Whenever an individual is diagnosed with a tumour in any organ of body, the first thing which crosses his and his relative’s mind are: Is this a cancer, and can I make it / will I survive this disease.
The good thing with urinary tract tumours are: we are diagnosing them at a very early stage today compared to 15 years earlier, thanks to increased awareness and advent of screening Ultrasonography in whole body health checkups. So the cure rates are fairly high. Moreover with advent of better technology, SURVIVAL WITH GOOD QUALITY OF LIFE and lesser morbidity of treatment are awesome.
Few things about Kidney masses or Tumours:
- Renal tumours of size 4 cm and above are malignant most of the time…….
- We don’t NEED A BIOPSY to diagnose, if a renal mass is cancerous, radiological tests can do it most of the time…
- Biopsies are only done in following circumstances: when we suspect lymphoma, renal metastasis, or patient is not fit for surgery and we want to start immunotherapy.
- Kidney cancers are curable most of the time; they are not as bad as a liver, stomach or pancreas cancer. Organ confined cancers has 5 year survival rate of 80%, patient with locally advanced tumour also has a 5 year survival 20 to 30%.
Treatment of Renal cancers:
- Once we know that the mass is cancer, we find out if the disease is confined to kidney/ spread to surrounding organs/ or spread to distant organs. This is, which we call staging,
- Having done the above ,staging, treatment guidelines are given to patient.
For renal cancers confined to kidney, Surgery to remove the tumour remains the best treatment for renal cancers. These cancers are not usually responsive to radiation. Nor they are very responsive to chemotherapy (except for transitional cancer of renal pelvis)
- Renal malignancy involving the renal pelvis and ureter/UROTHELIAL OR TRANSITIONAL CELL CANCERS (diagnosed on radiology, CT scan or MRI) is usually dealt with removal of the entire renal unit….. SO The person is left with only the opposite kidney to carry on the functions of kidney…..
- For the other larger group of renal cancers, KNOWN AS RENAL CELL CARCINOMA/RCC( this is again a radiological diagnosis, not requiring a biopsy) WHEN ITS confined to kidney, the treatment whenever possible will involve removal of the kidney tumour and saving the non tumour bearing areas of the same kidney, this is known as PARTIAL NEPHRECTOMY. So this operation saves the opposite kidney as well as normal parts of same kidney…
But sometimes the entire kidney has to be removed, to achieve cancer free status. This is known as Radical nephrectomy……
- Today we can do most of these procedures with minimally invasive surgery, laparoscopically or robotically), without the need of a big incision, which was required a decade ago.
- Even for locally advanced tumour, removing the tumour can give a hood quality of life and survival
- For metastatic disease, that means disease spreading to distant organs, Nephrectomy will immunotherapy is a good treatment today.