Renal cancer is also known as kidney cancer. It is one of the common cancers in the UK. Renal cancer is slightly more common in men than women. The incidence of renal cancer has been steadily increasing worldwide and in the UK. Modern lifestyle, poorly controlled high blood pressure, obesity and smoking are linked to the rise in incidence of renal cancer.
Most of patients with renal cancer are diagnosed incidentally. When a patient has a scan for unrelated medical reason.
Rarely, patients might present with symptoms suggestive of renal cancer. These symptoms might include blood in the urine, swelling in the area of the kidney and pain in lower back area (later on).
Less commonly, patient might present with generalised non specific symptoms including: fatigue, loss of appetite, weight loss, recurrent fevers, high blood pressure and anaemia.
Patients might need to have CT or MRI scans to make the diagnosis of renal cancer. Occasionally, a biopsy is recommended to make the diagnosis certain. Biopsy is usually performed under local anaesthetic. A small tissue sample is taken form the tumour. The tissue sample is examined under microscope to make the diagnosis.
More than 90 per cent of renal cancer originates from the lining of tiny tubules in the kidney, This type called renal cell cancer (RCC), RCC has different subtypes. This usually named according to the appearance of cells when examined under the microscope.
The surgical treatment of this cancer involves surgical removal of part or the whole kidney.
Less common type of kidney cancer is transitional cell cancer (TCC). This type fo cancer originates from the lining of the urinary system. It can be present in the kidney or the ureter (the tube draining the kidney). This cancer can be potentially more aggressive. Surgical removal of the kidney and ureter is the gold standard treatment for most cases.
All patients with renal cancer are discussed at multidisciplinary team (MDT) meeting. The team is made up of urologists with interest in renal cancer, radiologists with interest in renal cancer, oncologists with interest in renal cancer and renal cancer nurse specialists.
Treatment is planned according to the size, extend and location of tumour and patient’s general health. MDT will plan an individualised treatment to meet the needs of the patient.
Surgery is the mainstay treatment for renal cancer. Surgical removal of renal cancer is normally planned according the size and location of the tumour.
• Robotic Assisted Partial Nephrectomy: This is also known nephron sparing surgery. It involves removing the renal tumour with a very small amount of normal kidney tissue surrounding the tumour. This is now considered the main surgical treatment for all patients with tumour size up to 4cm and for some patients with tumour size between 4 - 7 cm. In most of the cases, the procedure is performed using the Da Vinci® Surgical System.
• Laparoscopic Radical Nephrectomy: This is a keyhole operation. The procedure involves removing the whole kidney and its adipose capsule (fat layer). The procedure is reserved for large tumour.
• Open Radical Nephrectomy: The procedure involves removing the whole kidney and its adipose capsule via open surgery. This operation is usually reserved for very large tumour.
• Nephroureterectomy: The procedure involves removing the kidney and the whole ureter (tube draining the kidney). The procedure is performed laparoscopically (keyhole) or using the Da Vinci® Surgical System.
This technique uses small freezing needles to kill cancer cells. It can cure small renal cancer (typically < 4cm).
• Percutaneous cryotherapy is performed with help of CT scan. Small needles are inserted through your skin with the guidance of CT scan.
• Laparoscopic cryotherapy is a keyhole procedure. The surgeon uses the camera to locate the tumour and insert the freezing needles directly to the tumour.
3- Active Surveillance:
Small renal masses are generally very slow growing tumours. Active surveillance is proven to be a valid strategy in patients for whom the risks of surgical treatments outweigh the benefits of treating small renal masses.
Once MDT outcome recommends active surveillance. Subsequently, the patient will be enrolled in the active surveillance programme. Patient will receive regular scans and follow-up appointments.