The urologist acts as the coordinator between the medical oncologist, radiation oncologist, cardio thoracic surgeon and palliative care team in the management of patients with advanced kidney cancer.
Radical nephrectomy is performed by the minimally invasive (laparoscopy) technique in tumors up to 7cm in size. Long-term cancer cure
results for laparoscopy are similar to open surgery. As laparoscopy only involves creating a small skin wound it has the advantage
of less pain and quicker recovery.
Open surgery is still required for very large kidney cancer or cancer that have invaded the
surrounding blood vessels. The tumor, entire kidney and the affected blood vessel may be removed totally in order to achieve a good
cure. Although it is more invasive, post operative pain is well controlled with specialized techniques of continuous anesthesia delivery
such as epidural anesthesia or patient-controlled anesthesia.
Kidney cancer may sometimes be diagnosed in the advanced stage. The tumor has invaded beyond the kidney and spread to other structures
such as lymph nodes, bones or lungs. In these situations, complete removal of the kidney containing the tumor is beneficial in order
to have a precise diagnosis of the type of cancer so that chemotherapy can be planned.
We work closely with the medical oncologist in the management of advanced kidney cancer. Patients can be started on chemotherapy as soon as they have recovered from their surgical wound, which is usually at 2-3 weeks after surgery. The newer group of oral (tablet) chemotherapy agents are easier to administer than the conventional injection medications. Results from these latest 'targeted-therapy' drugs are encouraging. Examples of these agents include Sunitinib and Sorafenid.
Our centre offers a comprehensive range of investigations in the diagnosis and staging of kidney cancer. Complete evaluation can usually
be accomplished accurately within a 24 hour time frame. These are some of the services that we provide:
1. Ultrasound of kidney
2.CT scan of kidney with 3D reconstruction. This is especially useful in delineating the extend of the tumor invasion to the surrounding
structures or organs.
3. CT angiography of the kidney. A thorough study of the kidney blood vessels is achieved without the need of
an additional angiogram study.
4. MRI kidney. This provides additional information on invasion of major veins that are related to
the kidney
5. CT Scan and Ultrasound guided biopsy. Biopsies of kidney tumors are difficult to perform and may be inaccurate in some
instances. Imaging guided biopsies yield a much better result.
6. Whole body bone scan. This is necessary to exclude tumor spread to
the bones.
7. PET Scan. This scan is sometimes used to exclude small tumor spread to other parts or organs in the body.
Kidney cancer is a urology cancer that begins in the kidney. There are several types of kidney cancer; renal cell carcinoma (also
known as renal cell cancer or renal cell adenocarcinoma) is by far the most common type, accounting for about 9 out of 10 kidney cancers.
Less common cancers of the kidney include transitional cell carcinomas, Wilms tumors, and renal sarcomas.
Kidney cancer is a urology
condition that may cause blood in urine, pain over back or sensation of a lump. Up to 50% of current kidney cancer is detected through
imaging techniques such as ultrasound and CT scan, even before they cause any symptoms. Advanced kidney cancer spreading to the lungs
or bone would result in symptoms in these areas.
More information on types of kidney cancer, symptoms, diagnosis and staging can be
obtained in the following links:
We offer an integrated approach to management of kidney cancer with a close working relationship between urologist and medical oncologist.
Our priorities are complete cancer clearance with minimal disruption to quality of life.
Kidney cancer had been traditionally treated with total surgical removal of the kidney but recent results have shown that in smaller and early cancers, total removal of the kidney may not be necessary. Partial nephrectomy (removal of only the cancer portion) has similar long term results as total nephrectomy. Other alternatives include percutaneous Radio-frequency ablation or cyroablation.
