Treatment for early kidney cancer

Tuesday 1 November, 2016

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On this page: Active surveillance | Surgery | Other treatments | Chris's story | Key points


Early-stage kidney cancer (stages I and II) is localised – it is confined to the kidney or has not spread very far. The main treatment is surgery. Less often, non-surgical treatments, such as radiofrequency ablation and stereotactic body radiotherapy, are used to try to kill the tumour without removing it from the body. Sometimes the best approach for localised kidney cancer is not immediate treatment, but to watch the cancer carefully (active surveillance).

Active surveillance

When small tumours (less than 4 cm in diameter) are found in the kidney, they are less likely to be aggressive and might not grow during a person’s lifetime. In this case, your doctor might recommend active surveillance, also known as observation. This involves regular ultrasounds or CT scans. If these imaging tests suggest that the tumour has grown at any time, you will be offered treatment (usually surgery).

Active surveillance might help to avoid the loss of kidney function and other side effects associated with surgery. It can also be a reasonable option if you are not well enough for an operation and the tumours are small.

You might feel anxious about not treating a cancer in your body right away. However, this is a common approach for early kidney cancer and will only be recommended if the doctor thinks it is the best thing to do. If you are worried, discuss your concerns with your urologist or a counsellor.

Surgery

Surgery is the main treatment for kidney cancer that has not spread outside the kidney. Depending on the type of kidney cancer, the stage and grade of the cancer, and your general health, you might have one of the following operations:

Kidney surgery - radical nephrectomyRemoving the whole kidney (radical nephrectomy)

This is the most common operation for large tumours. The whole affected kidney, a small part of the ureter and the surrounding fatty tissue are removed. The adrenal gland and nearby lymph nodes might also be removed. Sometimes the kidney cancer may have spread into the renal vein and even into the vena cava, the main large vein that runs up the body next to the spine. Even if the cancer is in the vena cava, it is sometimes possible to remove all the cancer in one operation.

Kidney surgery - partial nephrectomyRemoving part of the kidney (partial nephrectomy)

This is sometimes an option for tumours that are confined to the kidney, and is particularly useful for people with pre-existing kidney disease, cancer in both kidneys or only one working kidney. Only the cancer and a small part of the kidney are removed, which means more of the kidney’s function is preserved. A partial nephrectomy is a more difficult operation than a radical nephrectomy, and whether it is possible depends on the position of the tumour.

If a whole kidney or part of a kidney is removed, the remaining kidney usually carries out the work of both kidneys.

How the surgery is done

If you have surgery for kidney cancer, it will be carried out in hospital under a general anaesthetic.

Whether all or part of the kidney is removed (radical or partial nephrectomy), different surgical methods may be used. Each method has advantages in particular situations.

Open surgery

A cut (incision) is made at the side of your abdomen where the affected kidney is located. In some cases, the incision is made in the front of the abdomen or in another area of the body where the cancer has spread. If you are having a radical nephrectomy, the surgeon will clamp off the major blood vessels and tubes in the affected kidney before removing it.

Laparoscopic surgery

This is sometimes called keyhole or minimally invasive surgery. The surgeon will make several small incisions and insert a tiny instrument with a light and camera (laparoscope) into one of the cuts. The laparoscope takes pictures of your body and relays them to a TV screen. The surgeon inserts tools into the other incisions and performs the surgery using the images on the screen for guidance.

Robot-assisted surgery

This is a type of laparoscopic surgery. A surgeon makes small incisions in the abdomen, and the camera and instruments are inserted through the incisions to perform the surgery. The surgeon has a 3D view that can be magnified up to 10–12 times and carries out the surgery using a machine to control the robotic arms.

Making decisions about surgery

Talk to your surgeon about what types of surgery are available to you, and the pros and cons of each option. If your surgeon suggests robot-assisted surgery, check what fees are involved – unless you are treated as a public patient in a hospital or treatment centre that offers this at no extra cost, it can be an expensive operation.

Compared to open surgery, both standard laparoscopic surgery and robot-assisted surgery usually mean a shorter hospital stay, less pain and a faster recovery time. However, open surgery may be a better option in some situations.

What to expect after surgery

After surgery, you will usually be in hospital for 2–7 days. Once you are home, you will need to take some precautions while you recover.

Drips and tubes

While in hospital, you will be given fluids and medicines via a tube inserted into a vein (intravenous drip). You will also have other temporary tubes to drain waste fluids away from the operation site.

For a few days, you will most likely have a thin tube inserted in your bladder and attached to a bag that collects urine. This is called a urinary catheter. Knowing how much urine you are passing helps hospital staff monitor the function of the remaining kidney. When the catheter is removed, you will be able to urinate normally again.

Pain relief

You will have some pain in the areas where the incisions were made and where the kidney (or part of the kidney) was removed.

If you are in pain, ask for medicine to help control it. You might have an anaesthetic injected into the area around your spine (epidural), painkillers injected into a vein or muscle, or a patient-controlled analgesia (PCA) system. The PCA system delivers a measured dose of pain relief medicine when you push a button.

Returning home

When you get home, you will need to take things easy and only do what is comfortable. Let your family and friends know that you need to rest a lot and might need some help around the house.

Check-ups

You will need to visit the hospital for a check-up a few weeks after you’ve returned home. You can do this on an outpatient basis.

Movement

You may see a physiotherapist while you are in hospital. They can explain the safest way to move and show you exercises to do while you are recovering. These might include breathing exercises that can help you avoid developing a chest infection.

It will be some weeks before you can lift heavy things, drive, or return to work. Ask your doctor how long you should wait before attempting any of these activities.

Other treatments

Surgery is the most accepted treatment for early-stage kidney cancer. However, if you are not well enough for surgery and the tumour is small, your doctor may recommend another type of treatment to destroy or control the cancer.

Radiofrequency ablation

Radiofrequency ablation (RFA) uses high-energy radio waves to heat the tumour. The heat kills the cancer cells and forms internal scar tissue. For this procedure, the doctor inserts a needle into the tumour under the guidance of a CT scan. An electrical current is passed into the tumour from the needle. The treatment takes about 15 minutes and you can usually go home after a few hours. Side effects, including pain or fever, can be managed with medication.

Stereotactic body radiotherapy

Radiotherapy uses radiation, such as x-rays, to kill or damage cancer cells. It is also know as radiation therapy. Standard radiotherapy is not effective in treating primary kidney cancer, but stereotactic body radiotherapy (SBRT) is looking promising and your doctor may recommend it in particular situations. This is a highly targeted form of radiotherapy that focuses thin beams of radiation onto the tumour from different angles.

Clinical trials are currently testing whether particular targeted therapy and immunotherapy drugs should be given after surgery for early kidney cancer (adjuvant treatment).

Chris’s story

"A few years ago, I became very unwell with appendicitis and had to have my appendix removed. While in hospital, a scan picked up a lump at the bottom of my left kidney. This was an incidental finding – I had symptoms of appendicitis but no symptoms of kidney cancer.

"The urologist talked through the options with me. Because it was a small tumour, only part of the kidney needed to be removed. I could choose between open and laparoscopic surgery. I opted for laparoscopy because it would have a quicker recovery and I knew our hospital had a good track record with it. I was only in hospital for one and a half days. I felt better in two weeks and was back to driving in three weeks, although it took a few months to feel back to normal.

"The pathology tests on the tumour confirmed that it was renal cell carcinoma, but it was a type with a good prognosis."

Tell your cancer story.

Key points

  • If you have a small tumour (smaller than 4 cm), your doctor might recommend active surveillance rather than treatment. You will be monitored with regular check- ups, and treatment might be offered if the tumour changes.
  • The most common treatment for early kidney cancer is surgery. You might have either a radical nephrectomy (removing the whole kidney) or a partial nephrectomy (removing part of the kidney).
  • The surgery can be done using different surgical techniques. Open surgery involves one large cut, while laparoscopic surgery involves several smaller cuts and the use of a laparoscope, a tiny instrument with a camera and light. Robot-assisted surgery is a type of laparoscopic surgery. Each method has advantages in some situations, so discuss the options with your surgeon.
  • Most people are in hospital for 2–7 days after surgery for kidney cancer, and it may be a number of weeks until you can safely return to your usual activities.
  • The recovery time varies, depending on the type of surgery. Recovery after laparoscopic surgery is usually quicker than after open surgery.
  • If the tumour is small and you are not well enough for surgery, you may have other treatments that aim to destroy the tumour without removing it.
  • Radiofrequency ablation uses heat from a probe to kill the cancer cells.
  • Stereotactic body radiotherapy uses highly targeted beams of radiation to destroy or damage the cancer cells.

Reviewed by: Dr Craig Gedye, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Senior Conjoint Lecturer, School of Biomedical Sciences and Pharmacy, The University of Newcastle, NSW; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, WA; A/Prof Declan Murphy, Urologist, Chair of Uro-Oncology and Director of Robotic Surgery, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA, WA; Jodie Turpin, Consumer.
Updated: 01 Nov, 2016