Kidney cancers are tumors of the kidney. Also known as renal carcinoma, there are many different subtypes with different levels of aggressiveness. There are also some benign tumors.
Patients are typically diagnosed after blood is found in the urine, or in some cases through an incidental finding during workup for an unrelated condition.
Two crucial elements that determine how well patients do after treatment are the stage of the tumor and whether the tumor has spread outside of the kidney. The large majority of tumors are confined to the kidney and are very curable. Once the tumors have spread beyond the kidney, cure becomes more difficult and often requires additional treatments.
Treatment options for kidney tumors that have not escaped the kidney are surgery with complete removal of the kidney (radical nephrectomy) or a removal of just the kidney tumor leaving the rest of the kidney behind (partial nephrectomy). Other alternatives such as surveillance of the kidney tumor (active surveillance) and freezing of the kidney tumor (cryotherapy).
Surveillance of kidney tumors is an option for patients with small tumors – typically less than 2 cm in size – or in patients who may have other medical problems. There is increasing data to suggest that appropriate surveillance of the smaller tumors is safe and patients will often do well without aggressive intervention. Surveillance does require periodic examinations, imaging and lab tests. If the tumor grows in size, surgery can be done.
An alternative that has been offered is freezing of smaller kidney tumors in a process called cryotherapy. We do not favor it as a primary option because for patients in whom cure is desirable, cryotherapy can make future imaging of recurrent tumors more difficult and frequently a small rim of tumor is left behind. In patients who have small tumors, these patients do just as well with active surveillance without cryotherapy.
For patients who would like to be cured of their tumor, one good option is a partial nephrectomy – just removing the cancer, but leaving the rest of the kidney in place. This is usually done with an open incision, but occasionally can be done laparoscopically. The advantage to the partial nephrectomy is that the majority of the kidney is left in place which can be particularly important if patients have compromised kidney function. The disadvantage of the partial nephrectomy versus complete removal of the kidney, called a radical nephrectomy is that the surgery tends to be technically more challenging with a higher complication rate and a longer recovery.
The other options for the patients who have kidney tumors include complete removal of the kidney. This is usually done laparoscopically where small incisions are made into the abdomen instead of one large incision. The advantage to the laparoscopic nephrectomy is that the patients recover more quickly and can often be discharged home one day after surgery. The disadvantage to complete removal of the kidney is that you do lose the entire kidney, including healthy sections, and the kidney function that it provided.
Either way the decision to offer surveillance, partial nephrectomy, or laparoscopic radical nephrectomy is highly individualized; it is not only the size of the tumor, but its location as well as the patient’s overall health and ability to tolerate surgery that determines the best option.
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