sure all options are available to you!
cancer accounts for 2 percent of all cancers in the United States
annually. 30,000 cases are diagnosed each year and 12,000 people
die each year of the disease. It is more common in males and
usually occurs between the ages of 50 and 70. If diagnosed
in a timely fashion, most kidney cancers are curable and overall
survival rates are 79 to 100 percent.
If you are found to have a kidney mass that needs treatment,
make sure you see a urologist that offers all of the latest minimally
invasive treatment options. Most
urologists today do not offer these options and will do open surgery on every
patient! There is no need to have a big, painful incision in most cases! Dr.
Hendricks offers all available minimally invasive treatment options.
Most kidney cancers are discovered incidentally when found on abdominal imaging
(ultrasound, CT scan, or MRI) done for other reasons. The majority of patients
have no symptoms from their cancer. Some will have blood in their urine
(either gross-one can see it with the naked eye- or microscopic). Pain
is sometimes felt at the site of the cancer.
When a mass is found in the kidney that is not a simple cyst (fluid filled
sac, universally benign, NOT cancer), there is a 90 percent likelihood that
the mass is cancerous. Biopsies of these masses are NOT routinely done. The
reason for this is that if no cancer is found on the biopsy, it does not mean
there is no cancer in the remainder of the mass not biopsied. There is
a significantly high false-negative rate with kidney biopsies. The
universally accepted, BEST way to determine if it is a cancer is to remove
the mass and then have it looked at by a pathologist.
Before a kidney mass that is presumed to be cancer can be treated, tests
need to be done to see if the cancer has spread beyond the kidney to other
parts of the body. Kidney cancer typically will spread to the lungs or the bones,
so usually a plain xray of the chest will be done or a chest CT scan. A
bone scan may be necessary, as well as some other routine blood tests.
If these tests show no evidence of spread of the tumor, then the chance of
successful cure with surgery is highly likely. If the cancer has spread outside of
the kidney, then the likelihood of cure is less, the amount depending upon the
amount of spread of the tumor. If the cancer has spread, then consultation
with a medical oncologist is generally recommended to see if any treatment
protocols with chemotherapy or immunotherapy, sometimes in combination with
surgery, would be advisable.
There are a number of ways to treat localized kidney cancers. These
- Open radical nephrectomy
-the entire kidney is removed with the surrounding
fat and adrenal gland.
- Open partial nephrectomy
-that part of the kidney with the tumor is removed,
leaving the rest of the kidney intact.
- Laparoscopic radical nephrectomy
-same as open radical nephrectomy,
but done through small "key-hole" incisions
rather than a large
- Laparoscopic partial nephrectomy
-same as open partial nephrectomy,
but done through small incisions
as in #3.
of the tumor to kill the cancer. This
can be done laparoscopically or percutaneously
through small incisions.6) Radiofrequency ablation-radiofrequency
energy used to superheat the
tumor to try and kill it.
Open radical nephrectomy has been the treatment standard for years,
but now there is quite a bit of data showing that laparascopic nephrectomy
is equal in terms of cancer cure with quicker recovery. Smaller
tumors can be treated with laparascopic partial nephrectomy, cryoablation,
or radiofrequency ablation, thereby preserving most of the kidney that
does not contain tumor.
It appears that laparoscopic partial nephrectomy will be as efficacious
at curing the cancer as radical nephrectomy, but we do not have long
term results yet. Cryosurgery
is 95 percent effective at treating tumors smaller than 5 centimeters. For
tumors that are 3 centimeters or less, success is nearly 100 percent with up
to four year follow-up available. Radiofrequency ablation does not appear
to be as promising as cryoablation. Each of these modalities
are potentially beneficial as they are minimally invasive AND allow
preservation of the normal parts of the kidney.
Tumors that are located in middle of the kidney are more appropriately
treated by laparoscopic radical nephrectomy. If a patient has
decreased kidney function already and has a large tumor or one that
is in the middle of the kidney, then an open partial nephrectomy, although
more invasive than other options, would be advised in order to preserve
some of the kidney and try to prevent dialysis.
Dr. Hendricks offers tailored treatment for each patient with kidney
offers all of these currently available treatment options, performs
them regularly, and uses them appropriately.
has an informative page on kidney cancer here.
Napa Valley Urology Associates