Each year, kidney cancer is diagnosed in approximately 38,000 Americans and is the cause of death in nearly 12,000 Americans. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma.
Today more than 100,000 survivors of kidney cancer are alive in the United States.
The good news is if found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent and that with timely diagnosis and treatment, kidney cancer can be cured.
Most people have two functional kidneys. The kidneys produce urine that drains through narrow tubes (called ureters) into the bladder. A kidney tumor is an abnormal growth within the kidney. The terms “mass,” “lesion” and “tumor” are often used interchangeably. Tumors may be benign (non-cancerous) or malignant (cancerous). The most common kidney lesion is a fluid-filled area called a cyst. Simple cysts are benign and have a typical appearance on imaging studies. They do not progress to cancer and usually require no follow up or treatment. Solid kidney tumors can be benign, but are cancerous more than 90 percent of the time.
Symptoms and Severity
Many kidney tumors do not produce symptoms, but some may be detected incidentally during the evaluation of an unrelated problem or during routine screening for people who are in high-risk categories various diseases such as, tuberous or sclerosis. Some people may notice pain in the side, abdomen or back. Other signs may include a palpable mass that can be felt and/or blood in the urine. If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung, bone pain or fracture may occur when cancer is in the bone and neurologic symptoms may occur when cancer is in the brain.
Unfortunately, there are no blood or urine tests that directly detect the presence of kidney tumors. When a kidney tumor is suspected, Dr. Alarcon will order a kidney imaging study for you. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, you will be evaluated to see if the cancer has spread beyond the kidney (metastasis).
For a tumor confined to the kidney (a “localized” tumor), there are four main treatment options:
surveillance, surgery, ablation and embolization.
- Surveillance: Active surveillance simply means that you and Dr. Alarcon are working together to actively observe a small tumor. Active surveillance is a reasonable option for some people with a small renal masses that has a reliable rate of growth and pattern. Some kidney masses that are small and grow slowly can be observed and treated in a delayed manner. Studies have demonstrated that small renal masses tend to grow at a rate of 0.1 to 0.8 cm per year. Alternatively, kidney masses that grow more quickly are suspicious for kidney cancer and should be treated.
- Surgery: Surgery to remove a tumor (called a nephrectomy) is considered the standard of therapy for most kidney cancers. A radical nephrectomy is surgical removal of the entire kidney. A partial nephrectomy is surgical removal of part of the kidney (in this case, the part that contains the tumor). The goal of partial nephrectomy is to remove the entire tumor while preserving as much normal kidney tissue as possible.
A Nephrectomy can be performed as an open surgery or as a laparoscopic surgery through several small incisions. Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that are confined to the kidney. Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, shorter hospital stay and shorter recovery time. If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the “key hole” incisions to a larger incision). Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein.
- Ablation: Tumor ablation destroys the tumor without surgically removing it. Examples of ablative technologies that use extreme cold (called Cryotherapy), or technologies that use extreme heat including radiofrequency, high-intensity focused ultrasound, microwave thermotherapy and laser coagulation. Ablation can be used during open or laparoscopy surgery and can also be performed through small needles inserted directly into the skin (percutaneously). Since renal tumor ablation is a relatively new procedure, long-term results are less unknown. However, ablation may be less invasive than nephrectomy and 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. In general, tumor ablation is best reserved for older or somewhat frail patients. The risk to tumor recurrence with these approaches is somewhat higher than with surgical excision.
- 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, especially when the tumor is actively bleeding. Embolization can stop the bleeding and permits physicians to stabilize the patient before surgery. Embolization is usually performed under sedation and is accomplished by advancing a long narrow catheter from a peripheral artery (such as in the groin) into the artery of the kidney. The catheter is used to deposit small embolic material particles in the vessels of the kidney. These particles block the flow of blood to the tumor and, therefore, stop active bleeding. Furthermore, without a blood supply, the tumor eventually dies. Since it is unclear whether or not embolization completely eliminates the tumor, it is not considered a primary form of therapy for kidney cancer. Image above illustrates kidney tumor on the outer edge of the gland.