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Kidney Cancer

As a possible kidney cancer patient, you may have lots of questions about the disease such as:

  • What is the prognosis for kidney cancer?
  • What is the survival or cure rate for kidney cancer patients?
  • What are the early signs and symptoms of kidney cancer?
  • What causes kidney cancer?
  • How is kidney cancer treated?
  • What is thermal ablation or freezing of kidney cancer?
  • Testimonials

When you visit your doctor, you may want to write down any questions you may have about kidney cancer. Fully understanding the disease and treatment options will help you to make the best decisions about your care.

Overview

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

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.3 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.

For a tumor to grow and spread, it must stimulate new blood vessels to provide the tumor with nutrients and oxygen. This process, known as angiogenesis. 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.3

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

Symptoms

Unfortunately, kidney cancer does not have early symptoms but you should see your doctor if you notice the following:3

  • 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.

Causes & Risk Factors

Researchers have found several risk factors that make you more likely to develop kidney cancer. The following may increase your risk of developing kidney cancer:3

  • Smoking
  • Hypertension
  • Obesity
  • Family history of kidney cancer
  • Chronic kidney failure and/or dialysis
  • Diet with high caloric intake or fried/sautéed meat
  • Von Hippel Lindau disease (rare genetic disorder that causes tumor growths)
  • Tuberous sclerosis (common genetic condition that produces growths in the body from birth throughout adulthood)

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.3

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.

Treatment

The primary treatment option for kidney cancer is surgery to remove all or part of the kidney and the tumor; kidney cancer does not respond well to radiation and chemotherapy treatments.4

Radical Nephrectomy versus Partial Nephrectomy (Kidney-sparing)

The removal of the entire kidney is called a radical nephrectomy. Depending on your disease state and tumor location, you may not have to lose your entire kidney to surgery. An emerging surgical technique, called partial nephrectomy, aims to remove only the diseased part of your kidney and spare the healthy, functioning kidney tissue.

Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease (CKD) after surgery compared to patients who receive a kidney sparing partial nephrectomy.5

In fact, the American Urological Association states that partial nephrectomy is the gold standard treatment option for small to medium-sized kidney tumors or masses.4

Surgical Treatment Options

Thermal Ablation - An alternative therapy for kidney cancer is to treat the cancerous tissue using extreme temperatures. Cryotherapy freezes the tissue to kill cancer cells where radiofrequency uses heat to destroy cancer cells. Both methods use several tiny probes that are inserted into the kidney tumor either through an open or laparoscopic surgical technique. Thermal ablation therapy does not take the cancerous tissue out of the body, but rather uses probes to deliver extreme temperatures to tumors in the hopes that all cancerous tissue is destroyed.

An important note, studies show that patients treated with ablation (cryoablation or radiofrequency) had a significantly higher rate of recurrence – meaning the cancer returned – as compared to partial nephrectomy patients.6

Traditional Open Surgery - Kidney surgery is traditionally performed using an open approach, meaning doctors must make a large incision in the abdomen. Another approach is conventional laparoscopic surgery. It is less invasive, but limits the doctor's dexterity, vision and control, compared to open surgery.

Laparoscopic Surgery - With laparoscopic surgery, the surgeon makes several small incisions, instead of the one large incision. The surgeon also uses telescoping equipment to view and remove the bladder. This surgery may take longer, but it is typically less painful during recovery.1 Because of the long-handled instruments used in laparoscopic surgery, there are certain limitations during delicate or complex operations.

da Vinci ® Surgery for Kidney Cancer (Partial Nephrectomy)

The da Vinci Surgical System uses state-of-the-art technology to help your doctor provide the gold standard treatment, where indicated, and also perform a more precise operation. da Vinci offers several potential benefits to patients facing kidney surgery, including:

  • Excellent clinical outcomes and cancer control7
  • Short hospital stay8
  • Low blood loss7,8
  • Precise tumor removal and kidney reconstruction8,9
  • Excellent chance of preserving the kidney, in certain operations9
  • Low rate of operative complications9

If your doctor is able to preserve your healthy, functioning kidney tissue, this can help to prevent future kidney disease and even dialysis.

This procedure is performed using the da Vinci Surgical System, a state-of-the-art surgical platform. By overcoming the limits of both traditional open and laparoscopic surgery, da Vinci is changing the experience of surgery for people around the world.

If you are a candidate for kidney surgery, talk to a urologist who performs da Vinci kidney procedures. To find a doctor trained in this procedure, use our surgeon locator.

As with any surgery, these benefits cannot be guaranteed since surgery is specific to each patient, condition and procedure. It is important to talk to your doctor about all treatment options, including the risks and benefits. This information can help you make the best decision for your situation.

* In Nephrectomy, one incision is enlarged for removal of the kidney.

________________________________________

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com

  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 , URL: http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=124
  4. American Urological Association; Guideline for Management of the Clinical Stage I Renal Mass; 2009; URL: http://www.auanet.org/content/guidelines-and-quality-care/clinical-guidelines/main-reports/renalmass09.pdf
  5. 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
  6. Kunkle D, Egleston B, Uzzo R; Excise, Ablate or Observe: The Small Renal Mass Dilemma – A Meta Analysis and Review. The Journal of Urology, Vol. 179, 1227-1234, April 2008
  7. Benway BM, Wang AJ, Cabello JC, Bhayani SB; Robotic Partial Nephrectomy with Sliding-Clip Renorrhaphy: Technique and Outcomes; European Association of Urology, Accepted December 28, 2008. Published online ahead of print on January 7, 2009
  8. Rogers CG, Menon M, Weise ES, Robotic partial nephrectomy: a multi-institutional analysis; J Robotic Surgery (2008) 2:141-143 DOI 10.1007/s11701-008-0098-2
  9. 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.

Kidney Cancer Causes & Risk Factors

Researchers have found several risk factors that make you more likely to develop kidney cancer. The following may increase your risk of developing kidney cancer:1

  • Smoking
  • Hypertension
  • Obesity
  • Family history of kidney cancer
  • Chronic kidney failure and/or dialysis
  • Diet with high caloric intake or fried/sautéed meat
  • Von Hippel Lindau disease (rare genetic disorder that causes tumor growths)
  • Tuberous sclerosis (common genetic condition that produces growths in the body from birth throughout adulthood)

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.1

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com

1"Kidney Cancer", American Urological Association Foundation, www.urologyhealth.org, URL: http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=124

PN 873588-A U2-1-11

Symptoms of Kidney Cancer

Symptoms

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

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

If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon 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. And, neurologic symptoms may occur when cancer is in the brain.

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, http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=124

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.

Process of Kidney Cancer

Origins

A kidney tumor is an abnormal growth within 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 lesion is a fluid-filled area called a cyst . Simple cysts are benign, do not turn into cancer and usually require no follow-up or treatment. Solid kidney tumors can be benign, but are cancerous more than 90 percent of the time. 1

Tumor Growth

Kidney cancer can potentially grow into the renal vein and the 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, particularly an MRI, can help to determine 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 continue 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, or VEGF. VEGF acts on nearby blood vessels stimulating them to sprout new vessels to supply the tumor. 2

1."Kidney Cancer", American Urological Association Foundation, www.urologyhealth.org, URL: http://www.urologyhealth.org/adult/index.cfm?cat=04&topic=124

2.Ibid.

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.1

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.

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.2

  1. "Staging: Questions and Answers," National Cancer Institute. www.cancer.gov. URL: http://www.cancer.gov/cancertopics/factsheet/Detection/staging
  2. "Kidney Cancer", American Urological Association Foundation. Urologyhealth.org. URL http://urologyhealth.org/adult/index.cfm?cat=04&topic=124:

Screening and Testing for Kidney Cancer

Overview

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 intravenously (IV directly into a vein).

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.

________________________________________

While clinical studies support the effectiveness of the da Vinci Surgical System when used in minimally invasive surgery, individual results may vary. There are no guarantees of outcome. All surgeries involve the risk of major complications. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation. Surgery with the da Vinci Surgical System may not be appropriate for every individual; it may not be applicable to your condition. Always ask your doctor about all treatment options, as well as their risks and benefits. Only your doctor can determine whether da Vinci Surgery is appropriate for your situation. The clinical information and opinions, including any inaccuracies expressed in this material by patients or doctors about da Vinci Surgery, are not necessarily those of Intuitive Surgical, Inc. and should not be considered as substitute for medical advice provided by your doctor. © 2010 Intuitive Surgical. All rights reserved.

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com
1"Kidney Cancer", American Urological Association Foundation; www.urologyhealth.org, http://urologyhealth.org/adult/index.cfm?cat=04&topic=124
2"About Kidney Cancer", Kidney Cancer Association, www.kidneycancer.org, URL: http://www.kidneycancer.org/knowledge/learn/about-kidney-cancer

Content provided by Intuitive Surgical. For more information, please visit www.davincisurgery.com

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