It is important to realize that with timely diagnosis and kidney cancer treatment in Delhi, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent. The following information addresses the most common questions about kidney tumors and serves as a supplement to the discussion that you have with your uro oncologist in Delhi.
What happens under normal conditions?
Most people have two functional kidneys. The kidneys produce urine that drains through narrow tubes (called ureters) into the bladder. The kidneys are usually located in each flank protected by muscles of the back and rib cage. The kidneys are contained within a fibrous sheath called the Gerota’s fascia and surrounded by a layer of fat. The kidney capsule is a thin layer that covers the outer surface of the kidney (similar to the red peel of an apple). The primary vein that drains the kidney (renal vein) merges with the vein that takes blood to the heart (vena cava). An adrenal gland is located above each kidney within Gerota’s fascia.
The adrenal glands, which are not part of the kidney, are located near the top of each kidney. The adrenal glands regulate blood sugar, potassium, body fluids and sex hormones. They also control the body’s response to stress by producing a hormone called adrenaline.
The kidney is the main filter of the body and thus performs many bodily functions, such as controlling fluid balance, regulating electrolytes (e.g., sodium, potassium, calcium, magnesium), preventing acid buildup, eliminating waste products, producing urine, and regulating blood pressure. The kidney also manufactures a hormone called erythropoietin that stimulates the production of red blood cells.
When the kidneys are damaged or a significant portion of kidney tissue is removed, the normal processes listed above may be impaired. In most cases, mild to moderate impairment causes very minor problems. In cases when kidney function is severely impaired, dialysis may be required.
What is a kidney tumor?
A kidney tumor is an abnormal growth within the kidney. The terms “mass,” “lesion” and “tumor” are often used interchangeably. Tumors may be benign (non-cancerous) or malignant(cancerous). The most common kidney lesion is a fluid-filled area called a cyst. Simple cysts are benign and have a typical appearance on imaging studies. They do not progress to cancer and usually require no follow-up or treatment. Solid kidney tumors can be benign but are cancerous more than 80 percent of the time.
What are the risk factors associated with kidney cancer?
The following associations may increase the risk of developing kidney cancer:
- family history of kidney cancer
- chronic kidney failure and/or dialysis
- diet with high caloric intake or fried/sauteed meat
- Von Hippel-Lindau syndrome
- tuberous sclerosis
What are the symptoms of kidney cancer?
Many kidney tumors do not produce symptoms but may be detected incidentally during the evaluation of an unrelated problem or during routine screening for people who are in high-risk categories (e.g. Von Hippel-Lindau disease, tuberous sclerosis). Compression, stretching and invasion of structures near the kidney may cause pain (in the flank, abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung, bone pain or fracture may occur when cancer is in the bone and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 20 percent of patients with kidney cancer and can occur at any stage (including cancers confined to the kidney). Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated red blood cell sedimentation rate, low blood count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high blood count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.
How is kidney cancer diagnosed?
Unfortunately, there are no blood or urine tests that directly detect the presence of kidney tumors.
When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if cancer has spread beyond the kidney (metastasis). An evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray, and blood tests. A bone scan is also recommended if the patient has bone pain, recent bone fractures, or certain abnormalities on their blood tests. Additional tests may be obtained when indicated. Kidney cancer has the tendency to grow into the renal vein and vena cava. The portion of cancer that extends into these veins is called “tumor thrombus.” Imaging studies, particularly CT or MRI, can help determine if tumor thrombus is present.
What are the different stages of kidney cancer?
The most commonly used staging system for kidney cancer was developed by the American Joint Committee on Cancer (AJCC). The most current version is the 2009 AJCC Staging System. This staging system includes the extent of the primary kidney tumor (T stage), the status of lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage). In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging cancer helps predict prognosis and survival. In general, cancers with higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates, and these patients need to consider more aggressive treatments.
Grade: Tumor grade is a subjective measure of how aggressive the tumor looks under the microscope; therefore, it is determined from a surgical specimen. The grade cannot be determined from radiographic imaging, blood tests or urine tests. Grade usually ranges from one to three or one to four, with higher numbers indicating a more aggressive tumor. Thus, higher grade implies a worse prognosis.
Stage I: The tumor is confined to the kidney and less than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
Stage II: The tumor is confined to the kidney and greater than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade into other adjacent organs or those with distant metastasis.
Stage IV: There are several combinations of T, N, and M categories that are included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall and those with distant metastases.
What are the treatment options for tumors that appear confined to the kidney?
When the tumor appears confined to the kidney (a “localized” tumor), there are three main options for kidney cancer treatment in Delhi: tumor removal, tumor ablation, and surveillance. Chemotherapy, hormone therapy, and radiation therapy are not effective treatments for kidney cancer.
Tumor removal: Tumor removal is considered the standard mode of therapy for most patients and is accomplished by performing a surgery called nephrectomy. Radical nephrectomy is the surgical removal of everything within Gerota’s fascia, including the whole kidney. Partial nephrectomy is surgical removal of part of the kidney (in this case, the part that contains the tumor). The goal of partial nephrectomy is to remove the entire tumor while preserving as much normal kidney tissue as possible. The kidney tissue that is conserved may prevent the need for dialysis if subsequent kidney damage occurs. Nephrectomy can be performed through a traditional incision (open surgery) or through several small incisions (laparoscopic orretroperitoneoscopic surgery). Partial nephrectomy is now considered the reference standard for the management of confined kidney tumors because it saves as much kidney function as possible. Loss of kidney function is associated with an increased risk of cardiovascular events and reduced survival bases on several recent studies in the field.
Open nephrectomy (radical and partial): Traditional open nephrectomy (partial or radical) is performed through a flank or abdominal incision. This incision is typically 3-8 inches in length and may include removal of a rib. In the past, open radical nephrectomy was considered the treatment of choice for tumors that appeared to be confined to the kidney. However, five- to 10-year follow up reveals that partial and radical open nephrectomies provide equally effective cancer treatment for many patients with a single, small, localized tumor. Therefore, partial and radical nephrectomies are now considered standard treatments. If you are interested in partial nephrectomy, it is important that you seek a urologist who has experience with this technique.
As stated before, partial nephrectomy is performed to preserve as much normal kidney tissue as possible; however, its complication rate may be slightly higher than radical nephrectomy. Open partial nephrectomy is usually the treatment of choice when radical nephrectomy results in either immediate dialysis or a high risk for subsequent dialysis, such as when the patient has a single functioning kidney, poor overall kidney function, medical or genetic diseases that threaten kidney function or bilateral kidney tumors. Partial nephrectomy is usually not recommended in patients with tumors that have any of the following characteristics: extension into the renal vein, close proximity to the main kidney vessels or factors that would make complete tumor resection unlikely. When the tumor cannot be safely removed by partial nephrectomy, radical nephrectomy is performed. If you elect to undergo a partial nephrectomy, there is always a risk that the entire kidney may need to be removed.
Laparoscopic radical nephrectomy: Laparoscopic nephrectomy is performed using telescopes that are inserted into the abdominal cavity through small “key hole” incisions; however, a somewhat larger incision is often made to permit removal of an intact kidney. Nephrectomy performed by inserting the telescopes into the cavity that surrounds the kidney (rather than into the abdominal cavity) is called retroperitoneoscopic nephrectomy.
Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that appear confined to the kidney. Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, shorter hospital stay and shorter recovery time. If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the “key hole” incisions to a larger incision). Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein. Open nephrectomy is preferred in patients with severe scarring around the kidney or a history of extensive abdominal surgery. Best urologist in Delhi who are experienced with retroperitoneoscopy may consider this approach in patients with a history of extensive abdominal surgery.
Laparoscopic and retroperitoneoscopic partial nephrectomy: Information is accumulating on laparoscopic (or robotic) and retroperitoneoscopic partial nephrectomy, and these are good approaches in many patients. In general, this approach is best suited for relatively small, peripherally located tumors that are relatively easy to remove and for which reconstruction of the kidney is straightforward.
Tumor ablation: Tumor ablation destroys the tumor without surgically removing it. Examples of ablative technologies include cryotherapy, interstitial radiofrequency ablation, high- intensity focused ultrasound, microwave thermotherapy and laser coagulation. Ablation can be accomplished during open surgery, laparoscopy, retroperitoneoscopy or percutaneously (through the skin). Since renal tumor ablation is a relatively new procedure, long-term results are not as well defined, and tumor recurrences appear to be somewhat more common than after surgical excision. However, ablation may be less invasive than nephrectomy and may be useful in patients who cannot tolerate a more extensive surgery. Tumor ablation may also permit a better chance of preserving kidney function in situations when multiple tumors are present. In general, tumor ablation is best reserved for older or somewhat frail patients.