Overview

Therapeutic options

Causes of kidney cancer

Symptoms of kidney cancer

Screening and testing for kidney cancer

Stages of kidney cancer

Overview

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. 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 The most common kidney cancer is called renal cell carcinoma.

It is important to realize that with early diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent.3

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Therapeutic options

Kidney cancer is frequently resistent to radiotherapy or chimiotherapy, thus the golden standard for kidney cancer is the surgical removal of the kidney or of the tumor.

Open kidney surgery involves a big abdominal incision. conventional laparoscopic surgery, althought less invasive is limited by the doctors dexterity, filed of view and difficult control.

da Vinci ® Surgery for Kidney Conditions

If your doctor recommends surgery for kidney cancer, you may be a candidate for a new, minimally invasive approach — da Vinci® Surgery. da Vinci Surgery uses state-of-the-art technology to help your doctor perform a more precise operation than conventional surgery. It offers several potential benefits over conventional open surgery, including:

  • Increased potential to spare healthy kidney tissue and minimize the risk of chronic kidney disease 4,5
  • Significantly less pain 6
  • Less blood loss than open and traditional laparoscopic surgery 7
  • Fewer blood transfusions8
    Less risk of infection9
  • Shorter hospital stay and recovery10
  • Less scarring6

da Vinci Surgery for kidney cancer incorporates the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach.

The precision and dexterity of the da Vinci Surgical System’s advanced instrumentation facilitates a minimally invasive approach for treating kidney cancer.

As with any surgery, these benefits cannot be guaranteed, as surgery is patient and procedure specific.

  1. World Health Organization; Global cancer rates could increase by 50% to 15 million by 2020; URL: http://www.who.int/mediacentre/news/releases/2003/pr27/en/
  2. “Cancer Facts & Figures 2008”, American Cancer Society, www.cancer.org , URL: http://www.cancer.org/downloads/STT/2008CAFFfinalsecured.pdf
  3. ‘Kidney Cancer”, American Urological Association Foundation, www.urologyhealth.org
  4. Bhayani SB, Das N.; Robotic-assisted laparoscopic partial Nephrectomy for suspected Renal Cell Carcinoma. BMC Surgery 2008, 8:16 doi:10.1186/1471-2482-8-16
    Huang WC, Elkin EB, Levey AS, Jang TL, Russo P; Partial Nephrectomy Versus Radical Nephrectomy in Patients With Small Renal Tumors-Is there a Difference in Mortality and Cardiovascular Outcomes; The Journal of Urology, Vol. 181, 55-62, January 2009
    Ramaswamy M. and Sundaram CP.; Laparoscopic live-donor nephrectomy. University Hospital, Liverpool, UK, and Indiana University Hospital, Indianapolis, USA. January 2006
    Nazemi T; Galich A, et al. Radical nephrectomy performed by open, laparoscopy with or without hand-assistance or robotic methods. Int. braz j urol. vol.32 no.1 Rio de Janeiro Jan./Feb. 2006
    Ibid.
    Renoult E, Hubert J, et al. Robot-assisted laparoscopic and open live-donor nephrectomy. Nephrology Dialysis Transplantation 2006 21(2):472-477
    Ibid.

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Causes of Kidney Cancer

Origins

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

Tumor Growth

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 the 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 travelling 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.2

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.

“Kidney Cancer”, American Urological Association Foundation, www.urologyhealth.org
Ibid.

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Symptoms of Kidney Cancer

Unfortunately, kidney cancer does not have early symptoms but you should see your doctor if you notice the following:1

  • Blood in your urine
  • Lump in your abdomen
  • Unexplained weight loss
  • Pain in your side
  • Loss of appetite

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.

  1. “Kidney Cancer”, American Urological Association Foundation; www.urologyhealth.org

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Screening and Testing for Kidney Cancer

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.1

Tests to Determine Kidney Cancer Stage

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
Computed Tomography (CT scan)

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 then 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, dye may be swallowed before the scan or delivered through an.
Magnetic Resonance Imaging (MRI)

An MRI is a highly specialized scan that is similar to a CT scan, but may be 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.
Ultrasonography (ultrasound or US)

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.
Intravenous Pyelogram (IVP)

An intravenous pyelogram (IVP) test may also be used. Special dye is injected into a blood vessel, usually in the arm. The dye circulates through the blood stream 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.
Chest X-ray

A plain x-ray of the chest may be done to see if the 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.
Angiography

This procedure is used to visualize 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.
Biopsy Procedure

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.

  1. “Kidney Cancer”, American Urological Association Foundation; www.urologyhealth.org
    “About Kidney Cancer”, Kidney Cancer Association, www.kidneycancer.org , URL: http://www.kidneycancer.org/knowledge/learn/about-kidney-cancer

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Stages of Kidney Cancer

Definition of Staging

A staging system lets doctors know if the 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

General Information on Staging

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.

Purpose of Staging

Staging helps with the cancer diagnosis and treatment process in important ways, including:
Helping the doctors to effectively plan a patient’s treatment
Estimating the patient’s prognosis (likely outcome or course of the disease)
Helping to identify clinical trials that may be suitable for a particular patient.2

Staging helps researchers and health care providers exchange information about patients and provide a common language for diagnosis, treatment and clinical trials.

Staging Kidney Cancer

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 the cancer has spread.

In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery. Pathologic stage is based on the analysis of the tissue that has been surgically removed.

Stages
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 diaphragm
T3c

Tumor extends into vena cava above 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 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.3
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  1. “Staging: Questions and Answers,” National Cancer Institute. www.cancer.gov. URL: http://www.cancer.gov/cancertopics/factsheet/Detection/staging
    Ibid.
    “Kidney Cancer”, American Urological Association Foundation. Urologyhealth.org.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual. Always ask your doctor about all treatment options, as well as their risks and benefits.