renal%20cancer
RENAL CANCER

Renal cancer is the disease in which certain tissues of the kidney starts to grow uncontrollably and form a tumor.

It is also called as renal adenocarcinoma or hypernephroma.

Classic triad of symptoms are flank pain, palpable abdominal mass and gross hematuria.

Surgical Intervention

  • The preferred treatment for renal cell carcinoma
  • The choice of surgical procedure depends on the extent of the disease, as well as patient-specific factors such as age and comorbidity
  • May be carried out through a conventional approach or by a minimally-invasive approach

Partial Nephrectomy or Nephron-Sparing Surgery (NSS)

  • Indicated in patients with solitary kidney, one kidney with contralateral renal function and bilateral synchronous renal cell carcinoma (RCC)
  • May also be considered in young patients or those with comorbidities at relative risk for progressive chronic renal disease 
  • Preferred surgical management for patients with stage I (pT1a, pT1b)
  • Only the diseased or injured portion of the kidney is removed
  • Contraindicated in patients with locally advanced tumor growth, tumor in an unfavorable location, or with confirmed nodal metastases

Radical Nephrectomy

  • The most widely used approach and the preferred procedure if there is evidence of invasion into the adrenal gland, renal vein or perinephric fat
  • Involves the removal of the entire kidney along with a section of the tube leading to the bladder, ureter, adrenal gland and fatty tissues surrounding the kidney
  • Preferred surgical management for patients with stage II-III
  • With increased risk for chronic kidney disease and cardiovascular morbidity and mortality compared to NSS

Ablative Techniques

Cryoablation

  • Indicated for <3 cm solitary renal tumor located away from the collecting system

Microwave Ablation

  • Indicated for frail patients at high surgical risk with ≤3 cm solitary renal tumor, renal impairment, hereditary RCC or multiple bilateral tumors

Radiofrequency Ablation

  • An alternative treatment in patients with contraindications to nephrectomy, Von Hippel-Lindau disease and unfit elderly patients
  • Creates molecular friction, denaturation of cellular proteins and cell membrane disintegration
  • Heat-based tissue destruction with a high-frequency electrical current (400 to 500 kHz)

Other Procedures

Adrenalectomy

  • Considered in patients with large upper pole tumors or abnormal-appearing adrenal glands on CT scan and must be decided on an individual basis

Cytoreductive or Debulking Nephrectomy

  • Mostly involves the removal of the primary tumor from the kidney
  • Recommended in patients with good performance [Eastern Cooperative Oncology Group (ECOG) performance status <2] preceding systemic therapy and no brain metastasis
  • May be considered in patients with stage IV or relapsed disease if primary tumor is surgically resectable

Metastasectomy

  • The lungs, bones, brain and liver are the most common sites of metastasis
  • Patients with stage IV disease may be considered for metastasectomy if:
    • Primary RCC and oligometastatic sites (includes lung, bone, brain) present upon initial diagnosis
    • Patient develops oligometastases after prolonged disease-free interval after nephrectomy

Regional Lymph Node Dissection

  • May be considered in patients with enlarged or palpable lymph nodes seen in preoperative imaging tests

Risks and Side Effects of Surgery

  • Short-term risks includes reactions to anesthesia, excess bleeding (may require blood transfusions), blood clots and infections
  • Damage to internal organs and blood vessels (spleen, pancreas, aorta, vena cava, large or small bowel) during surgery
  • Leakage of urine into the abdomen (after partial nephrectomy)
  • Kidney failure (if the remaining kidney fails to function well)

Palliative Surgery

  • For management of spinal cord compression or possible/confirmed fractures in weight-bearing bones in select patients
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