Guest post by Reza Mehrazin, MD, Assistant Professor of Urologic Oncology in the Department of Urology at the Icahn School of Medicine at Mount Sinai. To make an appointment with Dr. Mehrazin, call 212-241-4812.
Kidney cancer, also known as renal cell carcinoma (RCC), is among the most lethal of urologic cancers. In 2015, 61,560 new cases are estimated to occur in the United States and approximately 23% of these patients are expected to die from their disease. The incidence of kidney cancer, particularly small tumors which are less than 4 cm in diameter, has been on a rise and this has largely been attributed to the increased use of cross-sectional abdominal imaging, such as CT or MRI scans. Although surgery and removal of the tumor is the standard of care for kidney cancer, there is growing understanding that in some patients who are elderly and/or have other medical conditions, the potential benefits of surgery is questionable. For these patients, active surveillance or close monitoring of the renal tumors could be a great option. There are many studies that show that an initial short-term period of observation to better understand the tumor growth rate may be safe for small kidney tumors in select candidates.
If surgery is the route opted by the patient and surgeon, the decision to select the appropriate approach (open surgery, robotic surgery, laparoscopic, total or partial nephrectomy) comes down to three things: 1) the size and anatomic complexity of the tumor (appearance of the tumor); 2) the patient’s age and medical comorbidities; and 3) the surgeon’s experience and training.
Dr. Mehrazin and Acara in treatment room.
Partial nephrectomy or removal of part of the kidney with the tumor is considered the standard of care for the treatment of small kidney tumors. This approach becomes even more important when the patient has several medical comorbidies (e.g. high blood pressure, diabetes, kidney dysfunction, etc.), tumor on both kidneys, or the patient has only one kidney. During partial nephrectomy, the surgeon blocks the blood flow to the kidney, removes the entire tumor, repairs the remaining normal kidney, and re-establishes the blood flow back into the kidney. With the introduction of minimally invasive surgery, while maintaining the principles of open surgery, we can now use laparoscopic or robotic technology to do partial nephrectomy. Many studies have shown that, when compared to the conventional open surgical technique, laparoscopic or robotic surgery has resulted in significantly less blood loss during the surgery, less pain, a shorter hospital stay, and earlier return to daily activities.
At times, when partial nephrectomy is not advisable, radical or total nephrectomy is the recommended approach. In total nephrectomy, the entire kidney and part of the ureter are removed. Laparoscopic nephrectomy is considered the standard of care. At times, when the tumor appears to be involving the surrounding structures, open approach is recommended. Open approach, if necessary, allows the surgeon to perform lymphadenectomy (removal of enlarged lymph nodes).
Other less commonly used treatment approaches for treating small renal lesions is tumor ablation. This approach is usually reserved for frail patients who will not benefit from surgery or observation.
In summary, the incidence of kidney cancer is on the rise and, fortunately, there are many different management options available for patients. Patients should seek care from doctors and institutions that can offer all treatment options and exceptional individualized care.