Treatment for early kidney cancer

Saturday 1 November, 2014

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On this page: Surveillance | Surgery | Radiofrequency ablation | Cryotherapy | Arterial embolisation | Key points


Treatments for early-stage kidney cancer include surgery and radiofrequency ablation. Other options might include cryotherapy and arterial embolisation. In some cases, your doctor might recommend surveillance.

Surveillance 

When small tumours (less than 4 cm in diameter) are found in the kidney, they are less likely to be aggressive. Sometimes, a smaller tumour is benign (not cancer). Even if a small tumour is cancerous, it might not grow during a person’s lifetime and, if so, might pose little risk to their health.

Doctors might suggest keeping a watch on some small tumours rather than treating them immediately. This is called surveillance. This will be done using regular ultrasounds or CT scans. If these imaging tests suggest that the tumour appears to grow at any time, you will be given treatment (usually surgery).

Surveillance might help to avoid the loss of kidney function and other side effects associated with different types of treatment. This is particularly important if the tumour is unlikely to be cancerous.

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

Surgery

Surgery is the main treatment for kidney cancer that has not spread outside the kidney (stages 1 and 2). The operation your doctor recommends will depend on the type of kidney cancer you have, your general health and the stage and grade.

If surgery is an option, the operation your doctor recommends will depend on the type of kidney cancer you have, your general health and the stage and grade of the cancer.

Types of surgery

You might have one of the following operations:

Removing the whole kidney (radical nephrectomy)

This is the most common type of operation for large renal cell carcinoma tumours. The whole affected kidney, a small part of the ureter and surrounding fatty tissue are removed. The adrenal gland and nearby lymph nodes might also be removed. However, sometimes it’s not possible to remove all the tissue affected by the cancer.

Removing part of the kidney (partial nephrectomy)

This is more commonly performed for tumours smaller than 4 cm in diameter that are easily accessible. It might also be used for people with cancer in both kidneys or only one working kidney. The cancer along with a small part of the kidney is 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. 

Types of surgery

Jodie’s story

"I had not been well for about a year and one day I saw blood in my urine. By the end of the day I was in such pain I ended up in emergency, where I was told it was kidney stones that should pass in a couple of days. When they didn’t, I followed up with my doctor who sent me for further scans.

"I was in shock when the specialist said I had kidney cancer. I was booked in for surgery about three weeks after the initial diagnosis, but within a week I couldn’t pass urine and ended up back in emergency, where I stayed until my surgery.

"After the surgery I was in quite a bit of pain and discomfort, and had lots of trouble going to the toilet. My greatest concern has been about the cancer coming back. For a while it was my first waking thought. Time has helped me deal with this. Every check-up has reassured me that things are okay. At first I had six-monthly check-ups, but now they’re yearly.

"My family was great during this period; both my husband and son were very supportive. I was concerned I was driving my family crazy because I found the experience so consuming it was all I could talk about. I couldn’t find information and there was no support group that I was aware of, except online – that’s why I felt it important to become a volunteer in a peer support program. I always tell people that it was a really scary experience, but that it’s okay to be afraid.

"At the time of the diagnosis I was working as an office manager, but afterwards we decided we needed to reassess our life. I changed jobs and we moved house. I now work in aged care, which I love, and we moved from a big house to a small apartment overlooking the sea. I learnt to go with the flow and that life will be all right." 

Tell your cancer story.

How the surgery is done 

The surgery can be performed using different surgical methods.

A radical nephrectomy is usually performed as keyhole surgery (laparoscopically), but if the tumour is large, it may be performed by an open cut (incision). In most cases, a partial nephrectomy is done by a conventional incision , but sometimes it’s done laparoscopically or with the assistance of a robot.

Surgery is usually carried out under a general anaesthetic.

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.

Keyhole surgery (laparoscopy)

The surgeon will make several small incisions and insert a tiny telescope (laparoscope) into one of the cuts. The laparoscope takes pictures of your body and projects them onto a TV screen. The surgeon inserts tools into the other incisions and performs the surgery using the images on the screen for guidance.

People who have laparoscopic surgery usually have a shorter hospital stay, less pain and a faster recovery time. However, laparoscopic surgery is not the best approach for everyone. Talk to your doctor about your options.

Robot-assisted surgery

This is a type of keyhole surgery. A surgeon makes small incisions in the abdomen and the camera and instruments are put in through the incisions to do the surgery. The surgeon then carries out the surgery using a machine to control the robotic arms. The surgeon has a 3D view of the operating area that they can magnify up to 10–12 times. There is no evidence yet that this type of surgery is better than other types. 

There is currently no standard treatment given to reduce the risk of kidney cancer coming back after surgery (called adjuvant treatment). Targeted therapies and immunotherapies are being tested in clinical trials to work out if they can help reduce the risk of the cancer coming back.  

What to expect after surgery 

After surgery, you will be in hospital for 3–7 days.

Drips and tubes

You will be given fluids and medication through a tube inserted into a vein (intravenous drip). You will also have other temporary tubes in place to help drain waste fluids away from the site of the operation.

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, and it helps 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 medication to help control it. You might have an anaesthetic injected into the area around your spine (called an epidural), pain-killers injected into a vein or muscle, or a patient-controlled analgesic system, called a PCA system. The PCA system delivers a dose of pain relief medication when you push a button.

Movement

You may see a physiotherapist while you are in hospital. They can explain the safest way to move after your surgery 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 a while 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.

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. 

Radiofrequency ablation 

Radiofrequency ablation (RFA) is a minimally invasive treatment that is still being assessed in clinical trials. RFA uses a probe that generates heat to kill cancer cells and form internal scar tissue in a specific area of the body.

Although it is not as effective as surgery, RFA is sometimes used for patients who have a renal cell carcinoma smaller than 4 cm that is located near the edge of the kidney. These patients are unable to have an operation.

You might be given an anaesthetic, and a specialist then inserts a needle into the tumour under the guidance of a CT scan. An electrical current is passed into the tumour from the needle.

Most people only need to have this treatment once. It 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.

Cryotherapy 

Cryotherapy (or cryosurgery) is a type of treatment that freezes and kills cancer cells. It is an emerging treatment that is still being evaluated. Trials have shown that cryotherapy is not as effective as surgery, and is not suitable for kidney tumours larger than 4 cm.

You will be given an anaesthetic for this treatment. The doctor will insert a probe into the tumour (either during surgery or under CT scan guidance) and inject liquid nitrogen, which freezes the surrounding area and destroys the cancer cells. Afterwards, the frozen tissue thaws and is absorbed by the body.

The procedure typically takes about an hour. You might have to stay in hospital overnight. Side effects include pain, which can be managed with medication, or bleeding.

Few hospitals are equipped to perform cryotherapy, so if it is recommended, ask your doctor where it is administered and how much it costs.  

Arterial embolisation 

Arterial embolisation is a procedure that blocks the blood supply to the tumour. Without blood flow, the tissue can’t get the food and oxygen it needs to survive, so the kidney and the tumour inside it shrink and die.

This procedure might be an option if you are unsuitable for surgery.

During treatment, a tube called a catheter is inserted into the artery using an x-ray as a guide. A substance is then injected through the catheter to block the artery’s blood flow.

Side effects might include pain in the back and a high temperature. Another risk of this treatment is the cancer cells breaking off and spreading to other parts of the body. Discuss this with your doctor.

Key points

  • If you have a small tumour (smaller than 4 cm) or a tumour that is benign (not cancer), your doctor might recommend surveillance rather than treatment. This means that instead of having treatment, you will be monitored with regular check-ups. If the tumour changes, treatment might be offered.
  • 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 performed using different surgical techniques, including open surgery, keyhole surgery or robot-assisted surgery.
  • The recovery time after surgery varies, depending on the type of surgery.
  • Most people are in hospital for 3–7 days following surgery.
  • If the tumour is smaller than 4 cm, you may have other treatments, some of which are still being evaluated in clinical trials.
  • Radiofrequency ablation uses heat from a probe to kill cancer cells.
  • Cryotherapy freezes and kills cancer cells. This treatment is not available at all hospitals.
  • If you’re unable to have surgery, arterial embolisation may be a treatment option. This blocks the blood supply to the tumour so it shrinks and dies. 

Reviewed by: A/Prof Manish Patel, Urological Cancer Surgeon, University of Sydney and Westmead and Macquarie University Hospitals, NSW; Prof Ian Davis, Professor of Medicine and Head of Eastern Health Clinical School, Faculty of Medicine and Nursing and Health Science, Monash University, and Senior Medical Oncologist, Eastern Health, VIC; Karen Hall, Nurse Counsellor, Helpline, Cancer Council SA, and Clinical Nurse, Oncology/Haematology Inpatient Unit, Flinders Medical Centre, SA; Julie McGirr, Cancer Helpline Nurse, Cancer Council Victoria, VIC; and Jodie Turpin, Consumer.

Updated: 01 Nov, 2014