Renal cancer (renal cell cancer, adenocarcinoma) originates from the tissues inside the parenchyma, which mainly drains blood and produces urine. Approximately 1 million small filters are present in a kidney. Liquid is absorbed by small tubules or excess molecules are excreted inside it and finally urine is produced.
This urine passes through pelvis (the main area where urine is collected inside the kidney),ureter (the channel between kidneys and bladder) and finally reaches the bladder. Adenocarcinoma of the kidney originates from the small tubules of kidney and transitional cell cancer originates from pelvis and ureter. Smoking and excessive use of pain killers increase the risk of renal cancer.
Most frequent signs for renal cancer are hematuria and the presence of an abdominal mass.
Early stages may be asymptomatic and are diagnosed incidentally with ultrasonography or during another radiological examination at another medical visit.
For the evaluation and diagnosis of renal cancer, abdominal and renal examinations are necessary. Those are;
In case of a suspicion in clinical diagnosis; Doppler Ultrasonography or ideally Computed Tomography or Magnetic Resonance Imaging can be used for definitive diagnosis.
Ultrasonography: Evaluation of kidneys with ultrasonography is the primary approach.
Computed Tomography: Transverse sections enable the evaluation of all internal organs inside the abdomen. Besides, intravenous contrast injection allows for the evaluation of the contrast uptake of the renal mass observed on ultrasonograpy.
Before any surgical intervention, it shows the location of mass with definitive sizes.
In case of any renal mass located away from renal vessels, it is important to spare the rest of the kidney during the extraction of the mass. Especially for bilateral renal tumors, protecting the residual healthy renal tissue is very important for keeping the patient away from dialysis.
MR Imaging: When CT is not suitable for the evaluation of renal vascular structures inside the renal mass, MRI is utilized.
Biopsy: For certain patients with suspected conditions, it may be considered and performed with CT guidance.But there are some problems regarding the evaluation of biopsies. The most important one isthe lack of adequate specimen.
Today, renal cancer diagnosed by CT and MRI should be surgically explored and removed.
Factors that affect the prognosis and are important in the selection of treatment modalities are;
Staging is needed for the evaluation of renal cancer’s clinical situation and treatment plan.
The most important parameters are tumor size and the tumor’s relation with kidney and surrounding tissues. For early-stage renal cancer, the gold standard for treatment is the total extraction of renal tumor. Giant and metastatic renal cancers (Figure-4) require open surgical approaches instead of laparoscopic methods.
Surgery: Nephrectomy is the total surgical removal of kidney. For advanced-stage renal cancers, surrenal gland (adrenal) and perirenal fat (gerota) should be totally removed with an operation called “radical nephrectomy”. For early-stage, small renal masses, “partial nephrectomy” is considered with the removal of only the mass while protecting the rest of the kidney.
Radiotherapy: With the use of advanced technology, dose-regulated radiation beams can be focused onto the tumor. But the benefit is limited for renal cancer treatments. It is used especially for palliative conditions to relieve skeletal pain.
Chemotherapy: Systemic chemotherapy is mainly performed to destroy cancer cells. Chemotherapy may be used as single agent or in combination. But the effect of chemotherapy is limited in renal cancer. It is mainly preferred in advanced-stage patients or patients with distant metastasis.
Immunotherapy (Biological/Immune Treatment): Induces immune system against tumor cells. Interferons and Interleukin-2 are mainly used for this purpose.
The most frequent complaint is fatigue during the treatment. Fever, vomitting, diarrhea, muscular pain and loss of attention may be observed. At the end of the treatment, there will be a reduction in those complaints.
Hormonal Treatment: It is often used in advanced-stage renal cancer. It is performed not for curative purposes, but for the relief of palliative symptoms. Progesterone is mostly used. Sweating, fluid loss and weight changes may be observed as side affects.
Tunc Technique in Laparoscopy
By using his own “Tunc Technique” which is globally accepted by authors as a laparoscopic renal cancer treatment method, Prof. Lutfi TUNC issued one of the most prestigous medical publications in the literature.
In 2013, he performed live surgery at the European Urology Association Congress, one of the most prestigious congresses in urology, and he was well-appreciated by the participants.
In most hospitals, a group of specialists discuss about your condition for providing you with the best treatment and comfort. This multi-disciplinary team consists of an urologist, radiotherapist and clinical oncologist so as to consider hormonal treatment or chemoterapy options.
Besides, specialist nurses, social service providers and physiotherapists play a role during this process. Patients mostly discuss with a surgeon, oncologist and specialized nurse about their treatment plan.
Second Opinion
A multidisciplinary team uses national treatment guidelines for making a decision to provide you with the best treatment approach. You may also ask for a second opinion. If you consider that this will be of help to you, you may request from your specialist or general practitioner to refer you to another specialist.
What is important to know is that asking for a second opinion may pose a delay concerning your treatment. So, you should make sure that your specialist’s decision and your decision are helpful for you. If you are already determined to obtain a second opinion, you should come and see the doctor with one of your relatives and make a list of your questions. This may resolve your anxiety.
Prof. Lutfi TuncUrology, Da Vinci Robotic & Laparoscopic Surgery