Kidney Cancer

Kidney Cancer

Every year, about 75,000 people in the United States are diagnosed with kidney cancer. Fortunately, the majority of these patients have early stage disease and are cured with surgery alone. Still, it can be very scary to be diagnosed with a kidney tumor, and about 15,000 deaths are attributed to the disease each year. Every day, the experienced cancer specialists at Urology Partners use state-of-the-art medicine to turn a kidney cancer diagnosis on its ear.

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The experienced physicians at UPNT are among the first and most experienced surgeons in the world to perform lifesaving robotic surgical procedures to remove kidney tumors.

Understanding the “T” word.

The term “tumor” refers to an area in an organ that is not typically supposed to be there. A tumor may also be referred to as a “mass,” “lesion,” “neoplasm” or “cyst.” All of these terms mean the same thing, but none of them indicate whether or not a tumor is cancer. Often, tumors are found accidentally when an individual is undergoing x-rays for other reasons. Sometimes, they are found when investigating why a patient is experiencing side pain or blood in the urine.


How do we know when a tumor is cancer?

Imaging tests help provide answers. At UP, we review different features of each imaging test to decide if a mass could be cancer. Depending on the original imaging test (CT, MRI, ultrasound), additional tests may be recommended to get more information. Some of these tests may include an injection of an enhancer—a Gadolinium-based contrast agent to help show internal parts of the mass. Following testing, tumors may be referred to as an “enhancing” or “non-enhancing” lesion based on whether there was an uptake of the contrast agent in the lesion. Tests may be repeated over time to see if there are changes in the tumor. All kidney tumors are categorized as either cystic masses or solid masses.


Cystic Mass

Simple Cysts (Bosniak I) are “simple” water-filled bubbles in the kidney. They do not have any internal structure. They are typically perfectly round. They can be very small (1/8 inch) or they can be very large (up to about 8 inches). They are typically not associated with any pain or symptoms. They are not cancers and they do not turn into cancers. They almost never need any kind of treatment or surgery. They are sometimes monitored with additional imaging tests to see if they are changing or growing over time. Rarely, the fluid might be drained from the cyst. This is typically done by a radiologist under light anesthesia. This procedure might be performed to tell whether the cyst is causing pain. If a simple cyst is thought to be causing pain or blockage of the urinary tract, laparoscopic surgery may be recommended to remove the top of the cyst. This is called laparoscopic cyst decortication.

Hemorrhagic/Proteinaceous Cysts are a specific type of “complex” cyst that contain either blood or a thicker protein fluid inside. These cystic masses are not cancers and do not require surgery. They do typically need to be watched with repeated imaging tests.

Complex Cysts (Bosniak II, III, IV) are cyst-type masses that have some internal tissue or structure. This category of cysts is named after the radiologist who first suggested classifying them into different types—Dr. Morton Bosniak. The Bosniak type is typically decided by the radiologist and urologist after reviewing a CT or MRI with contrast injected into a vein. The Bosniak types are:

Bosniak II and IIF Cysts The least complex of all the “complex” cysts, this type of cyst may contain some calcium and have internal walls called septations. While the septations do not have measurable blood flow inside them, the cyst walls may be a little thicker than the walls of a “simple” cyst. Almost always benign (non-cancerous), they rarely require surgical removal, but may be monitored with additional imaging tests over time.

Bosniak III Cysts Several internal features separate these cystic masses from “simple” or other “complex” cysts. They can have thicker walls and some of those walls may show blood flow inside them on the imaging test. As many as half of these can be cancer. These cysts can sometimes be observed with additional imaging tests, although many of them will need to be removed surgically. If the cyst is removed and found to be cancer, almost all patients are cured and do not need any additional treatment.

Bosniak IV Cysts The most complex type of cystic masses, these lesions typically have a solid portion that has blood flow inside it. Most of these lesions are removed surgically, and determined to be cancer after they are removed. After surgery, almost all patients are cured and do not need any additional treatment.


Solid Mass

Most solid masses in the kidney that take up injected contrast agent will eventually be found to be cancer. That does not mean all solid masses are cancer. Sometimes an x-ray report will say a kidney mass is kidney cancer. However, a scan cannot diagnose cancer. The only way a mass is determined to be cancer is through a biopsy (the examination of tissue under a microscope). There are two main types of kidney cancer: renal cell cancer and transitional cell cancer.

Renal cell cancer is the most common diagnosis in patients with a solid-enhancing mass. However, unlike many cancers, renal cell (kidney) cancer is curable in most cases. Surgery is usually the only treatment a patient will need in order to be cured. Most patients do not need chemotherapy, radiation therapy or immunotherapy. The prognosis for a patient with kidney cancer depends on the grade (the measure of how aggressive the cells are) and the stage (how far the cancer has spread).

Two types of solid masses are associated with renal cell cancer: oncocytoma and angiomyolipoma.

Oncocytoma is a solid-enhancing mass that often looks very similar to kidney cancer on imaging, but is actually benign. Neither CT, MRI or ultrasound can reliably diagnose an oncocytoma from a kidney cancer. If a patient has a needle biopsy that shows oncocytoma, their mass may be monitored over time with additional imaging tests; however, surgery may still be needed.

Angiomyolipoma is a solid-enhancing mass that is benign. It is made up of abnormally placed blood vessels, muscle and fat cells. Some imaging tests may show large areas of fatty tissue. If this is present inside the mass, the diagnosis is typically made without a biopsy. Most of these masses can be safely observed with additional imaging. Large masses or masses that are irregular in shape may still need to be biopsied or removed with surgery.

Transitional cell cancer of the kidney or ureter is a cancerous mass in the urinary tract part of the kidney or in the tube that drains the kidney (ureter). It is sometimes referred to as urothelial cancer, renal pelvis cancer or ureter cancer. This cancer is the same disease often found in patients with bladder cancer, and can be more aggressive than renal cell cancer. Small tumors may be treated through telescopes in the urinary tract (ureteroscopes) using either laser or cautery to destroy the cancer cells. However, most masses require surgery to remove the kidney and ureter tube (robotic nephroureterectomy).

 

There Are Effective Treatment for Kidney Tumors

Appropriate treatment is determined by the size and composition of the tumor. The physician may recommend one of the following treatment options.

Kidney Tumor Biopsy Kidney Cyst Drainag Robotic Surgery



Kidney Tumor Biopsy


A needle biopsy may be done to see what the cells of the mass look like under a microscope and determine if the mass is cancer. A biopsy is typically performed by a radiologist and patients are given a light anesthetic. Afterward, there may be mild pain or blood in the urine, but patients usually recover quite quickly. Patients would need to be off blood-thinning medications before and after this procedure. Biopsy results usually take a week or so to come back.



Kidney Cyst Drainage


If your doctor is concerned that your "simple" kidney cyst is causing pain or blocking the urine tube (ureter), a cyst drainage procedure may be recommended. Typically, this is done by a radiologist and under light anesthetic. There may be mild pain after the procedure, but typically patients recover quite quickly. Blood-thinning medications should not be used before or after this procedure.



Robotic and Laparoscopic Surgery


Urology Partners uses several types of robotic and laparoscopic procedures to treat kidney tumors and masses.

Robotic Surgery For KidneyRobotic Partial Nephrectomy
Also known as partial kidney removal, this is the most common procedure for kidney tumors that need to be removed. The physicians at UPNT were some of the first doctors in the world to do this procedure in 2004, and have successfully performed several thousands of these operations. The technique involves using the robotic da Vinci Surgical System to safely remove the kidney tumor and sew the kidney back together with stitches. This treatment option is mainly used for smaller kidney tumors. Patients must be off blood-thinning medications before and after this procedure.

During this surgical procedure, patients are under complete anesthesia. Once the mass is removed, it is sent to a pathologist to determine if it is cancer. Results for the pathology test usually take about one week. Patients spend one or two nights in the hospital after this surgery, and are prescribed pain medicine and IV fluids. Most patients recover from this operation within two to three weeks. A post-op appointment with the surgeon is scheduled to ensure healing is taking place as it should.  

The advantage of robotic surgery over traditional open or laparoscopic surgery is that the surgeon can see much better, has better control of the instruments and patients recover more quickly with less pain.

Robotic/Laparoscopic Radical Nephrectomy
Also known as complete kidney removal, this is the second most common surgery for kidney masses. It involves using a tiny incision to telescopically remove the kidney. It is typically used for larger kidney masses, masses located deeper in the kidney, masses that might invade surrounding areas and for kidneys that do not work.

During this surgical procedure, patients are under complete anesthesia. Once the mass is removed, it is sent to a pathologist to determine if it is cancer. Results for the pathology test usually take about one week. Patients typically spend one or two nights in the hospital after this surgery, and are prescribed pain medicine and IV fluids. Most patients recover from this operation within two to three weeks. A post-op appointment with the surgeon is scheduled to ensure healing is taking place as it should.  

The advantage of robotic surgery over traditional open surgery is that the surgeon can see much better and patients recover more quickly with less pain.

Laparoscopic Cryoablation (Freezing)
This minimally invasive surgery destroys tumor cells by freezing them. This procedure is done through tiny keyhole incisions using telescopes and ultrasound to find the mass. The tumor is frozen to well below -20° Celsius. It is then allowed to defrost slightly, then frozen a second time to ensure the cells are dead. At this very cold temperature, the dead cells turn into scar tissue.

Patients must be off blood-thinning medications before and after this procedure. Often, the surgeon will biopsy the mass immediately before treating it. Once the mass is removed, it is sent to a pathologist to determine if it is cancer. Results for the pathology test usually take about one week. Patients typically spend one night in the hospital after this surgery, and are prescribed pain medicine and IV fluids. Most patients recover from this operation within two to three weeks. A post-op appointment with the surgeon is scheduled to ensure healing is taking place as it should.  

Robotic Nephroureterectomy
This surgery involves removing the diseased kidney and the entire kidney tube (ureter) that connects the tube to the bladder. This surgery is typically recommended for patients who have cancer or tumors of the urinary tract (kidney or ureter tube).

During this surgical procedure, patients are under complete anesthesia. Once the mass is removed, it is sent to a pathologist to determine if it is cancer. Results for the pathology test usually take about one week. Patients typically spend one or two nights in the hospital after this surgery, and are prescribed pain medicine and IV fluids. Many patients are sent home with a catheter to drain the bladder, which helps the bladder heal. Most patients recover from this operation within two to three weeks. A post-op appointment with the surgeon is scheduled to ensure healing is taking place as it should.  

The advantage of this surgery over traditional open surgery is that the surgeon can see much better and the patients recover more quickly with less pain.

Robotic/Laparoscopic Kidney Cyst Decortication
This minimally invasive surgery is done to remove a “simple” (Bosniak I) cyst that is either causing pain or blocking the flow of urine to the bladder. Patients must be off blood-thinning medications before and after this procedure. Patients are under complete anesthesia during the procedure, typically spend one night in the hospital after surgery, and are prescribed pain medicine and IV fluids. Most patients recover within two to three weeks. A post-op appointment with the surgeon is scheduled to ensure healing is taking place as it should.  

The advantage of this procedure over traditional open surgery is that the surgeon can see much better and the patients recover more quickly with less pain.



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