Kidney Cancer Treatment
There are a number of treatment options for kidney cancer; the ideal kidney cancer treatment depends on a number of factors, including the extent of the tumour and the current health of the patient.
Kidney cancer treatment options vary and these should be discussed with the doctor to identify which is the best course of treatment for individual patients. They include active surveillance, surgery, ablative therapy, systemic therapy or immunotherapy and radiation therapy.
Radical Nephrectomy
The most common form of kidney cancer surgery for renal cell carcinoma (RCC), radical nephrectomy involves removal of the entire kidney, at times along with the adjacent adrenal gland if suspicious of cancer spread, surrounding fatty tissues and nearby lymph nodes (regional lymphadenectomy), depending upon how far the cancer has spread.
Partial Nephrectomy
It may be possible to remove only the cancerous tissue and part of the kidney if the tumour is relatively small and technically safe and feasible. A partial nephrectomy is also the procedure of choice for patients with kidney cancer in both kidneys and for those who have only one functioning kidney.
Partial nephrectomy is proven to preserve long term renal function better compared to removing the entire kidney. This is certainly the case if a patient has other diseases that can affect kidney function in the future (such as high blood pressure, diabetes), or if the opposite kidney is not working properly, has never formed or has already been removed.
Robotic and Laparoscopic Radical Nephrectomy and Partial Nephrectomy
Robotic and laparoscopic techniques allow the kidney to be removed using key-hole incisions in the abdomen. Occasionally 1 or 2 additional retraction ports may be required. Conversion to the standard open operation is easily accomplished, should technical difficulty be encountered.
Laparoscopic surgery uses hand-held key-hole instruments while the robotic surgery provides a 3-D magnified view with wristed instruments that are easier to move than standard hand-held key-hole instruments. Dr Kim performs both laparoscopic and robotic surgery but a standard laparoscopic approach using the hand held keyhole instruments is generally sufficient for a radical nephrectomy.
In comparison, a partial nephrectomy is more complex and so using the robot can arguably help make the operation easier to perform.
Advantages of Robotic and Laparoscopic Surgery
The main advantage of robotics and laparoscopy are the reduction in pain and post-operative recovery time. Patients can usually mobilise unassisted next day and are often ready for discharge around 2-3 days after surgery. Patients receiving the open operation usually experience a significantly greater degree of pain and take a longer period to recover. As such they are not ready for discharge until a week or 10 days after surgery.
Most patients after robotic and laparoscopic kidney cancer surgery are able to return to normal activities within two to three weeks after surgery, while patients after the open operation usually take 4 to 6 weeks. Regardless of the type of surgery patients are still recommended to avoid any strenuous physical activity in the first four weeks.
Recent results from multi-centre trials have shown robotic and laparoscopic kidney surgery to be safe in the treatment of localised renal cancer, hence widening the indication for the operation.
Disadvantages of Laparoscopic Nephrectomy
This operation is technically demanding and is associated with a steep learning curve. The operating time is longer than open operation, although with experience this reduces significantly.
Problems associated with CO2 distension of the abdomen can cause problems such as shoulder pain, CO2 retention, possible embolisation and tumour spillage, which have not occurred in renal cell carcinoma.
Radiation Therapy
Radiation in the form of X-rays or other high-energy rays is used to shrink and kill cancer cells in some kidney cancer patients. The radiation is delivered as a focused beam (external beam radiotherapy) that is projected into the body through a linear accelerator.
Radiation therapy can be used as palliative therapy to lessen pain or bleeding in patients with inoperable or widespread metastatic RCC.
Follow-up Care and Recurrent Kidney Cancer
Some patients who undergo surgery to remove a cancerous kidney or kidney tumours experience a recurrence of the disease. For this reason, patients usually undergo regular assessment and surveillance scans after surgery.
These include:
- complete physical examination,
- a chest X-ray,
- CT scans and ultrasounds,
- complete blood tests; and
- assessments of liver and kidney function
If the disease recurs but remains confined to a few small areas, additional surgery may be recommended.
On the other hand if the disease is more widespread systemic therapy or immunotherapy will be considered.
Radiotherapy is also employed mainly in the palliative setting.
If you would like to know more about kidney cancer treatment in Sydney, contact Advanced urology now.