Kidney cancer develops when abnormal cells in the kidneys start to mutate and grow uncontrollably and more rapidly than normal cells. A mass of cancerous cells is called a malignant tumour, or more simply, cancer.
Usually cancer occurs in just one kidney, but in rare cases, can occur in both. Cancer cells in the kidney can spread by breaking away from localised tumours to nearby parts of the body such as the neighbouring lymph nodes, as wells as the adrenal glands, lungs, bones and liver.
The kidneys are vital organs that filter water and other waste products from your blood, produce urine and hormones, and maintain levels of minerals in your bloodstream. They are about 10cm in size and bean-shaped. They are located in the upper back of the abdomen.
There are several sub-types of kidney cancer based on the appearance of the malignant cells and other factors. Roughly 90 percent of kidney cancers are renal cell carcinomas (RCC).
The three most common types of renal cell carcinomas are:
Clear cell carcinoma: This is the most common type of RCC, accounting for about 75% of cases. When viewed under a microscope, the cancerous cells appear clear.
Papillary renal cell carcinoma: This is less common, accounting for roughly 10–15% of RCC cases. When viewed under a microscope, the cancerous cells look like small finger-like fronds called papillae.
Chromophobe renal cell carcinoma: Even less common, this accounts for just 5% of cases. When viewed under a microscope, the cancerous cells appear large and pale.
Other kidney cancers include translocation carcinomas, sarcomatoid carcinoma, and urothelial carcinoma, amongst other rare types.
Like other forms of the disease, we don’t know exactly what causes kidney cancer. However, there are a number of risk factors associated with its occurrence and development:
• Family history – those with a family member who had kidney cancer have a slightly increased risk of the disease.
• Gender – males are more likely to get kidney cancer
• Smoking is a major risk factor for kidney cancer, particularly prolonged smoking
• Obesity can increase the risk of kidney cancer
• Having high blood pressure can increase the risk of kidney cancer
• Exposure to asbestos or cadmium, usually work-related
• Prolonged or advanced kidney disease
• Inherited conditions – a small amount of kidney cancers occur in people with particular inherited conditions such as Von Hippel-Lindau (VHL) disease, hereditary papillary RCC and Birt-Hogg-Dubé syndrome.
The treatment of kidney cancer depend on its growth and extent of the tumour. Surgery is the most common treatment:
Surgery – Nephrectomy is a surgical procedure to remove either part or all of the kidney to treat cancer.
Radical: Radical nephrectomy involves removing the whole kidney, along with a section of the ureter, the adrenal gland which sits atop the kidney, and the fatty tissue surrounding the kidney. If both kidneys need to be removed, this is called bilateral nephrectomy.
Partial: Partial nephrectomy involves removing only the diseased or injured portion of the kidney. This is suitable if the cancer is present in both kidneys, is in its early stages and is small (less than 4 cm), or if the patient has just one working kidney.
Chemotherapy – No real chemotherapy agents work well with kidney cancer. We do use targeted therapies called Tyrosine Kinase Inhibitors (TKI) that can help in the setting of metastatic disease.
Other agents like chemotherapy and various antibodies are being investigated in clinical trials.
Dr Arianayagam is an expert in the field urological cancer surgery, including robotic surgery and laparoscopic surgery for the treatment of kidney cancer. He is one of the most experienced robotic surgeons in Sydney.
In particular, Dr Arianayagam specialises in laparoscopic and robotic partial nephrectomy where a diseased portion of the kidney is removed leaving the rest of the organ intact.
He also performs zero ischaemia partial nephrectomy, where the artery to the kidney is not clamped. This has the advantage of having no ischaemia to the kidney and hence improved function. It is even more challenging than the traditional laparoscopic approach due to the risk of increased bleeding.
If you have any further questions about kidney cancer and would like to book an appointment, please feel free to call.