It is important to distinguish the difference between kidney cancers originating from the parenchyma (or meat of the kidney) versus the lining of the inside of the kidney where urine drains. In 2012, there were an estimated 375,000 new cases of kidney and renal pelvis cancers diagnosed in the United States. The majority of these are renal cell cancers of the parenchyma. A small percentage of these cancers are urothelial carcinoma (the lining), which necessitate a different treatment paradigm.
Kidney Cancer Diagnosis
As radiographic imaging technology has evolved, so has the detection of various cancers. Often times a patient gets an imaging study such as a CT or an MRI for other reasons, and the images detect an incidental renal mass. The masses rarely cause symptoms, but if large enough they can cause symptoms such as abdominal fullness or blood in the urine. There is currently no guideline that recommends screening of the general population for renal cancer.
Kidney Cancer Treatment
The most definitive way to treat a kidney tumor is to excise it. With robotics technology, this can be accomplished using small keyhole incisions to facilitate removal of the mass and retaining as much as healthy kidney as possible. In some cases when the mass is too large or if the tumor is in a difficult location, then removal of the entire kidney is needed. The advantages of robotic partial nephrectomy (removal of just the tumor) include less postoperative pain and less bleeding compared to open surgery. Typical hospital stay is approximately 3 days. Another advantage of partial nephrectomy is that retaining healthy kidney is advantageous for patients in the long term if they have diabetes, hypertension, and/or chronic kidney disease.
In some patients with co-morbid conditions in whom surgery would pose significant risks, ablation therapy or active surveillance are alternative options.
After surgery the pathology is reviewed. The majority of renal cell carcinomas are clear cell type, and are graded on a scale from 1-4 with 4 being the most aggressive. The pathologist can also indicate what stage the cancer is, since the extension of the tumor into surrounding tissues and its size can impact the stage and indicate a possible higher chance of recurrence. Follow up after surgery includes a 1-2 week post operative check to review pathology, then usually a 6 month follow up for a CT scan, chest X-ray, and blood work.