the surgeon to operate on the site of surgery without the need to make larger incisions on the body. Candidates of this type approach are usually in the hospital for two days after surgery and are able to return to regular activities within one to two weeks. Patients will be advised not to do any heavy lifting or engage in any strenuous activities for up to four weeks immediately following their surgery. This minimally invasive approach has shown faster recovery times.
Open Partial Nephrectomy
If minimally invasive robotic surgery is not an option, traditional open surgical procedures are an option. At Comprehensive Urology our urologists, will only advise open surgery if they feel that your cancer has a higher chance of being cured though this type of method. During an open partial nephrectomy, the surgeon will make a flank incision in order to work on the kidney between the ribs. Although this is considered a more traditional approach, it has been highly successful in the past, as well as today. The typical recovery time after this approach is usually three to five days with the ability to resume to normal activities in two weeks. Heavy lifting and under strenuous activity is also advised against.
Percutaneous ablation, also known as percutaneous kidney cyroblation, is a minimally invasive surgical procedure created to treat kidney cancer. Percutaneous ablation is becoming a viable choice for kidney cancer treatment since it avoids large incisions to the body that is required by traditional “open” surgical treatments. It even avoids minor incisions associated with laparoscopic cyroablation for kidney cancer.
The literal meaning of the term “percutaneous” means “through the skin.” This procedure does not involve any incisions. Rather, needles are precisely placed directly through the skin with the help of imaging device such as a CT scanner, MRI or ultrasound targeting. Since this is a very particular procedure, only some forms of kidney cancer are treatable through this method. For instance, if the cancer is located too close to other body structures, such as the bowel or ureter, percutaneous ablation is not recommended as it may damage nearby organs.
Percutaneous Ablation Compared to Traditional Kidney Cancer Treatment
The concept of percutaneous ablation is a relatively new concept in the surgical treatment of any cancer. The traditional method that surgeons have used to treat cancer is by cutting out the diseased area, which is a process called extirpation Ablation is a whole new approach to kidney cancer treatment. Instead of making incisions to the body, this procedure uses special devices to precisely destroy cancerous tissue at the very site it exists in the body. Although ablation is used to treat other cancers such as lung, liver and prostate cancer, it has been quite successful in treating kidney cancer overall.
How is the Procedure Performed?
Percutaneous ablation technology is FDA approved and uses CT scanner, MRI or ultrasound devices to determine where the ablation probes will be inserted through the skin. This is a crucial part of the procedure as it precisely destroys the tumor without affecting the surrounding areas. Most surgeons recognize cyroablation or thermal ablation as safe and effective methods of treating kidney cancer since no incisions or movement of the kidney are involved. These have been successful in precisely targeting the exact site of cancer and preserving as much healthy kidney tissue as possible.
Candidates for Percutaneous Kidney Ablation
Although the procedure has been a very promising approach to kidney cancer treatment thus far, there are still many factors to consider in terms of what types or stages of kidney cancer percutaneous ablation is best suited for. Some of the things your doctor will take into account are:
- Size and general appearance of the tumor
- Local anatomy of the tumor
- Age of the patient
- Health condition of the patient
- Overall kidney function
- Number of lesions on the kidney
Kidney cancer treatment can take various forms. The exact type of treatment needed is dependent on each individual patient and the stage and severity of his or her cancer. Some of the most common treatment options for kidney cancer include active surveillance.
During active surveillance, a patient’s kidney cancer is closely monitored, but the patient receives no treatment unless there is evidence that the cancer is growing or spreading. Typically, active surveillance is performed on older individuals who have cancer which is small and slow-growing. One of the main benefits of active surveillance is that it eliminates the risk of complications that sometimes accompany cancer treatment, particularly the recovery from surgery or chemotherapy side effects. However, active surveillance can be a risk itself: if treatment is delayed for too long, it’s possible that a patient’s kidney cancer could spread beyond the point where it is no longer easily curable or the patient’s overall health situation may become worse with time making it more difficult to tolerate or recover from surgery.
If you or someone you love has been diagnosed with kidney cancer, there are now several non-surgical treatments available to target cancer cells within the kidney. One of the latest options is called medical therapy or targeted drug therapy. For some patients, surgery may not be the best option or, in the event that surgical treatment has not sufficiently eliminated all cancer cells, medications may offer the best chance at beating kidney cancer.
At Comprehensive Urology, our kidney cancer specialists strive to not only find the best possible treatment for our patients, but we customize our approach for each individual to ensure the best chance at preserving a high quality of life.
What is involved with Medical Therapy?
Essentially, medical therapy uses specific medications or substances to identify and target cancer cells while leaving normal, healthy cells alone. These drugs are often prescribed to treat patients with metastatic kidney cancer, meaning that the cancer has spread to other organs or parts of the body.
The first medications that were FDA-approved specifically for kidney cancer, such as Sunitinib, Sorafenib, and Temsirolimus work by interfering with cancer cell function, preventing the cell from growing and dividing or even attacking the blood vessels that support and allow the cell to grow. Each medication is typically prescribed one at a time. If one does not seem to have an impact, another drug will be prescribed and so on.
Also, it is iimportant to mention that even with the spread of disease outside the kidney, patients may still benefit froms urgery in addition to chemotherapy (called cytoreductive surgery), which has been shown to improve survival
What are the Benefits of Medical Therapy for Kidney Cancer?
One of the main benefits of medical therapy is that it is non-invasive. Patients simply need to take a single pill once a day for the prescribed amount of time, in which the doctor will monitor how the patient’s body is reacting to the drug. The most common side effects of medication therapy are nausea, high blood pressure, hair discoloration, and diarrhea.
Since medical therapy is often prescribed for advanced stages of kidney cancer, particularly if it has spread to other parts of the body, medications may be used to manage the disease and prevent it from progressing further. While recurring or advanced kidney cancer may not be curable, it is possible to control it.
Contact a Los Angeles Kidney Cancer Treatment Expert
The Urology associates at Los Angeles Comprehensive Urology diagnose and treat many people for kidney cancer. If you’re interested in learning more about kidney cancer and its treatment, schedule your initial consultation with a robotic surgeon and kidney specialist by calling (310) 499-2756.
Kidney cancer is relatively common urological condition which, if identified and diagnosed early enough, is highly curable. As with all cancers, early diagnosis of kidney cancer is critical when treating the disease. At Comprehensive Urology, our expert doctors use state of the art technology and advanced knowledge and techniques during kidney cancer treatment.
Next, read about Bladder Cancer.