Kidney cancer treatment

How is cancer in the kidney diagnosed?

In some cases, kidney cancer does not show any symptoms. It is often discovered by chance - during a usual kidney check-up or an ultrasound examination of the abdominal cavity organs due to other concerns. Only an experienced specialist (urologist or nephrologist) can detect the disease early or confirm its absence.

Laboratory tests are routinely performed, but there are no specific tumour markers that would be suitable for the detection of kidney tumours. The blood and urine tests show the function of the kidneys and other organs such as the liver, heart, and lungs.

Imaging tests are essential for accurate diagnosis. First, healthcare providers should see the tumour to understand its location and size. The kidney ultrasound examination is a required examination method for detecting kidney carcinoma. Experienced doctors use it to distinguish a tumour from a benign cyst in over 90% of cases. In addition, ultrasound scans are painless and do not expose the patient to harmful radiation. Computed tomography of the abdomen and pelvis is a unique X-ray method for layer-by-layer body examination. CT offers the highest accuracy in distinguishing between a benign and a malignant kidney tumour. It also precisely determines the spread of the tumour. The typical CT picture of a renal cell carcinoma justifies the immediate operation. As more advanced options, your urologist might prescribe a contrasted CT scan or angiography (if any relation to vessels is suspected).

The biopsy is carried out to confirm that suspected cells are malignant. Then, the doctor inserts a hollow needle with a punch through the abdominal wall into the tumour. The procedure is usually done with the help of imaging techniques (ultrasound or CT). A biopsy is unnecessary for most kidney neoplasms that are not confirmed.

Magnetic resonance imaging is usually only performed if computed tomography is not possible due to the patient's intolerance to contrast containing iodine. In contrast to CT, MRI uses magnetic fields, and there are no X-rays.

After having the whole picture of the disease, a urologist can perform staging. For example, stages of cancer in kidneys include:

• Stage Ι - the tumour is limited to the kidney, without spreading to the lymphatic system and neighbouring organs;
• Stage ΙΙ - the tumour grows into the adrenal gland without spreading to the lymphatic system and adjacent organs;
• Stage ΙΙΙ - a tumour of any size spread throughout the lymphatic system. There is no spread to surrounding organs or distant metastases;
• Stage ΙV - a kidney tumour that grows into neighbouring organs or has distant metastases.

Treatment options for kidney malignancy

The treatment plan is adopted at an oncology meeting, where specialists from various fields participate, including a urologist-oncologist. The primary treatment method for kidney cancer is surgical intervention, and the presence of isolated metastases is rarely a contraindication.

Surgery is the treatment of choice for renal cancer. If possible, a doctor performs an organ-preserving operation (partial nephrectomy). The procedure is usually conducted as an open operation or as part of a laparoscopy (through minor cuts and a probe). Also, urologists might perform a radical nephrectomy (removal of the whole kidney). Modern surgical procedures include minimally invasive operations:

• Robot-assisted DaVinci kidney surgery is a minimally invasive surgical technique. The robotic system of the device makes it possible to ensure minimal trauma and reduce bleeding during the procedure.
• Renal artery embolisation (RAE) is the procedure of blockage of the kidney artery. During an embolisation procedure, the interventional radiologist injects tiny particles through a catheter into the vessels, feeding a tumour. It causes blood shortage and subsequent renal tumour shrinking.

Chemotherapy is the systemic use of antitumour drugs to reduce the size of the neoplasm so that it can be easily removed as the next step. In addition, there are more targeted types of chemotherapy:

• Transarterial chemoembolisation - is the injection of drugs into the vessel feeding cancerous cells. The simultaneous blockage of this artery kills renal cancer and metastasis.
• Transarterial chemoperfusion - is a chemotherapy method for introducing antitumour drugs into the arteries feeding the malignant neoplasm.

Some drugs force the immune system against the tumour by releasing the brakes on the immune system. Such medications are called immunotherapy and can be a great option if kidney cancer cells have specific particles on their surface to respond correctly. Another drug therapy is target medications. It has a significant result in treating locally advanced or metastatic kidney cancer. This is because they affect tumour metabolism's signalling pathways and slow down or stop growth.

Radiation therapy works by destroying cancer cells. However, radiotherapy is only used in the last stages to treat metastases in renal cell carcinomas, which are less sensitive to radiation. It also relieves discomfort and pain. Proton beams use high-powered energy for kidney cancer treatment. It is safer than conventional radiotherapy because it has minimal effect on surrounding tissues. At the same time, the protons are much more powerful and precise.

There are multiple cases when surgery is no longer the option. Healthcare providers can recommend interventional radiologists to heat and destroy cancer without complications. Ablation therapy directly kills the renal tumour tissue without significant surgical intervention. This technique uses cold (cryoablation), heat (radiofrequency ablation, RFA), microwaves (microwave ablation, MWA), or alcohol (ethanol ablation).

Patients must undergo a preventive examination and ultrasound examination of the kidneys at least once a year. It will not negate the chances of recovery and improve the quality of life. Detecting kidney cancer at an early stage gives high treatment results.