INTRODUCTION

The kidneys are reddish-brown, fist-sized organs located above the waist on either side of the spine. They filter blood and remove impurities, excess minerals and salts, and surplus water that leave the body as wastewater (urine). These organs also produce hormones to help control blood pressure, red blood cell production, and other functions. Because each kidney works independently, one kidney can be removed while preserving the function of the other.

Patients are often referred to us following the incidental discovery of a kidney mass, which may or may not be a malignant tumor (cancer). Some masses are benign (not cancerous). A careful diagnosis is needed to confirm the health problem of the patient and assess the extent of the tumor. Sometimes a biopsy is indicated if the results will alter the treatment. However the majority of the time, based on xray findings alone the diagnosis may be supported so that additional biopsies are not required. There is a myth that if you biopsy a lesion, the cancer will spread or explode, this is completely not true. The medical literature has less than 6 reported cases of cancer being “provoked” from a biopsy. We usually like to obtain high quality CT scan images with the use of intravenous dye to decide on the treatment. Without the dye, anatomic information cannot be obtained with certainty to assess the extent of the mass, whether there is lymph node involvement, or whether the tumor has invaded the blood vessel draining the kidney (tumor thrombus).

The images here show three dimensional reconstructions of a patients with a tumors of the kidneys. Obtaining these types of images can help us guide treatment and surgery. In fact, the second black and white image, was of a patient who had conventional CT images by an outside physician and was told she would need an entire kidney removed. The 3D images allowed us to obtain better anatomic information and offer surgery to preserve at least half of the kidney.

TREATMENT

The treatment of kidney cancer depends on the size and location of the tumor, whether the cancer has spread, and the person’s overall health. Kidney cancer is most often treated with surgery, targeted therapy, and/or immunotherapy. In situations when the tumor is small and growing slowly especially in older patients, we may recommend active surveillance, which means we closely monitor the patient and start treatment only when there is evidence that the disease is growing. If the cancer has not spread beyond the kidneys, surgery to remove the tumor and part or all of the kidney may be the only necessary treatment.

TYPES OF KIDNEY (RENAL) CANCER

• Renal cell carcinoma (RCC), which accounts for 85 percent of malignant kidney tumors. The most common subtype is called clear cell RCC.
• Transitional cell carcinomas, which are cancers of the lining of the kidneys, the urine collecting system (ureter) and sometimes the bladder. These tumor arise from the portion of the kidney which collects the urine and drains the urine from the kidney to the bladder. The treatment of these cancers requires removal of not only the kidney but also the ureter and a portion of the urinary bladder to assure that the cancer does not recur. Patients with transitional cell carcinoma of the kidney require life long surveillance of not only the bladder by a procedure called cystoscopy but also CT scans of the remaining kidney. Depending on the extent of the cancer, additional chemotherapy may be required to eradicate any cancer cells that may have escaped the organ or have involved the surrounding lymph nodes.
• Wilm’s tumor, which most commonly affects children. We need to identify the specific sub-type of kidney cancer or cell type to decide the best treatment strategy. Generally, the success of cancer treatment depends on whether or not the malignancy can be completely removed through surgery.

BENIGN (NONCANCEROUS) KIDNEY TUMORS

Renal adenomas

Very small, slow growing, benign tumors that can resemble early renal cell carcinomas.

Oncocytomas

A type of benign tumor that can grow quite large.

Angiomyolipoma

A rare benign tumor.

Having Your Robotic Laparoscopic Partial or Radical Nephrectomy