Kidney cancer, also called hypernephroma, can be cured with surgery when it is located in the kidney. However, if the tumour has spread to other places (metastasis), the prognosis is inferior, although a small percentage of patients may have a slow evolution for several years. 25-30% of patients diagnosed with kidney cancer have evidence of metastatic (distant) disease at the time the diagnosis is made.
The right kidney was removed and opened in half with a tumour in the upper pole. Personal archive of Dr Gómez Pascual (the year 2010)
There are no accepted risk factors for renal cell carcinoma. However, some epidemiological data indicate that smoking, obesity and arterial hypertension. Likewise, continued exposure to certain heavy metals ( cadmium ) can favour the development of kidney cancer.
What are usually the symptoms of kidney cancer?
Initially, it may not produce symptoms. Most of those diagnosed do so during the study of other types of problems for which the patient consulted, often digestive issues in which the request for a CT scan or ultrasound accidentally discovers a kidney tumour. Other times it manifests itself as follows:
Hematuria or blood in the urine (40-60%). If this blood loss is very intense, it can cause anaemia. Its company makes it necessary to rule out other genitourinary tract tumours.
The appearance of a lump in the abdomen (30% of cases)
Pain in the lower back (35-40%)
These symptoms are not exclusive to kidney tumours but also occur in benign diseases, for example, kidney stones or urinary tract infections.
How is it diagnosed?
Any renal mass that captures contrast (iodine or gadolinium) should be considered a renal carcinoma until proven otherwise.
Blood and urine tests: can show some changes associated with this disease, such as anaemia or impaired kidney function.
Renal ultrasound is a non-invasive and therefore harmless test used to see the structure and abnormalities of the kidney and urinary tract. Ultrasound is used.
Intravenous urography (IVU): These are X-rays with a urinary contrast to see if there are obstructions in the urinary excretory system (kidneys, ureters and bladder) or invasion of the urinary tract.
Computerised axial tomography (CAT): Imaging test of choice for diagnosing this disease.
Other additional diagnostic procedures (MRI, angiography, puncture biopsy…) have a limited role but can be considered in selected cases.
Nuclear magnetic resonance (NMR) will be the imaging technique of choice in the following cases:
- Allergy to iodinated contrast agents
- Renal insufficiency
- When the diagnosis is not conclusive by CT
- To assess tumour extension towards the renal vein and cava
SURGICAL TREATMENT OF KIDNEY CARCINOMA
Kidney cancer may be cured with surgery by removing the kidney when the tumour is localized (stage I).
In more advanced stages of the disease, surgery can help palliate the symptoms caused by the tumour, and in some patients with early-stage metastatic disease, better survival can be achieved if the tumour and metastases are entirely removed.
In operation, only the kidney may be removed (simple nephrectomy), or the surrounding tissues may need to be removed (radical nephrectomy). Radical nephrectomy entails the en bloc excision of the kidney affected by the tumour (ligation of the renal artery and vein as the first step), together with the perirenal fat, adrenal gland and Gerota’s fascia (extra fascial).
Surgery is the only treatment with curative possibilities for renal cell cancer (RCC). There are different surgical procedures: radical surgery, renal preservation surgery, 3D HD laparoscopic surgery or minimally invasive techniques.
The appearance of the abdomen of a patient after laparoscopic nephrectomy (minimally invasive treatment).
Since the 1980s, attempts have been made to minimise surgical aggression and perform organ preservation surgery, with urology being one of the best and fastest adopting these conservative procedures.
More and more elective renal preservation surgeries are being performed, and this is due to several reasons:
Technological advances in diagnostic imaging are increasing incidences of incidentally discovered kidney cancers. Diagnosing asymptomatic tumours is related to smaller tumours, lower stages and a better prognosis.
It is necessary to save renal mass due to the longer life expectancy and the need for the kidneys to be preserved until the end of life.
The benign nature of many lesions is considered a priori malignant. This occurs in 10% to 15% of solid or mixed lesions diagnosed in the kidney.
In small, low-stage tumours, renal-sparing surgery (or partial nephrectomy) provides similar results to radical nephrectomy. Its indication above 75 years of age is debatable since no benefit has been seen in survival compared to radical surgery.
kidney pathology
kidney cysts
Kidney cancer