Surgery is the most common treatment for kidney cancer. The goal is to remove the tumor(s) and preserve as much kidney function as possible. The type of surgery depends on the stage of the cancer. The impact on kidney function depends on the stage, the type of surgery needed, and overall health. It is possible to function with one partial or full kidney.
If both kidneys need to be removed, further treatment with dialysis will be necessary. Dialysis supports the function of the kidneys by filtering wastes and excess fluids from the blood. Dialysis is a permanent treatment unless a kidney transplant is an available option. A healthy kidney can be donated from a relative, friend, or from an organ donor who has recently died.
Surgery for Early Stage and Advanced Kidney Cancer
If the tumor is small and has not spread beyond the kidney, a partial nephrectomy may be done. The tumor is cut out along with a border of healthy tissue to make sure all the cancer is removed. This procedure preserves kidney function. If you need a partial nephrectomy, it is important to find a doctor or hospital that is experienced with the procedure.
A radical nephrectomy can be done for both early stage and advanced cancers. In this procedure, the kidney, adrenal gland, blood vessels, and surrounding fat and connective tissue are removed. If the tumor is in the lower region of the the kidney, it may be possible to save the adrenal gland. A radical nephrectomy results in the loss of one functioning kidney. If the remaining kidney is healthy, it can do the work of both.
Cancer can spread to the lymph nodes in areas outside of the kidney. Once there, it can travel to other parts of the body through the lymphatic system. During radical nephrectomy surgery, some or all of the lymph nodes suspected of having cancer will be removed and examined under a microscope. This is called a lymph node dissection.
Both types of nephrectomies can be done as:
Open —During open surgery, an incision is made in the abdomen or back, depending on the location and accessibility of the tumor. Doing so exposes the organs so they can be removed through the incision.
Laparoscopic —Tubes are inserted into small incisions. Lights, a camera, and surgical instruments can be used through the tube. Images from the laparoscope are viewed on a special monitor. Healing and recovery time for laparoscopic surgery is generally faster than open surgery
Robot-assisted —Robotic arms are inserted through small incisions. This allows for greater range of movement than a doctor's hand.
Surgery for Metastatic Kidney Cancer
A radical nephrectomy be considered for those with metastatic kidney cancer. Other surgical treatments may be available if a radical nephrectomy cannot be done. They may be done to ease symptoms of tumors in the kidney or those that have spread to other parts of the body.
Radiofrequency ablation —A CT-guided probe is inserted through the skin to the tumor site. The probe emits high energy radio waves which kill cancer cells with high heat.
Cryosurgery —An ultrasound-guided probe is inserted through the skin to the tumor site. Cancer cells are killed by freezing them.
Arterial embolization —A catheter is threaded through an artery in the thigh to the kidney's main artery. A substance is injected into the renal artery to block blood flow to both the tumor and kidney.
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Kidney cancer. National Kidney Foundation website. Available at: https://www.kidney.org/atoz/content/kidneycancer. Accessed December 31, 2018.
Kidney cancer (adult)—renal cell carcinoma. American Cancer Society website. Available at: http://www.cancer.org/acs/groups/cid/documents/webcontent/003107-pdf.pdf. Accessed December 31, 2018.
Renal cell carcinoma. Merck Manual Professional Version website. Available at: http://www.merckmanuals.com/professional/genitourinary-disorders/genitourinary-cancer/renal-cell-carcinoma. Updated October 2017. Accessed December 31, 2018.
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