Kidney Cancer

Cancer is the growth of abnormal cells that may progress and grow locally and sometimes may spread to other parts of the body (metastasize). These are also called malignant tumours. Lumps which grow but aren’t cancer and don’t spread are called benign lumps.

The urinary tract or system consists of the kidneys, ureters, bladder, and prostate in males and urethra. The kidneys are two bean shaped organs protected by the ribs towards the middle of the back. The kidneys filter blood and create urine. They keep a stable balance of salts and other substances in the blood as well as produce hormones that help build strong bones and help form red blood cells. Narrow tubes called the ureters carry urine from the kidneys to the bladder which is a chamber in the lower abdomen. Like a balloon, the bladder’s elastic walls stretch and expand to store urine. They flatten together when urine is emptied through the urethra to outside the body.

Sitting above each kidney is the adrenal gland. These glands are not part of the urinary system but cancer can spread to them. They secrete hormones which make us feel well and help monitor our blood pressure control.

Kidney cancer occurs in the cells of the kidney and in the early stages, the primary cancer forms a tumour confined to the kidneys. As cancer grows, it may invade other structures or organs such as the adrenal glands and it may spread to other parts of the body such as the lymph nodes, lungs, brain and bones.

Types of kidney cancer

  • Renal Cell Carcinoma (RCC) is the most common type and accounts for approximately 90 % of kidney cancers. This begins in the nephron of the kidney.
  • Urothelial carcinoma (previously called transitional cell carcinoma accounts for approximately 8 % of kidney cancers. This begins in the internal lining of the kidney.
  • Rarer cancers include renal sarcoma (affects the kidney connective tissue) and renal lymphoma (starts in the lymphatic tissue).
  • Up to 15% of lumps within the kidneys which have flow within them are benign (not cancerous).

Diagnosis

Less than 10% of kidney cancers cause symptoms. Most are picked up incidentally (doing a scan for another reason that finds it).

Kidney cancer can be present for sometime before a diagnosis is made. In cases where there are symptoms, they may consist of blood in urine, constant tiredness weight loss, fever and anaemia.

If kidney cancer is suspected, you may require to have further tests to confirm diagnosis. These tests include urine test, blood tests, renal ultrasound, CT Scan, cystoscopy and possibly retrograde pyelogram, intravenous pyelogram and chest X-ray. You may not be required to have all of the above tests. Your doctor will determine which tests are required and will discuss this further with you. Sometimes, doctors will consider performing a biopsy. The tissue is sent to pathology for further testing to determine the exact type of cancer cells and the grade of the cancer.

Treatment options

Active surveillance

Sometimes a decision is made to monitor the tumour closely and waiting to start active treatment if there is evidence the disease is progressing. This is also recommended for an older person with a small tumour as the likelihood of tumours progressing in most cases has been shown to be quite small.

Surgery

The best treatment for kidney cancer is surgical removal of the cancer. Surgical approaches offered at North Eastern Urology include the following: A Radical nephrectomy (this is the removal of all the tumour, the kidney and surrounding tissue. If lymph nodes are affected a lymph node dissection is also performed. A radical nephrectomy is usually recommended to treat a large tumour when there is little healthy tissue remaining. This can be performed either robotically, laparoscopically or as an open approach. A partial nephrectomy The management strategies for patients with kidney cancer are not always straightforward and may sometimes require input from medical disciplines outside urology. At NEU, we have Multi-disciplinary meetings in our rooms and have specialist medical oncologists, radiation oncologists and other urologists present. Also, through our association with Austin Health, our Urologists also attend their weekly Multidisciplinary meetings. This ensures that all our patients have access to all the latest therapies and clinical trials being run as well as the collective opinion of a team of specialists dedicated to the management of kidney cancer.

Alternative procedures

The following procedures/treatments are offered if surgery is not recommended due the person’s overall health and age.

  • Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumour to destroy the cancer with an electrical current. The procedure is performed by a radiologist or urologist. The patient is sedated and given local anaesthesia to numb the area.
  • Radiation is offered in rare cases.

The management strategies for patients with kidney cancer are not always straightforward and may sometimes require input from medical disciplines outside urology. At NEU, we have Multi-disciplinary meetings in our rooms and have specialist medical oncologists, radiation oncologists and other urologists present. Also, through our association with Austin Health, our Urologists also attend their weekly Multidisciplinary meetings. This ensures that all our patients have access to all the latest therapies and clinical trials being run as well as the collective opinion of a team of specialists dedicated to the management of kidney cancer.