The current standard of care for small kidney tumors is removal of the tumor with preservation of the healthy kidney (“partial nephrectomy”). For larger tumors complete removal of the kidney (“radical nephrectomy”) may be necessary. In all kidney cancer cases, minimally-invasive or robotic surgery is preferred over open surgery due to decreased pain and improved recovery. At Urology Specialists of Oregon we provide state-of- the-art care for kidney cancer. Dr. Simmons specializes in robotic surgery for kidney cancer, with emphasis and expertise in partial nephrectomy. He has been involved in over 400 robotic and laparoscopic kidney cancer surgeries since 2004. His outcomes and techniques have been published extensively.
Most kidney tumors do not cause any symptoms. Over 60% of kidney cancers are detected on a CT scan, MRI or kidney ultrasound done for other reasons. These are called “incidental” tumors. In other cases, patients may have pain in their side or blood in their urine which leads to a CT scan. In any event, kidney cancer is diagnosed based on radiologic imaging.
Determining the severity of a kidney cancer is called “staging.” Staging is done using either a CT scan or an MRI. The most important considerations are the size and appearance of the tumor on the CT scan. Other information such as lymph node enlargement and presence of metastatic cancer allow for your doctor to determine how effective treatment for cancer will be?
In general 80% of tumors are cancer and 20% are benign. Some benign tumors can be diagnosed based on how they appear on the CT scan, but in most cases benign and cancerous tumors look the same.
In general kidney tumors are not biopsied. Up to 20% of biopsies are inconclusive or inaccurate. Also, even if a tumor is benign, it often needs to be removed so it does not grow and shut down the kidney. There are some scenarios when a biopsy is mandatory. Your doctor will inform you about the need for a biopsy based on your specific case.
Kidney cancer is treated with surgery. These tumors do not respond to chemotherapy or radiation. Two surgical options exist – removal of the entire kidney (“radical nephrectomy”) or removal of the tumor with reservation of the normal surrounding kidney (“partial nephrectomy”). The current best practice for kidney tumors is to conduct a partial nephrectomy whenever possible. This is based on data that shows that patients with good kidney function tend to live longer than those with poor kidney function. There are clear reasons to remove the entire kidney or to remove only the tumor. This is a decision that must be made by your doctor based on their assessment of your tumor.
Most patients with small renal tumors are candidates for robotic partial nephrectomy. This approach allows for the tumor to be removed and the normal kidney to be preserved. The cancer control rates for partial nephrectomy are equal to those for radical nephrectomy (removal of the entire kidney). In the past partial nephrectomy was only able to be conducted through a large flank incision. The major advantage of robotic partial nephrectomy is that it is conducted through small “keyhole” incisions. This results in reduced pain, improved cosmetic effect, and faster recovery. Dr. Simmons has extensive experience with partial nephrectomy surgery, having learned open and robotic techniques from pioneers in the field. He has conducted over 400 of these surgeries, with cancer control rates and functional outcomes that rival the best centers in the US.
Cure rates depend heavily on the stage of the tumor. For small stage 1 tumors radical and partial nephrectomy are equally effective. Risk of developing kidney cancer metastasis within 15 years after surgery for stage 1 tumors ranges from 3-7%. For larger stage 2 tumors the risk for metastasis increases to 15-20%. For stage 3 tumors this risk increases to 35-50%. For stage 4 tumors this risk increases to 70-90%. Follow-up after surgery depends on tumor stage, and the schedule for repeat scans and lab tests is determined by your urologist.
Active surveillance of kidney cancer involves conducting a biopsy of the tumor to verify its pathology, followed by repeat imaging at regular intervals (usually every 6 months). Currently it is only recommended for tumors smaller than 4 cm, and it is usually reserved for patients who are not good candidates for surgery based on their age or presence of other major illnesses. Whether you are a candidate for this approach would involve an in-depth discussion with your urologist.
Patients with cancer are followed at regular intervals after surgery with CT scans. If disease shows up elsewhere in the body, then medications are given to slow growth and progression of the cancer. Over the past 5 years new drugs have been introduced that have vastly improved effectiveness. Additional drugs are in clinical trials, and the treatment of metastatic kidney cancer is set to improve drastically in the future. Any patient with metastatic disease will need to see a medical oncologist to determine appropriate treatment and to see if they are candidates for ongoing clinical trials.
If you have any questions or would like to schedule an appointment, contact Urology Specialists of Oregon at (541) 322-5753.