How is kidney cancer diagnosed?
If you arrive at your urologist’s office complaining of back or flank pain, weight loss and continuous fever, he or she will immediately take blood to assess your kidney function. Your urologist will also ask for a sample of your urine to test for the presence of blood. If these tests indicate a renal disorder, you will be sent for further tests.
There are many different diagnoses for blood in the urine, fever and localised pain. Kidney stones, kidney infections and other urinary tract infections are all possible and can usually be traced through blood and urine tests. Where the diagnosis is uncertain, you will be sent for ultrasound, CT or MRI testing. If an unusual group of cells is detected, an MRI using a special dye or contrast agent may be advised. This dye is administered intravenously via the hand or the arm.
When a tumour or mass is detected, the next step is a kidney biopsy. As the kidneys are relatively deep organs you may need to stop anticoagulant therapy or aspirin before this procedure. An intravenous line is placed in the arm or hand and a light sedative administered. A kidney biopsy requires you to lie on your stomach; the doctor will inject a local anaesthetic into the area of skin directly above the kidney. Using ultrasound, he or she guides a thin biopsy needle into the kidney. Usually, 3 - 6 tissue samples must be gathered to provide enough information for a diagnosis. For each sample, you will need to hold your breath for up to 30 seconds. Although this is an outpatient procedure, patients must lay on their back for 4 - 5 hours after the biopsy. It is often recommended to take time off work and avoid strenuous daily activities for a week to 10 days following a renal biopsy.
In the case of a suspicion of renal sarcoma, a test known as a Dotatate PET scan is required. This scan requires that some medications need to be stopped up to two months beforehand – your GP or our specialist physicians will be able to tell you if this applies to you. For this test, you will be administered a small quantity of radioactive tracer via an intravenous catheter then wait for 45 minutes until this tracer reaches potential cancerous cells. The scan itself takes up to 30 minutes and is carried out in the same way as a PET scan.
Depending on the type of kidney cancer that is diagnosed, further tests are then planned. These include blood tests together with CT or MRI or bone density scans that can indicate whether cancer cells have spread into other areas of the body.
How is kidney cancer treated?
The most common and recommended treatment for kidney cancer is surgery. In smaller tumours in older patients with little to no symptoms, active surveillance with regular diagnostic tests may be advised. Should the tumour then begin to show signs of growth, systemic therapies can be administered.
Removing the entire kidney is only done where the surrounding tissues have been affected by abnormal cell growth. Radical nephrectomy removes the kidney, all surrounding lymph nodes and possibly the adrenal glands. As the kidneys also lie close to major blood vessels, radical nephrectomy may also involve vascular surgery. Life-long medications may need to be taken depending on the health of the remaining kidney.
A partial nephrectomy surgically removes a localised tumour and does not involve the surrounding tissues or significantly affect the function of the operated kidney. Partial nephrectomies are often laparoscopic or robot-assisted procedures that do not require large skin incisions. This type of surgery is recommended for non-metastasized, localized tumours.
Nonsurgical treatments are usually only offered to those unable to undergo surgery due to low overall levels of health. These treatments include radiofrequency ablation of the tumour that destroys cancer cells using electrical current and microwave ablation that uses needles that emit microwaves to produce localised heat. Target cells are accessed by way of needles and these procedures are carried out under sedation and with a local anaesthetic together with medical imaging machines. Another option is cryoablation where, instead of electricity, low temperatures are applied directly to a tumour to freeze and kill the cancerous cells. This type of procedure is carried out under a general anaesthetic.
Pharmaceutical and radiological treatments for kidney cancer are limited to four types: targeted, radio, immuno- and chemotherapy. Targeted therapies either work to stop the formation of blood vessels that feed the tumour or slow down tumour growth by inhibiting growth-inducing proteins. Immunotherapy (or biologic therapy) increases the body’s natural immunity and help it to fight abnormal cells. Immunotherapy is often used in late-stage metastatic kidney cancer. Chemotherapy is rarely used for kidney cancer as the cells involved are very resistant to this type of treatment; however, chemotherapy can help shrink tumours and is often used for Wilms’ tumours in children. Radiation therapy is only used in cases where kidney cancer has spread or may spread or as a means to increase comfort where other areas of the body are affected. Hormone therapy does not have an effect on renal cancer.
Why do I need kidney cancer treatment?
Treatment is always necessary for any type of kidney cancer to prevent cancerous cells from travelling to other organs via the many surrounding blood vessels of this important part of the anatomy. Furthermore, when treated early to mid-stage, kidney cancer can be cured. Even in more advanced stages, new therapies and procedures are continuously increasing longer-term survival.
How do I prepare for kidney cancer treatment? What can I expect?
Pre-travel kidney cancer preparation
Approximately two to three weeks before a kidney cancer procedure you will be asked to supply the results of your blood and urine tests and copies of any imaging results (ultrasound, CT, MRI and/or PET). This means we can see how your kidney cancer is progressing and help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders and your overall state of health.
You will need to undergo an MRI or CT scan and possibly a bone scan – if these have not yet taken place - which will help us to see if cancer has spread to other organs. If kidney cancer has spread or metastasised you may need to consider both surgical and radiotherapeutic treatment or a combination of other therapies.
Approximately 2 weeks before your kidney cancer treatment you will need to ask your home doctor to take blood for a preoperative blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For surgical procedures, some blood-thinning medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Kidney cancer treatment in the hospital
Please scroll down to the appropriate section. The given information covers all available treatments for kidney cancer at Remedazo.
Partial nephrectomy
In most cases of early kidney cancer where the tumour remains local to a single area of the kidney, surgical removal of the tumour and a small surrounding area is necessary. This procedure is known as partial nephrectomy or nephron-sparing surgery. Partial nephrectomy can be a curative therapy and, as only one kidney is necessary, may not have any long-term side effects. While you may think that removing the entire kidney may have more positive effects, studies show that a partial nephrectomy can completely remove a tumour and achieve results similar to a total nephrectomy. Very rarely, radiation treatment may be advised after surgery.
The procedure requires a full anaesthetic. Usually, you will be given the choice between robotic-assisted surgery, laparoscopic surgery and open surgery. All types require you to be positioned on your side after you have been anaesthetised so the to-be-operated kidney is easy for the surgeon to reach. Open surgeries require an incision of approximately 8 cm. Robotic-assisted and non-robotic laparoscopic surgeries use 3 to 5 small incisions of approximately 2 to 4 cm each. During this procedure, the blood supply to the kidney must be temporarily halted, requiring rapid and precise tumour-removal. While the procedure itself can take between 2.5 to 4 hours, the time in which the kidney is starved of its blood supply is short – perhaps 15 to 20 minutes. If the tumour is close to the ureter, a stent may be placed to ensure easier kidney drainage during the healing process. All of these factors mean the relatively rare partial nephrectomy procedure requires significant and skills that can only be gained through multiple surgeries. Remedazo works with a handful of top urologists with significant partial nephrectomy experience.
Recovery from a partial nephrectomy is on the whole swift with easy to treat pain that is usually limited to the wounds and is often described as a burning sensation. Open procedures require a longer hospital stay of four to five days; laparoscopic procedures often only require a 2 to 3-day stay. You may usually fly home within a week after surgery, although you will need to wear compression stockings and perhaps split long-haul flights into shorter journeys.
Radical nephrectomy
A radical nephrectomy is a surgical procedure where the entire kidney is removed and possibly areas of surrounding tissues, the adrenal glands and larger blood vessels where a tumour has spread. This procedure can be done using the same methods as a partial nephrectomy; namely open, laparoscopic and robotic-assisted surgery. Radical or total nephrectomy can often be an easier procedure than a partial nephrectomy; however, where a tumour has spread into surrounding tissues this surgery becomes more complicated and may also require the presence of a vascular surgeon.
An open radical nephrectomy procedure is performed under a general anaesthetic and you may be given the option of an additional epidural anaesthetic in the upper back so you can administer patient-controlled epidural anaesthetic after surgery by way of a handheld control. Robotic-assisted and laparoscopic procedures involve smaller incisions through the muscles and do not require an epidural. Just like the partial nephrectomy procedure, you will be positioned on the side of the not-to-be-operated kidney once anaesthetised. A total nephrectomy procedure takes between 2 and 4 hours to complete. As the entire kidney is to be removed, the cutting off of its blood supply can continue for a longer period of time. Surgical incisions are the same for both partial and radical nephrectomy, although the removal of an entire kidney may mean a single laparoscopic incision may need to be widened
All kidney cancer surgeries insert a drain through an incision to remove fluids from the operation site. This drain will remain in place for 24 to 48 hours after surgery. In addition, a urinary catheter will be placed to lower discomfort after surgery and will usually be removed 24-hours post-surgery. Depending on the health of the remaining kidney, radical nephrectomy may or may not lead to urinary system side effects. Where the other kidney is healthy, surgical side effects are limited. Hospital stays and return to home times are the same as with partial nephrectomy procedures.
For all types of nephrectomy, you will be admitted to your chosen clinic on the day of the procedure. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting.
From midnight of the day before the partial or radical nephrectomy, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least 24-hours before an operation as this improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted.)
Approximately thirty minutes to one hour before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative kidney cancer surgery preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A possible epidural catheter for open nephrectomy procedures
A general anaesthetic
An arterial catheter
A urinary catheter (usually placed after you are asleep)
At the surgeon’s signal, you will be anaesthetised.
What happens after a nephrectomy? What can I expect?
You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Here you will be carefully monitored. Nephrectomy patients remain in the recovery ward until they are fully responsive and any pain is well under control.
When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward. Remedazo patients continue to be carefully monitored for a minimum of 24-hours after surgery. Pain medication is given as standard for the first 24-hours and then upon request and according to your personal doctor’s prescription. Arterial lines are usually removed within 12-hours after surgery. The intravenous catheter will continue to administer fluids for 24 to 48 hours and your drain will be removed by a trained nurse or doctor within 2 days. Urinary catheters are usually removed after 24-hours post-surgery.
The majority of kidney cancer patients are out of bed within 12 hours of exiting the recovery room. The average hospital stay for nephrectomy is 4 days. You will then be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further radiology treatment.
Long-term postoperative care includes the removal of stitches after 10 to 14 days. This can be done by your general practitioner at home if you are not attending further treatment sessions. It is advised not to lift heavy objects for at least 6 weeks after surgery. You can return to work after two weeks unless your job requires heavy lifting or exertion.
Benefits of kidney cancer surgery
Kidney cancer surgery aims to remove the tumour in its entirety and so has the potential to be a curative procedure. Surgery is nearly always recommended, even in cases of metastatic kidney cancer; however, the further cancer spreads the higher the chance you will need additional therapies, usually radiotherapy, immunotherapy and, in a smaller number of cases, chemotherapy. Open, laparoscopic and robotic-assisted surgeries do not require long stays in the hospital and have relatively rapid recovery times.
Disadvantages of kidney cancer surgery
Postoperative infection is always a risk with this type of surgery and patients are administered antibiotics as a preventive measure before surgery commences. Partial nephrectomy has a higher infection risk if urine leaks from the remaining healthy tissue. Your chosen clinic’s doctors and nurses are trained to recognise the symptoms of infection very early on. Other short-term risks include bleeding, adverse reactions to the anaesthesia, blood clots, an urge to urinate in the presence of a urinary catheter, and breathing problems.
Long-term complications often include high blood pressure and the potential to develop chronic kidney disease should the non-operated kidney lose function. In partial nephrectomy, the formation of scar tissue close to the ureter may cause a blockage. We recommend you visit your local general practitioner early on so he or she can keep an eye on your progress.
Kidney radiation therapy
Fractionated external beam radiation therapy (EBTR) may be given after nephrectomy to prevent the growth of potentially remaining cancer cells. This therapy is given over the course of 3 to 7 weeks in low doses. More recently, stereotactic body radiation therapy (SBRT) has provided patients with a higher dose, shorter course of radiation therapy.
Post-surgical radiation therapy is used if it is unsure whether all cancer cells have been removed. For advanced cases of kidney cancer, repeated radiation therapy can slow down tumour growth and keep cancer cells under control for significant periods of time.
Radiotherapy therapy for kidney cancer is composed of two main types – external beam radiation therapy (EBRT) and stereotactic body radiation. If kidney cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are drugs that contain radioactive substances that are injected and settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life in advanced kidney cancer.
External beam radiation therapy focuses beams of radiation into the kidney and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all transportation, support, accommodation and meals can be seamlessly arranged by the Remedazo team. EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the kidney and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT. You will be able to discuss all of these alternatives with a Remedazo oncology specialist.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the kidney such as major blood vessels, adrenal glands and ureter. In addition, radiation treatments can make you feel tired for weeks to months. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Kidney cancer immunotherapy
Checkpoint inhibitors allow your immune system to respond to the presence of cancer cells and attack them. Often, this response is absent during tumour growth. A drug known as nivolumab has been approved for the treatment of renal cell carcinoma and is often administered together with ipilimumab. Nivolumab blocks the activity of a protein that prevents T cells from recognizing and attacking inflamed tissues and cancer cells. Ipilimumab targets a similar-acting protein. These intravenous treatments require at least a 2-hour stay in a clinical setting every two to three weeks and have been shown to increase survival times in metastasised kidney cancer; however, immunotherapy is rarely offered before other types of therapy have been administered.
The side effects of immunotherapy are many and can be serious. Those offered this type of treatment are given in-depth information regarding side effects and the detection of their early signs. Remedazo can put you in touch with one of our specialist oncologists to discuss your eligibility for immunotherapy based upon your personal medical history.
Kidney cancer pharmaceutics
yrosine kinase inhibitors (TKIs) in combination with checkpoint inhibitors have been proven to be effective in the treatment of metastatic (M1) renal cell carcinoma; however, not every patient responds in the same way. These drugs prevent the growth of tumour blood supply and are often combined with early treatment modalities such as nephrectomy and radiotherapy. When used together with immunotherapy treatment, this combination can extend survival in cases of metastasised kidney cancer.
Kidney cancer cryotherapy
Cryotherapy uses cold temperatures to freeze cancerous cells. This can be a first-line treatment with very small, localised tumours where a patient is unable to undergo surgery. Multiple procedures may be required if cancer cells are left behind. Cryotherapy or cryoablation is usually done under a spinal anaesthetic or a general anaesthetic. Using a laparoscopic camera or via incisions made in the skin, the doctor locates the area of the kidney where an earlier biopsy has shown that cancer is present and inserts hollow needles through which an extremely cold gas is passed. Kidney cryotherapy requires an overnight hospital stay and a few days of over-the-counter painkillers.
Kidney Cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted and current kidney cancer treatment alternatives have been described in the necessary detail above. Complementary and alternative kidney cancer remedies are unproven and should not take the place of accepted treatment courses.
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist urologists and oncologists to determine the best treatment type for you. You can discuss all kidney cancer treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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