Kidney Cancer
Partial Nephrectomy
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Kidney Cancer Evaluation Services
National Cancer Institute, USA
American Cancer Society
National Institute of Health, USA
Kidney Cancer Management
Partial Nephrectomy
Partial nephrectomy or nephron sparing surgery is removal of only part of the kidney where the cancer is located. In the past decade, results of partial nephrectomy are proving to be similar in terms of cancer cure and control, when compared to traditional total nephrectomy. Tumours up to 5cm in size can be considered for partial nephrectomy.
Cancer in the upper part of the kidney was surgically removed
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Kidney is repaired with surgical sutures
Partial nephrectomy can be performed with the open technique or by minimally invasive surgery (laparoscopy). Laparoscopy has the advantage of less pain and quicker recovery as the tumour is removed via 3 small puncture wounds on the abdomen.
Radio frequency ablation of kidney cancer can be performed for smaller sized kidney cancer in patients who cannot afford any kidney function loss such as in patients with a single kidney or with severe kidney disease. It involves placing a needle, which emmits high-energy radio frequency on its tip, into the tumour. The high energy causes destruction and ablation to the tumour without having to remove it from the body.
Radio Frequency Ablation
Radical Nephrectomy
Radical nephrectomy or complete removal of the kidney may be necessary in large kidney cancer (more than 5cm) or cancer involving a critical part of the kidney or cancer that has invaded into the blood vessels around the kidney.
Radical Nephrectomy
Advanced Cancer
The radio frequency needle can be placed percutaneously via a small wound on the skin overlying the kidney. It's position is confirmed by ultrasound or CT scan guidance. For tumours that are located on the anterior (front) aspect of the kidney, the needle is placed with the assistance of laparoscopy. Three small incisions (5mm - 10mm) are made on the abdomen and the needle is introduced into the tumour under direct visual guidance from the camera of the laparoscope.
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Large cancer occupying almost half the kidney
Tumour and kidney removed via small incisions after laparoscopy
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Advanced Kidney Cancer
CT Scan with 3-Dimensional Reconstruction showing a large cancer in the left kidney
Laparoscopic partial nephrectomy for kidney cancer
Ultrasound guided percutaneous radio frequency ablation kidney cancer
CT Scan showing a large cancer in the right kidney with invasion into the renal kidney vein and inferior vena cava
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Solitary metastasis to the lungs can be surgically removed with collaboration with the cardio thoracic surgeon. Metastasis to the bone, which can cause significant pain and potential fractures are treated with intravenous chelating agents such as Zoledronic Acid. Localised metastasis to a particular bone can be controlled with low dose radiotherapy. Similarly, metastasis to the brain is palliated by radiotherapy and steroid injections.

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.
CT Scan showing kidney cancer metastasis to the brain
CT Scan showing kidney cancer metastasis to the mediastinal lymph nodes
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Updated 12 Nov 09
PET Scan showing recurrent kidney cancer after previous surgery - lump successfully removed surgically
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Video on Laparoscopic Radical Nephrectomy Surgery for 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.

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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
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.
CT angiography of the kidney. A thorough study of the kidney blood vessels is achieved without the need of an additional angiogram study.
MRI kidney. This provides additional information on invasion of major veins that are related to the kidney
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.
Whole body bone scan. This is necessary to exclude tumor spread to the bones.
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.

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