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Kidney Cancer Surgery

What is kidney cancer?

Kidneys are two bean shaped organs, one on either side of the spine which is involved in filtration of the blood and removal of waste products by way of urine.

Kidney cancer originated from the cells of the kidneys tubules (very small tubes in the kidney that filter the blood) or from renal pelvis (the part of kidney where urine collects). The most common type is renal cell cancer (also called renal cell carcinoma), which represents 85 percent of all kidney tumors. Other less common type of kidney cancer is Transitional cell carcinoma (which arises from the renal pelvis) and Wilm’s tumor (the type of kidney cancer that develops in children more commonly under the age of 5).

What causes kidney cancer?

Renal cell carcinoma typically occurs in people over the age of 50 and is twice more common in men than in women.

The exact cause of kidney cancer is not known. However, certain risk factors are associated with it, including smoking, overuse of certain painkillers for long time, including over-the-counter pain medications, long-term dialysis, exposure to asbestos or cadmium, being overweight and eating a high fat diet. In addition, few genetic conditions such as von Hippel-Lindau disease and tuberous sclerosis may increase the risk.
Kidney Cancer Surgery

What are the symptoms of kidney cancer? How it is diagnosed?

In the early stages, kidney cancer usually causes no obvious signs or symptoms. It is sometime found by chance when a person is having tests for something else.

The following symptoms should raise concern.
  • Chronic fatigue, anemia
  • Unexplained, rapid weight loss
  • Loss of appetite
  • Presence of blood in urine (seen either by the eye, or microscopically)
  • Fever
  • Leg and ankle swelling
  • Hypertension (high blood pressure)
  • Pain in side or lower back that doesn’t go away
  • Mass or lump in the abdomen

These symptoms can also be caused by noncancerous conditions, but only your doctor can tell for sure.

As kidney cancer grows, it may invade organs near the kidney such as the liver, colon or pancreas. Kidney cancer cells may also break away from the original tumor and spread (or metastasize) to other parts of the body such as the lymph nodes, bones or lungs. About one third of cases showing metastasis at the time of diagnosis.


How is the kidney cancer diagnosed and investigated?

In case where history and examination leads to the suspicion of kidney cancer, various tests which include urine examination, blood test and imaging test. Imaging tests done for the evaluation include Ultrasound, CT scan and MRI.
  • Ultrasound (Sonography): It is usually the first imaging test done to evaluate for the cause of blood in urine. An ultrasound of the abdomen with special attention to the kidneys, ureters, and bladder is ordered. Ultrasonography uses high-energy sound waves to produce images of the internal organs. It is generally not uncomfortable and usually no preparation is needed for this test other than keeping your bladder full during the examination.
  • CT scan (CAT scan) computed tomography: A CT scan is a specialized X-ray unit that is used to visualize internal organs. It is one of the primary imaging tools for the assessment of kidney cancers. To enhance the image of the abdominal organs, a dye may be taken by mouth and by intravenous route before the scan. There is generally no pain associated with the CT scan, although the IV dye may cause a hot flushing sensation. Some people may also experience an allergic reaction to the IV dye. Inform your doctor if you are allergic to Iodine or has any history of allergy to IV contrast.
  • MRI (magnetic resonance imaging): MRI is another highly specialized imaging method to create an accurate cross section picture of internal organs of the body and allowing a layer by layer examination. It uses a powerful magnet and radio waves to produce the images, therefore people with metallic implants within their body- such as pacemakers, prosthetic hip replacement and metal plates may not be the right candidate to undergo this investigation. The test may also require the patient to lie still for a long time in a narrow space.
  • Bone Scan: It is a sensitive investigation to check for the spread of the cancer to the bones. It is done by injecting small amounts of a special radioactive material in the blood stream. The radioactive material is then carried to the bone, where the there is lot of bone activity. It may light up both cancerous and non cancerous areas. Therefore interpretation by an expert and sometime additional test such as X ray or CT scan of the bone may also be needed.
  • Biopsy: Biopsy is performed only if the diagnostic imaging test results are equivocal. During biopsy, a small piece of kidney tissue is taken from suspected tumor site with a thin needle and is viewed under a microscope by a pathologist.

Other tests

In addition of the tests described above, one of more of the following tests may be required to complete the evaluation

Blood tests
Complete blood counts, Kidney function tests, Liver function test, Serum Calcium.

Urine examination
  • Urinalysis is usually a part of complete physical examination. Microscopic examination may show evidence of blood in urine.
  • Urine cytology: Microscopic examination of the urine sample to look for cancerous cell shed in the urine may be done in case of suspicion of cancer in the collecting system of the kidney.
Chest x-ray
An x ray of the chest is done to see if the cancer has spread to the lungs. If there is any suspicion on the x ray, the doctor may order for CT scan of the chest to evaluate.

What is the treatment for kidney cancer?

The treatment for kidney cancer depends upon the stage of the cancer and patient’s age and general health status. The stage of cancer is determined by various imaging tests like CT scan, MRI, Chest x ray and bone scan.

The treatment options offered to the patient (depending upon the tumor stage and health status) include

Surgery

Radical Nephrectomy: This procedure involves complete removal of the kidney along with surrounding fat, adrenal and lymph nodes. Now a days minimally invasive surgeries like Laparoscopic or Robotic Radical Nephrectomy are the modality of choice which gives results equivalent to open surgery while minimizing the morbidity of procedure.

Partial Nephrectomy: This is undertaken in case of small tumors where the cancer is removed along with some of the kidney tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed or in case of tumor involving both the kidneys.

When surgery to remove the cancer is not possible, a treatment called arterial embolization may be used to shrink the tumor. Embolization is indicated in case of uncontrolled hematuria or pain.

Radiation therapy

Radiation therapy uses high energy x-rays or other radiation to kill the cancer cells. Various types of cancers have different response to the radiation therapy. Occasionally, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment after the surgery, to increase the chances of cure is called as adjuvant therapy.

Chemotherapy

Chemotherapy is treatment of cancer that uses drugs to stop the growth of cancer cells by stopping the cell from growing. Various forms of drugs care given either by month or injected into a vein. The kind of medication (chemotherapy) to be given depends upon the type and stage of the cancer being treated.

Targeted therapy

This newer form of therapy uses medications that attack specific cancer cells without affecting normal cells. Antiangiogenic agents are a type of agents that may be used to treat advanced kidney cancers. They prevent formation of newer blood vessels in the tumor thus shrink the tumor or slow growth of the cancer.
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