What causes kidney cancer?
Most kidney cancers are sporadic (no obvious cause) however risks include:
- Smoking
- Obesity
- Family history
- Renal cysts acquired from chronic kidney failure
How common is kidney cancer?
- Accounts for 2-3% of adult cancers
- Men are at higher risk than women
What are the symptoms of kidney cancer?
Most kidney cancers these days are detected incidentally on x-rays (ultrasound or CT scan) during investigations of other problems.
Symptoms usually develop in advanced disease and can include:
- Blood in urine (haematuria)
- Flank pain
- Feeling a mass in the abdomen
- Weight loss
How is kidney cancer diagnosed?
- Renal masses are most commonly identified on ultrasound and/or CT scan
- A CT scan of the abdomen is necessary to provide information on size, extent and location prior to determining treatment options
- A CT chest is routinely performed to look for spread (metastasis) of cancer
What is the role of biopsy of a kidney tumour?
Biopsy is not indicated in most cases, as at least 80% of solid lesions in the kidney detected on CT will be kidney cancers
- Biopsy may be indicated if:
- There is a history of previous cancers elsewhere to rule out metastasis
- Lymphoma is suspected
- Tumour is <4cm, to help decide if treatment with surgery is required
How is localised kidney cancer treated?
Surgery is the most effective treatment option for attempting to cure kidney cancer.
If the staging x-rays show no spread beyond the kidney, the potential options include:
- 1. Radical Nephrectomy: removal of the entire kidney (with tumour) and surrounding fat
- In most cases this will be performed laparoscopically (key hole)
- 2. Partial Nephrectomy: removal of just the tumour from the involved kidney, (leaving the majority of healthy kidney behind)
- Now considered the gold standard treatment option for smaller kidney tumour (usually <4cm)
- This is usually performed robotically assisted (key hole)
- This is Particularly beneficial for patients with impaired baseline kidney function or medical conditions which may impair kidney function in the future (e.g. diabetes)
- 3. Ablative procedures:
- a. RFA (radiofrequency ablation)
- Uses thermal energy to ablate the tumour
- Used in carefully selected patients with small localised kidney tumours not fit for surgery or who don’t want surgery but want some form of treatment
- It is less effective than surgery, however offers better results than observation
- b. Cryoablation
- Similar to RFA, but utilises freezing/thawing to ablate the tumour
- 4. Observation is an option if:
- The patient is unfit for surgery due to age or other medical conditions
- The tumour is very small and slow growing (the risk of a tumour less than 4cm spreading to other organs is only 1-2%)
What if the kidney cancer has spread (metastasised)?
- 1. TKI’s (Tyrosine Kinase Inhibitors) and other targeted therapies
- Standard chemotherapy agents are not effective at treating kidney cancer
- TKI’s are a relatively new class of drugs that work by reducing the blood vessel growth to the cancer and shrink the tumour
- These agents will be administered under the care of a medical oncologist
- Survival can be improved by several months
- 2. Radiotherapy:
- May be used to help control local symptoms from a bleeding kidney cancer if surgery is not possible