Most kidney cancers are sporadic (no obvious cause) however risks include:
Smoking
Obesity
High blood pressure
Family history
Genetic conditions
Renal cysts acquired from chronic kidney failure
How common is kidney cancer?
Account for 3% of adult cancers
Males more commonly affected than females
What are the symptoms of kidney cancer?
Most kidney cancers these days are detected incidentally on x-rays (ultrasound or CT scan) during investigations of other problems
Symptoms can include:
Blood in urine (haematuria)
Flank pain
Feeling a mass
Weight loss
How is kidney cancer diagnosed?
Kidney cancers are most commonly diagnosed on ultrasound and/or CT scan
A CT scan is necessary to provide information on size and location prior to determining treatment options
Routine imaging of the chest is required to ensure no spread (metastasis) of the cancer
What is the role of kidney mass biopsy?
Biopsy is not indicated in most cases, as approximately 80% of solid lesions in the kidney detected on CT will be kidney cancers
Biopsy may be indicated if:
There is a history of previous cancers elsewhere to rule out metastasis
Lymphoma is suspected
Tumour is small (<3cm), to help decide if treatment with surgery is required
What are the treatment options for localised kidney cancer?
Surgery is the most effective treatment option for attempting to cure kidney cancer. See Urological procedures explained for details on each procedure
If the staging x-rays show no spread beyond the kidney, the potential options include:
Radical Nephrectomy (removal of the entire kidney & tumour, as well as fat surrounding kidney)
In most cases this will be performed laparoscopic (key hole)
Partial Nephrectomy: (surgical removal of just the tumour from the involved kidney, leaving the majority of healthy kidney behind)
Now considered the gold standard treatment option for smaller kidney tumour (usually <4cm)
May be performed laparoscopic or open depending on the size and location of the tumour
Particularly beneficial for patients with impaired baseline kidney function or medical conditions which may impair kidney function in the future (e.g. diabetes)
Ablative procedures:
RFA (radiofrequency ablation)
is a relative new treatment option for select patients with small localised kidney tumours not fit for surgery or who don’t want surgery but want some form of treatment
cancer cure rates are inferior to surgery and longer follow up data is lacking, however offers better results than observation
Observation:
May be discussed as an option if:
The patient is unfit for surgery due to age or other medical conditions
The tumour is very small and slow growing
The risk of a small kidney tumour (<3cm) spreading to other organs is very low (1-2%)
What are the treatment options if my kidney cancer has spread (metastasised)?
TKI’s – Tyrosine Kinase Inhibitors
Standard chemotherapy agents are not effective at treating kidney cancer
TKI’s are a relatively new class of drugs that result in a reduction to the blood vessel growth to the cancer
They can result in significant shrinkage of the tumour
These agents will be administered under the care of a medical oncologist
Survival can be improved by several months
Radiotherapy:
May be used to help control local symptoms from a bleeding kidney cancer if surgery is not possible
Also can be used to help control the growth of advanced kidney cancers where surgery is not an option
