The kidneys are essential organs that filter the blood, removing waste products through the urinary tract as urine. Once created, the urine then drains from each kidney into the bladder through tubes called ureters. It is stored in the bladder, then eliminated from the body via the urethra. Like any other organ, the kidney can be affected by cancer.

Kidney cancer accounts for around 3% of all cancers diagnosed in Australia each year. The commonest form of cancer is renal cell carcinoma (RCC), which grows from cells lining the microscopic tube system within the kidney. The cancer can grow slowly over a number of years and because of the kidney’s location in the body, usually causes no symptoms until it becomes quite large. For this reason, RCC is now most often detected incidentally on scans performed for other reasons, and when found at an early stage has an excellent chance of cure with surgical removal.

Diagnosis

Usually the diagnosis is only confirmed once the kidney has been removed and examined under a microscope. Pre-operative biopsies are not routinely performed, as they are difficult to interpret and can be misleading. More than 90% of large solid kidney masses are found to be cancerous, and therefore the decision can be made to proceed to surgery on the basis of the findings on a CT scan. In addition to making a diagnosis, examination of the cancer under a microscope also provides information regarding the grade of the tumour (how aggressive or rapidly growing the cells appear), and the stage (whether the tumour is confined to the kidney or has begun to spread).

Treatment

The best treatment for kidney cancer is surgical removal, as it is poorly responsive to radiotherapy or chemotherapy. The chance of cure depends upon the size of the tumour, the presence of any local invasion through the wall of the kidney or spread to adjacent lymph nodes, and the grade of the tumour. For small low grade tumours localized to the kidney, cure rates are >90% with surgery.

Radical Nephrectomy

The standard form of surgery for RCC, radical nephrectomy involves removal of the entire kidney, surrounding fatty tissue and nearby lymph nodes, depending upon how far the cancer has spread. It can be performed using a traditional open approach, requiring a large skin incision, or laparoscopically, as below.

Laparoscopic Nephrectomy

Laparoscopic nephrectomy is removal of the kidney using three or four 1cm “keyhole” incisions in the abdomen (one of these is enlarged to 7-8cm for removal of the kidney) rather than a single large incision. It is a standard option for the treatment of kidney cancer. Not all cancers can be removed laparoscopically however. If there is excessive inflammation around the kidney, a large tumour, or the possibility of spread to adjacent structures, then it may be better removed via open surgery.

Partial Nephrectomy

It may be possible to remove only the cancerous tissue and part of the kidney if the tumor is small and confined to the periphery of the kidney. A partial nephrectomy may be the procedure of choice for patients with RCC in both kidneys and for those who have only one functioning kidney. It is usually performed via the open approach, but may also be performed laparoscopically.

Systemic therapy

Unfortunately, kidney cancer has sometimes spread to distant sites in the body (metastasized) by the time of diagnosis. It is usually incurable at this stage, but modern systemic treatments may be given, which have shown improved survival. It is worth discussing this form of treatment with your urologist or medical oncologist (cancer specialist) as there may also be the option of involvement in clinical trials of newer drugs.

For a consultation with one of our urologists, please call AUA on 03 8506 3600.