KIDNEY CANCER

 

What causes kidney cancer?

Most kidney cancers are sporadic (no obvious cause) however risks include:

  • Smoking

  • Obesity

  • Family history

  • Genetic conditions

  • Renal cysts acquired from chronic kidney failure

 

How common is kidney cancer?

  • Accounts for 2-3% of adult cancers

  • Men are at higher risk than women

 

What are the symptoms of kidney cancer?

Most kidney cancers these days are detected incidentally on x-rays (ultrasound or CT scan) during investigations of other problems

 

Symptoms usually develop in advanced disease and can include:

  • Blood in urine (haematuria)

  • Flank pain

  • Feeling a mass in the abdomen

  • Weight loss

 

How is kidney cancer diagnosed?

  • Renal masses are most commonly identified on ultrasound and/or CT scan

  • A CT scan of the abdomen is necessary to provide information on size, extent and location prior to determining treatment options

  • A CT chest is routinely performed to look for spread (metastasis) of cancer

 

What is the role of biopsy of a kidney tumour?

Biopsy is not indicated in most cases, as at least 80% of solid lesions in the kidney detected on CT will be kidney cancers

 

Biopsy may be indicated if:

  • There is a history of previous cancers elsewhere to rule out metastasis

  • Lymphoma is suspected

  • Tumour is <4cm, to help decide if treatment with surgery is required

 

How is localised kidney cancer treated?

Surgery is the most effective treatment option for attempting to cure kidney cancer

 

If the staging x-rays show no spread beyond the kidney, the potential options include:

 

  1. Radical Nephrectomy: removal of the entire kidney (with tumour) and surrounding fat

  • In most cases this will be performed laparoscopically (key hole)

 

  1. Partial Nephrectomy: removal of just the tumour from the involved kidney, (leaving the majority of healthy kidney behind)

  • Now considered the gold standard treatment option for smaller kidney tumour (usually <4cm)

  • This is usually performed robotically assisted (key hole)

  • This is Particularly beneficial for patients with impaired baseline kidney function or medical conditions which may impair kidney function in the future (e.g. diabetes)

 

  1. Ablative procedures:

    1. RFA (radiofrequency ablation)

  • Uses thermal energy to ablate the tumour

  • Used in carefully selected patients with small localised kidney tumours not fit for surgery or who don’t want surgery but want some form of treatment

  • It is less effective than surgery, however offers better results than observation

    1. Cryoablation

  • Similar to RFA, but utilises freezing/thawing to ablate the tumour

 

  1. Observation is an option if:

  • The patient is unfit for surgery due to age or other medical conditions

  • The tumour is very small and slow growing (the risk of a tumour less than 4cm spreading to other organs is only 1-2%)

 

What if the kidney cancer has spread (metastasised)?

  1. TKI’s (Tyrosine Kinase Inhibitors) and other targeted therapies

  • Standard chemotherapy agents are not effective at treating kidney cancer

  • TKI’s are a relatively new class of drugs that work by reducing the blood vessel growth to the cancer and shrink the tumour

  • These agents will be administered under the care of a medical oncologist

  • Survival can be improved by several months

 

  1. Radiotherapy:

  • May be used to help control local symptoms from a bleeding kidney cancer if surgery is not possible

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