Kidney Cancer

01

Normal kidney function

• Detoxify and clean the blood.
• Balance body fluids.
• Maintain electrolytes such as sodium, potassium, calcium and magnesium.
• Remove waste as urine.
• Make hormones that support blood pressure, red blood cells and bone health.

02

Symptoms

Kidney cancer rarely causes early symptoms. In later stages, symptoms may include:

• Blood in urine, which may appear pink or red.
• Back pain below the ribs that does not go away.
• Weight loss.
• Fatigue.
• Intermittent fever.

03

Risk factors

• Older age, though incidental diagnosis in younger people is increasing.
• Smoking.
• Obesity.
• High blood pressure.
• Family history of cancer.
• Workplace exposure to certain chemicals.
• Male gender.
• Certain medicines and long-term dialysis in advanced kidney disease.

04

Diagnosis

05

Surgical treatment

Surgery is the standard of care for most kidney cancers. The recommended operation depends on tumor characteristics, stage and patient health.

• Radical nephrectomy removes the affected kidney with surrounding fat and sometimes adrenal gland.
• Partial nephrectomy removes only the tumor with a margin of healthy tissue and preserves kidney tissue when feasible.
• Surgery may be performed open, laparoscopic or robotic.

06

da Vinci robotic surgery for kidney tumor

Robotic surgery allows the surgeon to operate through small incisions with 3D HD vision and instruments that bend and rotate more than the human hand.

• Potential benefits compared with open surgery include shorter hospital stay, less pain, less blood loss, fewer complications and smaller scars.
• Potential benefits compared with traditional laparoscopy include shorter warm ischemia time, less blood loss, shorter hospital stay, fewer complications, lower positive margin rates and better kidney function outcomes in selected patients.
• The surgeon remains fully in control of the robotic system at all times.

07

When surgery is not possible

Cryoablation and radiofrequency ablation may be options for selected small kidney tumors in patients who cannot undergo surgery, though recurrence risk can be higher than surgery.

08

Advanced or recurrent kidney cancer

• Surgery to remove as much tumor as possible in selected patients.
• Immunotherapy to help the immune system fight cancer.
• Targeted therapy to block cancer growth signals.
• Radiation therapy for symptom control, especially bone involvement.

09

Understanding kidney masses

A kidney mass is an abnormal growth in the kidney. Some masses are benign and some are malignant. Larger masses are more likely to be cancerous, while many small localized masses are found incidentally during ultrasound or imaging for another reason.

• Localized tumors have the best chance of cure.
• Symptoms may include blood in urine, persistent side pain, weight loss, fatigue or fever.
• Small tumors may still need specialist evaluation because behavior cannot be judged by symptoms alone.

10

Imaging and biopsy decisions

Contrast CT or MRI is the standard evaluation for most kidney masses. Imaging helps define whether the mass appears cancerous, its size, location, relation to vessels and collecting system, and whether it has spread.

• Kidney function and serum creatinine should be checked before contrast imaging.
• Biopsy is not routinely required for many kidney masses because imaging often guides treatment.
• Biopsy may be considered if lymphoma, infection, metastasis from another cancer or non-surgical systemic treatment is suspected.
• Biopsy can sometimes be inconclusive and carries a small risk of tumor seeding along the biopsy track.

11

Partial nephrectomy and radical nephrectomy

Surgery is the standard treatment for most kidney cancers. The main surgical decision is whether the tumor can be removed while preserving the kidney or whether the whole kidney should be removed.

• Partial nephrectomy removes the tumor with a margin of healthy tissue and preserves kidney function when feasible.
• Radical nephrectomy removes the kidney with surrounding fat and sometimes the adrenal gland.
• Nephron-sparing surgery is preferred for suitable small tumors or patients with a solitary kidney.
• Open, laparoscopic and robotic approaches are selected based on tumor complexity and patient factors.

12

Ablation and advanced kidney cancer care

When surgery is unsafe or unsuitable, selected patients with small tumors may be treated with cryoablation or radiofrequency ablation. These options are generally reserved for patients with serious medical problems because recurrence risk can be higher than surgery.

• Cryoablation freezes cancer cells through a needle placed under imaging guidance.
• Radiofrequency ablation heats and destroys tumor cells through an image-guided probe.
• Advanced or recurrent kidney cancer may need surgery to remove tumor burden, immunotherapy, targeted therapy or radiation for symptom control.
• Radiation is usually used to control symptoms from spread, especially bone involvement, rather than as primary kidney tumor treatment.