By Dr. Santosh S. Waigankar,
While kidney cancer, also known as renal cell carcinoma accounts for only 2% of global cancer diagnoses and deaths, the last few decades have seen it more than doubling in the developed world. Today, it is the ninth most common cancer in men and the 14th most common cancer in women. In India, kidney cancer has been observed more in young patients with 12.3% of patients below the age of 40 years as against 5% in the West. Patients also present at a more advanced stage of the disease and at a younger age. The most important risk factors for kidney cancer are smoking, occupational exposure, cystic disease, heredity, obesity and high blood pressure.
In the early stages, kidney cancer may not lead to any signs or symptoms, but an increase in the size of the tumor can lead to blood in the urine, low back pain on one side (not caused by injury), a mass (lump) with other associated symptoms like increased tiredness, appetite loss, weight loss due to an unknown cause, continuous fever that is not caused by an infection, and anemia. However, advanced diagnostic techniques and routine health check-ups have increased early diagnoses of asymptomatic renal cancer.
At diagnosis, kidney cancer is usually not painful unless the tumor invades adjacent areas or obstructs urine outflow. However, some 20-30% of patients present with metastases (spread to different sites/organs), and 30% of patients, primarily presenting with a localized kidney tumor, develop them during follow-up. Pain management is an integral part of any cancer management, including renal cancers, whether it is pain-related to surgery or advanced disease. Modern pain management techniques are available to make the patient pain-free at every stage.
The gold standard of treatment is nephrectomy or removal of the kidney. It is the only curative treatment of Renal Carcinoma or kidney cancer and can be performed as a “Partial” (removing only a part) or “Radical” depending on the patient’s presentation and disease stage. In addition, both the surgeries can be done by open and Minimal Invasive techniques (Laparoscopic or Robotic).
Robotic surgery using the Da Vinci Robotic system is an advanced and cutting-edge surgical platform that uses only a few small (1 cm) incisions or keyholes to access the tumor in the kidney. With a magnified 3D high-definition vision system and instruments that bend and rotate far greater than the human hand, the surgeon can operate with enhanced vision, precision, and control. The patient benefits from minor scars, less blood loss, faster recovery, and a shortened hospital stay. Robotic surgery has improved outcomes by reducing blood loss and reducing surgical time, especially in partial nephrectomy. Recent advances like “Firefly” and “TilePro” have made it easier to handle complex tumors with robotic surgery and save the kidney.
In the case of advanced disease with metastasis, the advent of targeted therapies has considerably improved management, especially when combined with surgical removal of disease spread to other area and radiotherapy for disease spread to the brain. Kidney cancers are resistant to chemotherapy and radiotherapy. Targeted therapy incorporates certain drugs to improve outcomes in kidney cancers that are in advanced stages or spread to other parts of the body.
Kidney cancer spreads mainly to the lung, bone, brain, liver. Overall, 50-60% of patients may need treatment for the symptoms due to the disease’s spread and pain-palliative removal of the kidney may be considered in advanced disease. High dose radiotherapy may be given for bone metastases and the use of drugs such as bisphosphonates achieves good pain relief in bone metastases.
With advances in surgery including robotic surgery, partial nephrectomy or nephron sparing surgery is now the preferred therapy for kidney tumors whenever it is technically feasible. In this, only the tumor is removed sparing as much of the kidney as possible. This prevents the total loss of renal function that increases the risk of postoperative morbidity and mortality in numerous ways. Partial nephrectomy can be done for renal tumors up to 7cms in size, which at an earlier time would have undergone a radical nephrectomy. Urologic oncologists have been expanding the indications for partial nephrectomy to include tumors greater than 7cm.
The growing burden of kidney cancer can be addressed by targeting the modifiable risk factors, which include smoking, obesity, poorly controlled hypertension, diet and alcohol, and occupational exposures. Access to regular healthcare and more rigorous imaging guidelines will also help to detect kidney cancer at an earlier stage.
(The author is Consultant, Urologic Oncology & Robotic Surgery, Kokilaben Dhirubhai Ambani Hospital. The article is for informational purposes only. Please consult health experts and medical professionals before starting any therapy or medication. Views expressed are personal and do not reflect the official position or policy of the Financial Express Online.)