The kidneys are two organs in the back of the abdomen that filter your blood to make urine. Additionally, they make hormones that affect Vitamin D levels and red blood cell production. Most people are born with two kidneys, one that sits on the right and one on the left of the spine. They function separately so that most people are able to survive with just one kidney if necessary.
The majority of kidney cancers are renal cell carcinomas (90%+). These form in the renal tubules which are small structures inside of the kidney that are involved in filtering the urine. Most of the time, there is no obvious cause for kidney cancer, but there are some risk factors that raise the likelihood of getting kidney cancer such as:
- Certain medications
- High blood pressure
- Family history of Kidney Cancer
- Tuberous Sclerosis
- Von Hippel-Lindau Syndrome
Most people do not have any symptoms of kidney cancer and the tumor is found incidentally on an imaging test. Sometimes a kidney cancer can cause blood in your urine, back or abdominal pain, an abdominal mass, fatigue, and weight loss.
Most kidney cancer is now found by imaging tests done for some other reason. If a mass is detected, a urologist will get a medical history, do a physical exam, and may order additional imaging tests to find out the size and location of the tumor prior to treatment.
Unlike many other cancers, a biopsy is not routinely done to confirm kidney cancer prior to treatment. In many situations, the chance of the mass being cancer is very high, and sometimes a biopsy does not give an accurate diagnosis.
Surgery is the main treatment for most forms of kidney cancer. The primary goal is to remove all of the cancer cells from the body. There are several types of procedures that may be performed depending on the size and location of your tumor.
If only a part of the kidney needs to be removed with the tumor the procedure is called a partial nephrectomy. This is typically done for small masses less than 4cm and in some cases up to 7cm in size. This procedure may be done as an open, laparoscopic, or robotic procedure. A partial nephrectomy is a more complicated procedure than a radical nephrectomy (removing the entire kidney). This procedure involves isolating the tumor as well as the major blood vessels to the kidney, removing the tumor safely, and then repairing the kidney. A partial nephrectomy is usually performed for smaller, earlier stage cancers. This procedure has less of an impact on overall kidney function and is ideal for patients with poor kidney function before surgery. However, if the tumor is too large to be removed safely, or involves the major blood supply to the kidney, a radical nephrectomy may be performed.
A radical nephrectomy is a procedure that removes the entire kidney and the fat around the kidney. In some situations, the surgeon may also remove the adrenal gland and nearby lymph nodes. This procedure is the standard treatment for larger kidney masses and those that have spread into the renal vein.
In some situations, for small tumors, patients may elect active surveillance. This involves frequent imaging studies to monitor for cancer growth. The goal here is to delay treatment until a later date because some small kidney masses may not grow or spread.
If a patient is not healthy enough for a surgery, there are other alternatives such as cryotherapy or radio-frequency ablation. These procedures use either cold or heat to destroy cancerous cells. A small needle is inserted into the tumor and heat or cold energy is applied to the cancer and the surrounding tissue to kill the cancer cells without removing them. These procedures work well only for smaller tumors but do not treat cancer as well as surgery. However, these may be done under local or sedation rather than a general anesthetic.