KIDNEY TUMORS

KIDNEY TUMORS

 

Most people have two functional kidneys. A kidney tumor is an abnormal growth within the kidney. Tumors may be benign or malignant. The most common kidney lesion is a fluid-filled cyst. Simple cysts are benign and have a typical appearance on imaging studies. Solid kidney tumors can be benign, but are malignant in the vast majority. About 2-3 percent of all cancers arise from the kidney. The most common kidney cancer is called renal cell carcinoma (RCC).

Symptoms Of Kidney Cancer:

1) Asymptomatic (incidental detection) 2) pain in the flank, abdomen or back, 3) palpable mass, 4) blood in the urine (microscopic or gross) 5) symptoms due to distant spread to lungs, bone, liver etc. 6) paraneoplastic syndromes. 

Diagnosis Of Kidney Cancer:

1) The initial imaging study is usually an ultrasound followed by CT scan for confirmation and staging 2) An evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray and blood tests. A bone scan may also be required in some cases.

Treatment Options For Localized Kidney Cancer:

Radical nephrectomy: This is the gold standard for treatment and involves open surgical removal of the whole kidney and its covering fascia (of Gerota's) often with the ipsilateral adrenal gland.

Laparoscopic Radical Nephrectomy: Keyhole surgery is coming up in a big way because the smaller access incisions afford rapid recovery and less discomfort. It can be performed either retroperitoneally or transperitoneally, but is currently reserved for smaller tumors (<8cm) and at centers that have the necessary expertise and experience.

Partial Nephrectomy (open or laparoscopic): This is reserved for tumors less than 4 cm in size if the opposite kidney is normal, and is the treatment of choice for patients with solitary kidney. To do this operation laparoscopically requires a great degree of skill and experience with urologic laparoscopy and is currently available at very few centers in the world.

Experimental  Alternative: Tumor ablation methods: cryotherapy, interstitial radiofrequency ablation, high- intensity focused ultrasound, microwave thermotherapy and laser coagulation. Ablation can be accomplished during open surgery, laparoscopy, retroperitoneoscopy or percutaneously. Tumor ablation 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. Embolization: This is not a standard treatment option, but may be considered in patients who cannot tolerate tumor removal or ablation. It may also be considered as an adjunct to standard forms of treatment.

 

Treatment Of Kidney Tumors That Invade The Vena Cava:

When tumor invades into the renal vein or vena cava, open surgery is almost always recommended to remove the affected kidney and to extract the tumor from the veins. Sometimes embolization is performed before tumor removal. Embolization may also be considered in patients who cannot tolerate surgery.

 

Treatment options for metastatic disease: 

·         Nephrectomy followed by immunotherapy (with interferon alpha or interleukin-2)

·         Immunotherapy alone

·         Clinical research trials (involving chemotherapy or immunotherapy or combinations of both)

·         Newer monoclonal antibody based drugs

·         Radiation to metastases in bone or brain

Things to remember:

1)    After treatment for kidney cancer, routine life-long surveillance is necessary with periodic assessment by a physician, blood tests and X-rays. Unfortunately there are no proven ways to prevent recurrence

2) Patients with only one kidney after removal of the other usually have no adverse effects or handicaps although contact sports and drugs that can damage the kidney should be avoided.

3) There are many factors that affect outcome after treatment for kidney cancer. The two most important prognostic factors are tumor stage and grade. Higher stage and grade implies a lower chance of cure.

4) For kidney tumors, needle biopsy is usually not indicated because more than 90 percent of solid kidney tumors are cancer and biopsies have a significant rate of false-negatives.

5) In patients without lymphadenopathy, lymph node dissection does not improve the survival. In patients with enlarged regional lymph nodes and distant metastasis, recent data suggest that lymph node dissection improves survival.

6) If two adrenal glands are present, the one adjacent to the involved kidney should be removed when any of the following criteria are present: the adrenal gland appears to contain tumor based on CT scan or intraoperative findings, the tumor is near the adrenal gland (in the upper pole of the kidney) or the tumor is locally advanced. When the patient has bilateral kidney tumors or a solitary adrenal gland, sparing the adrenal gland may be considered even when the previous criteria are present.

7) This is only a brief guide and does not cover all aspects and eventualities.