Localised kidney cancer

Localised kidney cancer

If you are diagnosed with localised kidney cancer, your doctor can recommend treating the cancer with partial nephrectomy, radical nephrectomy, active surveillance, radiofrequency ablation, or cryotherapy. Each procedure has its own advantages and disadvantages. The choice of treatment depends on your individual situation.

This section describes the different treatment options, which you should discuss with your doctor.

This is general information which is not specified to your individual needs. Keep in mind that situations can vary in different countries.

What is localised kidney cancer?

Localised kidney cancer refers to a tumour which is limited to the kidney and has not extended to other parts of your body. It may be a stage I or II tumour, depending on its size (Fig 1 and 2).
Fig. 1: A stage I kidney tumour is a tumour up to 7 cm, limited to the kidney.
Fig. 2: Stage II tumours are still limited to the kidney, but are larger than 7 cm.

Treatment options

The best option for the treatment of a kidney tumour is surgical removal.

Localised kidney cancer can be removed through either partial nephrectomy or radical nephrectomy. Both procedures can be performed by open or laparoscopic surgery. Laparoscopic surgery can also be done with the aid of a surgical robot system.

During a partial nephrectomy only the tumour is removed, leaving the healthy kidney tissue untouched. This surgery is recommended whenever possible. If it is not possible to remove the whole tumour and leave part of the kidney intact, your doctor will recommend radical nephrectomy. This means that the kidney in which the tumour is located and the surrounding tissue are completely removed.

Sometimes, surgery may not be the best option for you. This may be because of your age or medical condition, for example.

If the tumour is smaller than 4 cm, your doctor may suggest a period of active surveillance. During active surveillance, your doctor schedules regular visits to monitor the tumour. If the tumour continues to grow you may need further treatment. A good option in this case may be ablation therapy.

Ablation therapy can be either radiofrequency ablation (RFA) or cryotherapy. The aim of these procedures is to kill tumour cells by heating (RFA) or freezing (cryotherapy).

These are some topics you should discuss with your doctor when planning your treatment pathway:

  • Your medical history
  • If there are any cases of kidney cancer in your family
  • What to consider if you only have one kidney
  • Whether your kidney function is normal or if it has already been affected by other conditions like diabetes or high blood pressure
  • Whether you have a tumour in one or both of your kidneys
  • The kind of treatment available at your hospital
  • The expertise of your doctor. Ask your doctor about his or her experience with the recommended treatment option
  • Your personal preferences and values
  • Support during and after treatment

Active surveillance

Active surveillance is a form of treatment for localised kidney cancer in which the doctor actively monitors the tumour. It is recommended if surgery is not the best option for you and you have a tumour in your kidney which is smaller than 4 cm.

Some of the reasons why your doctor may say you are unfit for surgery include your age or any medical conditions which make surgery dangerous for you. To determine if active surveillance is an option, your doctor may want to perform a renal tumour biopsy. The tumour tissue taken during biopsy is analysed to make sure it is not aggressive. If the tumour is aggressive and surveillance is not an option for you, you may be recommended further treatment.

If you are a good candidate for active surveillance, your doctor will set up a strict visiting schedule. On each visit, the urologist asks questions about any noticeable changes in your health, performs a physical examination, and discusses the results of your blood tests. Before each visit, you get a CT or an ultrasound scan of your abdomen to monitor the growth of the tumour. An x-ray of your chest may also be done to check your lungs.

In most cases, a follow-up visit is needed every 3 months in the first year after diagnosis. In the following 2 years the visits are scheduled every 6 months, and then once a year.

In general, small kidney tumours tend to grow slowly and the cancer rarely spreads to other organs. If tests during follow-up show that the tumour is growing fast, or if you develop symptoms which may indicate the disease is advancing, the urologist will immediately plan further treatment.

Options for further treatment include surgery to remove the tumour or the whole kidney, or ablation of the tumour by cryotherapy or radiofrequency ablation (RFA).

Factors which influence the decision for the best treatment option include:

  • Your age
  • Other medical problems you may have
  • The location of the tumour
  • The subtype of the tumour

If surgery is selected, partial nephrectomy should be favoured whenever possible. During this surgery, the tumour is removed but the surgeon leaves as much as possible of the healthy tissue of the kidney intact.

Radiofrequency Ablation

Radiofrequency ablation (RFA) is a treatment option for kidney cancer. It uses the heat produced by high-frequency radio waves to kill the cancer cells.

Cryotherapy

Cryotherapy, also known as cryoablation, is a treatment option for kidney cancer. It uses a liquefied gas, most commonly liquid nitrogen or argon, to kill tumour cells by freezing them. The liquefied gas reaches the tumour through a needle. In order to know the subtype of the tumour, a biopsy is generally performed before starting the treatment.

Follow-up

After surgery you will meet with your doctor. In this visit, both the results of the surgery and the follow-up schedule will be discussed. Ask for a care plan so you can see how often you will need to see your doctor, and what kind of tests could be needed before each visit. This depends on the characteristics of the tumour.

Write down questions you may have before the visit. Examples of questions you can ask are:

  • Is the cancer gone?
  • Do I need additional treatment? If so, what options are relevant for me?
  • What kind of tests do I need before the follow-up visits?
  • How will the treatment and the kidney cancer affect my quality of life?

It is important that you continue to attend these visits. During these, the doctor monitors your kidney and can detect possible tumour recurrence on time. It is also important to tell your doctor if you notice any new symptoms. Do not hesitate to contact your health care team and tell them about new symptoms before the visit.