Kidney cancer


Treatment for early kidney cancer

Tuesday 1 January, 2019

Early kidney cancer (stages I and II) is localised. That means the cancer is found only in the kidney or has not spread very far. The main treatment is surgery to remove the tumour from the body. Less often, non-surgical treatments, such as radiofrequency ablation and stereotactic body radiation therapy, are used to try to kill the tumour. 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 you may experience after 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, active surveillance 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, GP 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 grade and stage of the cancer, and your general health, you might have one of the following operations:

Removing part of the kidney (partial nephrectomy)

This is the preferred option for small tumours that are confined to the kidney. It may also be used 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.

Partial nephrectomy

Image: Partial nephrectomy. A small part of the kidney is removed.

If a whole kidney or part of a kidney is removed, the remaining kidney usually carries out the work of both kidneys. Your doctor will talk to you about any steps you need to take to protect the remaining kidney.

Removing 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.

Radical nephrectomy

Image: Radical nephrectomy. The kidney and a small part of the ureter are removed. The adrenal gland and nearby lymph nodes might also be removed.

If a whole kidney or part of a kidney is removed, the remaining kidney usually carries out the work of both kidneys. Your doctor will talk to you about any steps you need to take to protect the remaining kidney.

How the surgery is done

If you have surgery for kidney cancer, it will be carried out in hospital under a general anaesthetic. Your surgeon will talk to you about the risks of the procedure.

Your surgeon will use one of the following methods to remove part or all of the kidney (partial or radical nephrectomy). Each method has advantages in particular situations.

Open surgery

A long 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 cuts in the skin and insert a tiny instrument with a light and camera (laparoscope) into one of the cuts. The laparoscope takes pictures of your body and displays them on a TV screen. The surgeon inserts tools into the other cuts 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 cuts in the abdomen, and the camera and instruments are inserted through the cuts 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 the types of surgery available to you, and the pros and cons of each option. If your surgeon suggests robotassisted 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. See Understanding Surgery.

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.

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. Your recovery time will depend on your age, general health and the type of surgery that you had.

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 that is attached to a bag to collect 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.

Blood clots

You may have to wear compression stockings to help the blood in your legs circulate and prevent blood clots.

Pain relief

You will have some pain in the areas where the cuts in the skin 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.

Movement

Your health care team will probably encourage you to walk the day after the surgery.

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 or coughing 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.

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. Focus on eating a balanced diet (including proteins such as lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds and legumes/ beans) to help your body recover from surgery.

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.

Other treatments

Surgery is the most accepted treatment for early 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 (RFA)

Radiofrequency ablation 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 fine needle into the tumour through the skin, using a CT scan as a guide. 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 medicines.

Stereotactic body radiation therapy (SBRT)

Radiation therapy uses a controlled dose of radiation, such as x-ray beams, to kill or damage cancer cells. Standard radiation therapy is not effective in treating primary kidney cancer and is given primarily to control symptoms such as bleeding or pain. Some studies, however, show promising results for SBRT as a treatment for kidney cancer and your doctor may recommend it in particular situations. SBRT is a highly targeted form of radiation therapy that delivers tightly focused beams of high-dose radiation precisely onto the tumour from many different angles. SBRT is sometimes called stereotactic ablative body radiation therapy (SABR).

Key points about early kidney cancer

What it is

Early kidney cancer is cancer that has not spread outside the kidney. It is known as localised cancer or stage I or II.

The main treatment

The main treatment is surgery to remove the whole kidney (radical nephrectomy) or part of the kidney (partial nephrectomy).

How surgery is done

Surgery for kidney cancer may be done as:

  • open surgery – one large cut
  • laparoscopic surgery – several smaller cuts and the use of a tiny surgical instrument with a camera and light
  • robot-assisted surgery – a type of laparoscopic surgery.

Recovery time varies. Most people are in hospital for 2–7 days after surgery for kidney cancer, and it may be several weeks until you can safely return to your usual activities.

Other treatment options

For small tumours, other options may include:

  • active surveillance – watching the cancer carefully through regular check-ups before having treatment if the tumour changes
  • radiofrequency ablation – uses heat from a needle to kill the cancer cells
  • stereotactic body radiation therapy – uses highly targeted radiation to destroy or damage the cancer cells.

Expert content reviewers:

A/Prof Declan Murphy, Urologist and Director of Genitourinary Oncology, Peter MacCallum Cancer Centre, VIC; Dr Carole Harris, Medical Oncologist, St George and Sutherland Hospitals, and Clinical Lecturer, The University of New South Wales, NSW; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA; A/Prof Shankar Siva, Radiation Oncologist, Peter MacCallum Cancer Centre, VIC; Beth Stone, Consumer.

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