What is kidney cancer?
The majority of kidney tumors are now found incidentally due to the increase in the use of ultrasound, CT scans, and MRI scans to evaluate other medical problems. The majority of kidney cancer cases are renal cell carcinomas or RCC and develop from the outer portion of the kidney, also known as the cortex. There are about 30,000 new cases diagnosed per year and there are several different types of renal cell carcinoma, but for the most part all present and are treated in the same way. Another type of tumor that can occur in the kidney is called urothelial carcinoma and this is the same type of tumor cell that causes bladder cancer.
How is kidney cancer diagnosed?
As mentioned previously, the majority of kidney tumors are diagnosed incidentally on imaging studies done for another reason. On these studies, an abnormal appearing solid mass or an unusual kidney cyst is identified. Many people develop cysts in the kidney as they age, and the majority are benign and just simple sacs filled with fluid. If a cyst has multiple strands of tissue on the inside, or septations, it may be cancerous.
The best test to diagnose a kidney tumor is to obtain a CT scan or MRI both without and then with intravenous contrast. If the mass gets brighter (enhances) with the contrast, there is a high likelihood that the mass is a cancer. Most small kidney tumors do not cause symptoms but large tumors , or tumors that have spread, can cause pain, bleeding, fatigue, weight loss, and abnormalities with calcium levels. Most renal cell carcinomas do not cause blood in the urine but urothelial cancers typically do cause blood in the urine and this is how many are discovered.
How is kidney cancer treated?
The majority of incidentally found kidney tumors can be cured with surgery. At Specialized Urologic Consultants, we offer state of the art laparoscopic and robotic surgery for the removal of kidney tumors.
Depending on the size and location of the tumor, a partial nephrectomy can be performed. During this procedure, the tumor is removed along with a margin of normal kidney but the remainder of the kidney is spared to help preserve as much kidney function as possible. This can be done open, laparoscopically, or with the daVinci robotic system.
For larger tumors or tumors in a difficult location, a laparoscopic or robotic radical nephrectomy can be performed which removes the entire kidney.
In cases of urothelial cancers of the kidney or ureter, a laparoscopic nephroureterectomy can be performed. This is similar to a nephrectomy but the entire ureter is also removed, all the way down to the bladder.
Depending on tumor location, some renal cell cancers can be ablated either with heat or freezing. For tumors that are less than 3-4 cm, special probes can be placed into the mass under ultrasound or CT guidance and then ablated with heat, called radiofrequency ablation or RFA, or frozen which is called cryoablation.
Kidney cancers that have not spread outside the kidney to surrounding organs or other parts of the body can be difficult to manage. We work closely with our medical oncology colleagues in the management of metastatic kidney cancer as a special type of chemotherapy known as immunotherapy, is often required. Several newer medications called tyrosine kinase inhibitors have been developed in recent years have also shown effectiveness in treating advanced renal cell carcinoma.
Surveillance after the treatment of kidney cancer depends on the stage of the cancer but often includes routine blood work, chest x-rays, and intermittent abdominal imaging with CT scans or MRI’s.