Treatment for early kidney cancer

Early kidney cancer (stage 1 or 2) is localised. That means the cancer is found in the kidney only. The main treatment for early kidney cancer is surgery. Less often, thermal ablation, cryotherapy and stereotactic body radiation therapy are used. Sometimes the best approach for early kidney cancer is to watch the cancer over time.

Active surveillance

Your doctor may suggest monitoring the cancer closely rather than starting treatment. This approach is known as active surveillance. The aim is to maintain kidney function and avoid unnecessary treatment, while looking for changes that mean treatment should start.

Active surveillance may be suggested if the tumour is less than 4 cm in size. It might also be an option if you are not well enough for surgery and the tumours are small, or if you are older.

Active surveillance involves having regular ultrasounds or CT scans. If these imaging tests suggest that the tumour has grown, you may be offered active treatment (usually surgery). Ask your doctor how often you need check-ups.

Surgery

Surgery is the main treatment for early kidney cancer. Depending on the type of kidney cancer, the grade and stage of the cancer, and your general health, you might have surgery to remove part or all of a kidney.

Partial nephrectomy

This removes the cancer and a small part of the surrounding tissue, leaving some healthy tissue in the affected kidney. This operation may be recommended for tumours smaller than 7 cm that are in the kidney only. It may also be used for people who have existing kidney disease, cancer in both kidneys, or only one working kidney.

A partial nephrectomy is a more complex operation than a radical nephrectomy. Whether it is possible depends on where the tumour is in the kidney, as well as the expertise of the surgeon and hospital.

Removes part of the kidney

Radical nephrectomy

The whole affected kidney, a small part of the ureter and the surrounding fatty tissue are removed. The adrenal gland and nearby lymph nodes might also be removed. This is the most common operation for large tumours.

Sometimes the kidney cancer may have spread into the renal vein and even into the vena cava, the large vein that takes blood to the heart. Even if the cancer has spread to the vena cava, it is sometimes possible to remove all the cancer in one operation.

Removes the whole kidney and some surrounding tissue.

The remaining kidney

If a whole kidney or part of a kidney is removed, the remaining kidney usually does the work of both kidneys. Your doctor will talk to you about how to keep the remaining kidney healthy, which may include taking steps to reduce your risk of high blood pressure, heart problems and diabetes.

How the surgery is done

If you have surgery for kidney cancer, it will be carried out in hospital. A nephrectomy is a major operation and you will be given drugs (general anaesthetic) to put you to sleep and temporarily block any pain or discomfort during the surgery.

One of the following methods will be used to remove part or all of the kidney (partial or radical nephrectomy). The method recommended for you will depend on the size and location of the tumour and your general health. Your surgeon will talk to you about the risks of the procedure.

Open surgery

This is usually done with a long cut (incision) at the side of your abdomen where the affected kidney is located. In some cases, the incision is made in the front of the abdomen or in another area of the body where the cancer has spread. If you are having a radical nephrectomy, the surgeon will clamp off and divide the major blood vessels and tubes to the affected kidney before removing it.

Keyhole surgery

This is also called minimally invasive surgery or laparoscopic surgery. The surgeon will make a few small cuts in the skin, then insert a tiny instrument with a light and camera (laparoscope) into one of the cuts. The surgeon inserts tools into the other cuts to remove the cancerous tissue or kidney, using images from the camera as a guide.

Robot-assisted surgery

This is a type of keyhole surgery performed with help from a robotic system. The surgeon sits at a control panel to see a three-dimensional picture and moves robotic arms that hold the instruments. Robotic surgery has meant that more partial nephrectomies can be performed with keyhole surgery, reducing complications and improving recovery time.

Making decisions about surgery

Talk to your surgeon about the types of surgery suitable for you. Ask about the advantages and disadvantages of each method. There may be extra costs involved for some procedures and they are not all available at every hospital.

Compared to open surgery, both keyhole (laparoscopic) surgery and robot-assisted surgery usually mean a shorter hospital stay, less pain and a faster recovery time. But in some cases, open surgery may be a better option.

What to expect after surgery

After a nephrectomy, you will usually be in hospital for 2–7 days, but it can take 6–12 weeks to fully recover. Your recovery time will depend on the type of surgery you had, your age and general health. Once you are home, you will need to take some precautions.

Drips and tubes

While in hospital, you will be given fluids and medicines through a tube inserted into a vein (intravenous drip). You will also have other temporary tubes to drain waste fluids away from the operation site.

For a few days, you will most likely have a thin flexible tube inserted in your bladder that is attached to a bag to collect urine. This is called a urinary catheter. Knowing how much urine you are passing helps hospital staff monitor how the remaining kidney is working. When the catheter is removed, you will be able to urinate normally again.

Pain relief

You will have some pain and discomfort for several days after kidney surgery. This will be managed with pain medicines. You may be given tablets or injections, or you may have patient-controlled analgesia (PCA), which delivers a measured dose of pain medicine through a drip when you press a button. If you still have pain, let your doctor or nurse know so they can change your medicine as needed.

Blood clots

You will usually have to wear compression stockings to help the blood in your legs circulate and prevent blood clots developing. Depending on your risk of clotting, you may be given daily injections of a blood-thinning medicine.

Moving around

Your healthcare team will probably encourage you to walk the day after the surgery. A physiotherapist may show you exercises to do while you are recovering and explain how to move safely. Doing breathing or coughing exercises can help you avoid developing a chest infection.

It will be some weeks before you can lift heavy things, reach your arms overhead or drive. Ask your doctor how long you should wait before attempting any of these activities or returning to work.

Returning home

When you get home, you will need to take things easy and only do what is comfortable. Let your family and friends know that you need to rest a lot and might need some help around the house.

To help your body recover from surgery, try to eat a balanced diet (including proteins including lean meats and poultry, fish, eggs, milk, yoghurt, nuts, seeds, and legumes such as beans).

Check-ups

You will need to visit your surgeon for a check-up a few weeks after you’ve returned home. You will usually leave the hospital with the details of your appointment. If you haven’t been given an appointment time, check with your surgeon’s rooms.

Other treatments

If surgery is not the best approach, other treatments may be recommended to destroy or control early kidney cancer.