Kidney cancer treatment

What is kidney cancer?

Kidney cancer (also known as renal cancer) is the uncontrolled growth of cells in the kidneys. The most common type is Renal Cell Carcinoma (RCC). Other rarer types include upper urinary tract urothelial carcinoma (UTUC). This causes about 5-10% of kidney cancers and affects the tube that connects the kidney to the bladder, called the ureter.

What are the common causes of kidney cancer?

Common risk factors for kidney cancer include:

• Male gender
• Older age
• Smoking
• High blood pressure
• Obesity
• Certain genetic mutations
• History of certain kidney conditions or a previous kidney transplant

What are the symptoms of kidney cancer?

While over 50% of people with kidney cancer do not have symptoms, those who do, generally complain of:

• Side and back or loin pain (known as flank pain)
• Blood in the urine
• A lump felt in the sides/back

How is kidney cancer diagnosed?

If kidney cancer is suspected, first a set of blood tests and an ultrasound test of the abdomen (tummy) will be done. If these suggest the presence of kidney cancer, a CT or MRI scan is used to assess the extent and spread of it (stage of the disease). Sometimes, a biopsy is needed to confirm the diagnosis.

What treatments are available for kidney cancer?

Treatment for early or localised disease is different to treatment for advanced or metastatic disease (cancer that has spread to other sites within the body).

The main treatments for localised kidney cancer include:

• Active surveillance
  This involves the use of scans to monitor the rate of growth of the cancer over time. This non-invasive treatment option is used for people with small tumours or those who are not suitable for surgery.
• Medical treatment
  This includes immunotherapy (medications that alter the body’s response to the cancer). There are a number of medications that may be used alone, or in combination, with surgical treatment. This is an evolving field of kidney cancer treatment.
• Ablation
  This involves applying an energy source to the tumour in order to destroy the cancer cells. Examples include cryoablation (freezing) and radiofrequency ablation (heating). They are useful for certain groups of people including those with small tumours, or those who are not fit for major surgery.
• Surgery
  Surgery for kidney cancer can involve a procedure where only part of the kidney is removed (known as partial nephrectomy, or nephro-sparing surgery) or surgeries where the entire kidney is removed (known as radical removal). Depending on the extent of spread of the kidney cancer, surrounding tissues may also need to be removed. These surgeries can be done through open surgery (where a large incision is made on the stomach and the surgeon manually operates on the kidney), keyhole surgery (where small incisions are made and a camera and tools are passed through in to the abdominal space) or by robotic-assisted keyhole surgery (where the surgeon remotely controls the instruments placed in the abdomen).

Robotic surgery for renal cancer

The first robotic surgery for kidney cancer took place in 2000. It involves the patient being asleep under general anaesthesia. A few small incisions are then made on the abdomen and a camera and robotic arms are placed through these incisions into the abdominal space. Unlike traditional keyhole surgery where the surgeon is directly controlling these arms, robotic-assisted surgery allows the surgeon to control the arms remotely. The instruments used in robotic surgery allow surgeons to perform more complex tasks (such as reconstructing the kidney) using a keyhole approach. This not only allows a more steady and precise use of surgical instruments, but also allows the use of multiple arms at once. The high-quality camera of the robotic system creates a clear and flexible view for the surgeon.

One of the major benefits of robotic surgery for kidney cancer over traditional surgery includes a shorter ‘ischaemic time’ (temporary pause of oxygen-rich blood flowing to the kidney). Blood supply is temporarily stopped to the kidney to reduce the amount of blood lost during surgery. A shorter ischaemic time improves surgical outcomes.

Robotic surgery for kidney cancer is considered a very safe and effective surgical option. As with any surgery, there are however some risks to consider. These include the risk of bleeding, urine leak, infection, and injury to nearby organs and tissues.

Here at the Royal Free Hospital PPU, we have been using our state-of-the-art Da Vinci XI system since 2014. Our surgeons are among the highest volume kidney cancer surgeons in the country and offer a wide range of procedures for the treatment of kidney cancers, including:

• Robotic partial nephrectomy – the removal of part of a kidney, to treat small cancers of the kidney. Robotic partial nephrectomy is now widely used, and many studies have shown that it is associated with less bleeding during the surgery, less pain afterwards, a shorter stay in hospital and a quicker recovery than traditional open surgery.
• Robotic radical nephrectomy – the removal of the entire kidney. This is the surgery of choice for larger or more complex tumours. Robotic surgery is especially useful in advanced kidney cancers that are surgically more challenging. Benefits of robotic surgery to remove the whole kidney compared to traditional surgery include a shorter length of stay, less requirement for pain medication after the surgery, and less blood loss.
• Robotic nephro-ureterectomy – the removal of the kidney, the tube that connects the kidney to the bladder(ureter) and a small portion of the bladder. This is done for patients with upper tract urothelial carcinoma (UTUC). This procedure involves operating in relatively narrow spaces, and so robotic surgery is especially useful as it gives the surgeon more flexibility and vision than traditional keyhole surgery. Robotic nephro-ureterectomy is associated with less pain, less blood loss during surgery, fewer wound complications, and a shorter hospital stay when compared to traditional surgery. It also allows the surgeon to remove a urinary catheter (inserted at the time of surgery to allow the bladder repair to heal) before the patient goes home in most cases

What we offer

Here at the Royal Free Hospital Private Patients Unit (PPU), we are proud to offer you access to leading specialists in renal surgery. Our experienced consultants include Mr Ravi Barod, Mr Faiz Mumtaz, and Mr Prasad Patki. They are supported by an experienced multidisciplinary team, all dedicated to delivering the highest standards of care.