As a possible kidney cancer patient, you may have lots of questions about the disease such as:
When you visit your doctor, you may want to write down any questions you may have about kidney cancer. Fully understanding the disease and treatment options will help you to make the best decisions about your care.
Each year, kidney cancer is diagnosed in about 190,000 people worldwide.1 Kidney cancer is slightly more common in men and is usually diagnosed between the ages of 50 and 70 years.2 It is important to realize that with early diagnosis and treatment, kidney cancer can be cured. In fact, if found early, the survival rate ranges from 79 to 100 percent.3
A kidney tumor is an abnormal growth in the kidney. The terms "mass," "lesion" and "tumor" are often used interchangeably. Tumors may be benign (non-cancerous) or malignant (cancerous). The most common kidney mass is a fluid-filled area called a cyst. Simple cysts are benign, do not turn into cancer, and usually do not require follow-up care. Solid kidney tumors can be benign but are cancerous more than 90 percent of the time.3 It is possible that kidney cancer can grow into the renal vein and vena cava. The renal vein is the kidney's primary draining vein and the vena cava is the vein that takes blood to the heart. The portion of cancer that extends into these veins is called "tumor thrombus." Imaging studies, such as an MRI, can help to find out if tumor thrombus is present.
For a tumor to grow and spread, it must stimulate new blood vessels to provide the tumor with nutrients and oxygen. This process, known as angiogenesis. Kidney cancers are considered very angiogenic and are very efficient at traveling through the blood vessels in the body. They do this by secreting a protein called vascular endothelial growth factor (VEGF). VEGF acts on nearby blood vessels and stimulates them to sprout new vessels to supply the tumor.3
Kidney cancer can form in the small tubes inside the kidney. Those tubes are located in the center of the kidney where urine collects and used to filter blood. The most common kidney cancer is called renal cell carcinoma.
Unfortunately, kidney cancer does not have early symptoms but you should see your doctor if you notice the following:3
If cancer spreads (metastasizes) beyond the kidney, symptoms depend on the organ involved. Shortness of breath or coughing up blood may occur when cancer is in the lung. Bone pain or fractures may occur when cancer is in the bone. When cancer is in the brain, you may have neurologic symptoms.
In some cases, kidney cancer causes related conditions called paraneoplastic syndromes. These syndromes occur in about 20 percent of kidney cancer patients and can occur in any stage, including cancers confined to the kidney. Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats, and high blood pressure. In many cases, the paraneoplastic syndrome improves or disappears after the cancer is removed.
Researchers have found several risk factors that make you more likely to develop kidney cancer. The following may increase your risk of developing kidney cancer:3
Unfortunately, there are no blood or urine tests that detect kidney cancer. When kidney cancer is suspected, your doctor will order a kidney imaging study. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be needed to completely evaluate the tumor.3
If cancer is suspected, you should be evaluated to see if it has spread beyond the kidney (metastasized). An evaluation consists of imaging studies such as an ultrasound or CT scan. These tests may be followed by an MRI, X-rays, and blood tests. You may also need a bone scan if you have had bone pain, recent fractures, or abnormal blood tests. Additional tests may be ordered if your doctor feels they are needed to completely evaluate the tumor.
The primary treatment option for kidney cancer is surgery to remove all or part of the kidney and the tumor; kidney cancer does not respond well to radiation and chemotherapy treatments.4
The removal of the entire kidney is called a radical nephrectomy. Depending on your disease state and tumor location, you may not have to lose your entire kidney to surgery. An emerging surgical technique, called a partial nephrectomy, aims to remove only the diseased part of your kidney and spare the healthy, functioning kidney tissue.
Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease (CKD) after surgery compared to patients who receive a kidney sparing partial nephrectomy.5
In fact, the American Urological Association states that partial nephrectomy is the gold standard treatment option for small to medium-sized kidney tumors or masses.4
An alternative therapy for kidney cancer is to treat the cancerous tissue using extreme temperatures. Cryotherapy freezes the tissue to kill cancer cells where radiofrequency uses heat to destroy cancer cells. Both methods use several tiny probes that are inserted into the kidney tumor either through an open or laparoscopic surgical technique. Thermal ablation therapy does not take the cancerous tissue out of the body, but rather uses probes to deliver extreme temperatures to tumors in the hopes that all cancerous tissue is destroyed.
On an important note, studies show that patients treated with ablation (cryoablation or radiofrequency) had a significantly higher rate of recurrence – meaning cancer returned – as compared to partial nephrectomy patients.6
Kidney surgery is traditionally performed using an open approach, meaning doctors must make a large incision in the abdomen. Another approach is conventional laparoscopic surgery. It is less invasive but limits the doctor's dexterity, vision, and control, compared to open surgery.
With laparoscopic surgery, the surgeon makes several small incisions, instead of one large incision. The surgeon also uses telescoping equipment to view and remove the bladder. This surgery may take longer, but it is typically less painful during recovery.1 Because of the long-handled instruments used in laparoscopic surgery, there are certain limitations during delicate or complex operations.
The da Vinci Surgical System uses state-of-the-art technology to help your doctor provide the gold standard treatment, where indicated, and also perform a more precise operation. da Vinci offers several potential benefits to patients facing kidney surgery, including:
If your doctor is able to preserve your healthy, functioning kidney tissue, this can help to prevent future kidney disease and even dialysis.
This procedure is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.
If you are a candidate for kidney surgery, talk to a urologist who performs da Vinci kidney procedures. To find a doctor trained in this procedure, use our surgeon locator.
As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition, and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.
* In Nephrectomy, one incision is enlarged for removal of the kidney.
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered a substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.
Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com
A kidney tumor is an abnormal growth in the kidney. The terms "mass," "lesion" and "tumor" are often used interchangeably. Tumors may be benign (non-cancerous) or malignant (cancerous). The most common kidney mass is a fluid-filled area called a cyst. Simple cysts are benign, do not turn into cancer, and usually do not require follow-up care. Solid kidney tumors can be benign but are cancerous more than 90 percent of the time.1
It is possible that kidney cancer can grow into the renal vein and vena cava. The renal vein is the kidney's primary draining vein and the vena cava is the vein that takes blood to the heart. The portion of cancer that extends into these veins is called "tumor thrombus." Imaging studies, such as an MRI, can help to find out if tumor thrombus is present.
Tumors must stimulate the growth of new blood vessels to provide the tumor with nutrients and oxygen. This process, known as angiogenesis, is needed for a tumor to grow and spread to other areas of the body. Kidney cancers are considered very angiogenic and are very efficient at traveling through the blood vessels in the body. They do this by secreting a protein called vascular endothelial growth factor (VEGF). VEGF acts on nearby blood vessels and stimulates them to sprout new vessels to supply the tumor.1
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered a substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.
Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com
1"Kidney Cancer", American Urological Association Foundation, www.urologyhealth.org
PN 873588-A U2-1-11
A staging system lets doctors know if cancer has spread and to what extent. Staging describes the extent or severity of cancer-based on the size of the original (primary) tumor and the extent to which it has spread in the body. There are several staging systems for prostate cancer but the most widely used system in the United States is called the TNM System. It is also known as the Staging System of the American Joint Committee on Cancer (AJCC).1
Staging is based on knowledge of how cancer develops. Cancer cells divide and grow to form a mass of tissue called a growth or tumor. As a tumor grows, it can spread to nearby organs and tissues. Cancer cells may also break away from the tumor and enter the bloodstream or lymphatic system. By moving through the bloodstream or lymphatic system, cancer can spread from the primary site to form new tumors in other organs. The spread of cancer is called metastasis.
Staging helps with the cancer diagnosis and treatment process in important ways, including:
Staging helps researchers and health care providers exchange information about patients and provide a common language for diagnosis, treatment, and clinical trials.
The AJCC staging system includes the primary kidney tumor (T stage), the lymph nodes near the kidney (N stage), and the presence or absence of metastases (M stage) to determine if cancer has spread.
In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. The clinical stage is based on radiographic imaging before surgery. The pathologic stage is based on the analysis of the tissue that has been surgically removed.
| Stage | Explanation / Description |
|
Stage I |
The tumor is confined to the kidney. There is no spread to lymph nodes or distant organs. |
|
Stage II |
The tumor has invaded the fat around the kidney or the adrenal gland above the kidney. There is no spread to lymph nodes or other organs. |
|
Stage III |
There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade other nearby organs or more distant organs. |
|
Stage IV |
There are several combinations of T, N, and M categories included in this stage. This stage includes any cancers that have invaded into nearby organs such as the colon (large bowel) or the abdominal wall as well as more distant organs in the body. |
Primary tumor (T)
| TX |
Primary tumor cannot be assessed |
|
T0 |
No evidence of primary tumor |
|
T1 |
Tumor 7.0 cm or less, confined to the kidney |
|
T1a |
Tumor 4.0 cm or less, confined to the kidney |
|
T1b |
Tumor 4.0-7.0 cm, confined to the kidney |
|
T2 |
Tumor greater than 7.0 cm, limited to kidney |
|
T3 |
Tumor extends into major veins/adrenal/tissue; not beyond Gerota's fascia |
|
T3a |
Tumor invades adrenal/perinephric fat |
|
T3b |
Tumor extends into renal vein(s) or vena cava below the diaphragm |
|
T3c |
Tumor extends into vena cava above the diaphragm |
|
T4 |
Tumor invades beyond Gerota's fascia, into adjacent organ systems |
N - Regional lymph nodes
| NX |
Regional nodes cannot be assessed |
|
N0 |
No regional lymph node metastasis |
|
N1 |
Metastasis in a single regional lymph node |
|
N2 |
Metastasis in more than one regional lymph node |
M - Distant metastasis
| MX |
Distant metastasis cannot be assessed |
|
M0 |
No distant metastasis |
|
M1 |
Distant metastasis |
In general, cancers with a higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates; these patients need to consider more aggressive treatments.2
If cancer is suspected, you should be evaluated to see if it has spread beyond the kidney (metastasized). An evaluation consists of imaging studies such as an ultrasound or CT scan. These tests may be followed by an MRI, X-rays, and blood tests. You may also need a bone scan if you have had bone pain, recent fractures, or abnormal blood tests. Additional tests may be ordered if your doctor feels they are needed to completely evaluate the tumor. The most common tests to diagnose and evaluate kidney cancer are:2
A CT scan is a highly specialized x-ray used to visualize internal organs and provides a very accurate cross-section picture of specific areas of the body. It is one of the primary imaging tools for assessing kidney cancer. CT scans are more detailed than ordinary x-rays, taking pictures of your organs one thin slice at a time from different angles. Then a computer puts the images together to show the size and location of any abnormalities. To enhance the image of the abdominal organs, a dye may be swallowed before the scan or delivered intravenously (IV directly into a vein).
An MRI is a highly specialized scan that is similar to a CT scan, but maybe better for assessing certain areas of the body like the bones. It creates an accurate cross-section picture of specific organs within the body to allow for a layer-by-layer examination using a powerful magnet to produce the images.
If there is blood in the urine, an ultrasound of the abdomen with special attention to the kidneys, ureters, and bladder may be ordered. Ultrasound uses sound waves to produce images of internal organs. That helps the radiologist to detect any masses that may be present.
An intravenous pyelogram (IVP) test may also be used. A special dye is injected into a blood vessel, usually in the arm. The dye circulates through the bloodstream to the different organs of the body including the kidneys. X-rays are taken of the kidneys as the dye circulates through them. This will identify any abnormalities within the kidney. If either the ultrasound or IVP is abnormal, a CT scan may be ordered.
A plain x-ray of the chest may be done to see if cancer has spread to the lungs. If something is seen on the x-ray, the doctor may order a CT scan of the chest to help determine what it is.
This procedure is used to visualize the location and function of arteries. A catheter is usually threaded up a large artery in the leg into an artery leading to your kidney (renal artery). A contrast dye is then injected into the artery to outline blood vessels. Angiography can outline the blood vessels that supply a kidney tumor, which can help a surgeon better plan an operation.
If, after diagnostic tests are completed, there is a strong suspicion that the kidney mass is malignant (cancerous), surgical removal of the kidney tumor will be performed immediately. If the diagnostic test results are not clear, a biopsy may be performed. During a biopsy procedure, a small sample of tissue is removed from the mass and examined to determine whether it is benign or malignant. There are several ways to perform a biopsy of a kidney mass. The most common method is a procedure called a fine needle aspiration (FNA) or fine needle biopsy. Using ultrasound or a CT scanner for guidance, the doctor will insert a long thin needle through the skin directly into the mass and remove the sample tissue for analysis by a pathologist.
While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered a substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.
Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com
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