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The curative treatment of kidney cancers is dependent on early cure and surgical removal. Classically patients with kidney cancers present with blood in the urine or flank pain however an increasing number are being detected incidentally due to the increased use of ultrasound. For patients with these symptoms or abnormal ultrasound scans it is imperative therefore to seek urgent advice from urological surgeons as early detection can increase the chance of not only cure but successful keyhole surgery and even preserving kidney function. Our surgeons have pioneered keyhole and robotic approaches to kidney surgery and are committed to the ethos of aiming to provide the highest chance of cure with the lowest possible risk to the patient

 

Renal Cell cancer

This is responsible for 1 in 30 of all adult cancers and 85% of all primary renal tumours with a male to female predominance of 2 to 1. The major known risk factor is smoking although some genetic variants exist. Classically these tumours presented with blood in the urine, (Haematuria), flank pain and an abdominal mass. The majority we now see are being detected much earlier due to a patient having abdominal ultrasound scans for other reasons. The diagnostic test is usually based on a CT scan(computerized tomography) of the abdomen and chest.

For certain tumours that are very small it is impossible to determine whether they are cancerous or not and an option for these very small lesions can include biopsy to aid in diagnosis. 

For very small tumours that experience tells us are likely to be slow growing an option open to patients is monitor the lesion with regular scans and defer treatment until the tumour increases in size.

Although this may appear an unusual treatment, the kidney prevents cancer spreading to other organs or elsewhere in the same kidney, by surrounding the tumour in a reactive ‘capsule.’

Should the lesion require treatment this capsule phenomenon can allow us to plan to surgically remove the tumour from the kidney rather than removing the entire kidney – ‘nephron sparing surgery’. For tumours that are over 4cm in size however, the chance of having other areas of cancer in the same kidney increases and so removal of the kidney and tumour en mass remains the curative gold standard.

With sufficient expertise most nephrectomies can be performed laparoscopically however our expertise with the DaVinici robotic platform allows us to offer nephron sparing surgery to a larger proportion than most surgeons

 

Transitional Cell cancer.

This is a cancer of the lining of the urinary tract and can occur in the bladder or at any point in the tube that connects the kidney to the bladder; the Ureter. 
Although there are occupation risk factors the greatest increased risk is seen in patients who are or have been smokers. It usually presents at a smaller size that Renal Cell cancer because of its tendency to cause Haematuria or even blocking the kidney. It is, however, a potentially more aggressive variant of cancer than Renal cell cancer and therefore for patients with Haematuria urgent investigation and opinion of a urologist is essential. If detected and treated without delay by surgical removal it still has an excellent chance of being cured. The operation is called Nephroureterectomy and is more extensive than Nephrectomy as the ureter needs to be removed along with the kidney because of the high chance of multiple areas of tumour existing within it. In addition to the Nephrectomy approach, which can be still performed laparoscopically, many surgeons still perform a lower abdominal incision to disconnect the ureter from the bladder.

We have pioneered techniques to allow both the kidney and the ureter disconnection to be performed laparoscopically using the same small incisions classically used solely for the nephrectomy. Unfortunately it is not possible to cure all cancers and although there are no chemotherapy or radiotherapy options to cure kidney cancer once it has spread, we work closely with our oncological colleagues to offer patients in this position access to the latest drugs that can slow down the progression of the disease

 

Patient information - what to expect

Patients presenting with one of the cardinal symptoms of blood in the urine, flank pain,fabdominal mass will be seen by one of our consultant urologists as a matter or priority in consulting suites and a detailed medical history  taken and examination performed. It is likely that further investigations such as blood test, an abdominal CT scan and possibly an inspection of the bladder under local anaesthesia (cystoscopy) will be arranged.

If the investigations are diagnostic of kidney cancer you will be reviewed by one of our national experts in this field. The investigations to date will be reviewed at our Multidisciplinary team meeting and the diagnosis and possible treatment options will be discussed in detail, all questioned answered and written information provided. If the tumour is amenable to surgical cure and the appropriate procedure has been agreed, our dedicated team of secretaries will liaise with you and help you to arrange authorisation through your insurance company or will retrieve an inclusive quote for you if you are self funded. The operative date will be arranged and usually a pre-operative assessment at an interim date will be performed before you are admitted on the day of surgery. The procedure will be performed by the consultant you chose and they will continue to review you post operatively. You will subsequently be seen in the consulting suite with the formal histology of the specimen, at which point your further follow up plan will be arranged. 

 

Information leaflets

Patient information sheet Radical Nephrectomy.doc
Patient information sheet Radical Nephroureterectomy.doc

Links

www.nhs.uk/conditions/Cancer-of-the-kidney/Pages/Introduction.aspx
www.cancerresearchuk.org/about-cancer/type/kidney-cancer
www.macmillan.org.uk/information-and-support/kidney-renal-cancer/treating