Renal Cancer surgery

Kidney cancer or renal cancer is cancer that originates in the kidneys, two bean-shaped organs, each about the size of your fist. Kidneys are located behind your abdominal organs, with one kidney on each side of your backbone.

The most common kidney cancer affecting adults is renal cell carcinoma while children are more likely to develop a kind of kidney cancer called Wilms’ tumour. There are other types of kidney cancer as well

Surgery is the main treatment for most kidney cancers. Removing the kidney containing cancer can help some patients live longer, so a doctor may suggest surgery even if the patient’s cancer has spread beyond the kidney. Kidney removal can also be used to ease symptoms such as pain and bleeding.

Depending on the stage and location of cancer and other factors, surgery may remove either cancer along with some of the surrounding kidney tissue (known as a partial nephrectomy), or the entire kidney (known as a radical nephrectomy). The adrenal gland (the small gland that sits on top of each kidney) and fatty tissue around the kidney may be removed as well.

 

Symptoms of kidney cancer

Kidney cancer may not show specific symptoms in early stages. In the later stages, kidney cancer signs and symptoms may include:

  • Blood in your urine, which may appear pink, red or cola colored
  • Persistent pain in the lower back, not related to any injury
  • Swelling on ankle and legs
  • Weight loss
  • Fatigue
  • Intermittent fever

If any of these symptoms persist, try keeping a diary to record how many of these symptoms you have over a longer period. Consult your GP if you have these symptoms regularly (on most days for three weeks or more). Note that the symptoms of kidney cancer may resemble other conditions or medical problems. Always consult your doctor for a diagnosis. If your doctor suspects renal cancer, you may be referred to a urologist or an oncologist.

 

Diagnosis of kidney cancer

If your doctor suspects that you might have kidney cancer based on your symptoms, he/she is likely to perform the following tests:

  • Blood and urine tests – These tests may give your doctor clues about what’s causing your signs and symptoms.
  • Imaging tests – These tests are used to view a kidney tumour or abnormality. Imaging tests might include ultrasound, computerized tomography (CT) scan or magnetic resonance imaging (MRI).
  • Biopsy – Based on the results of your tests, a biopsy may be conducted. A biopsy is a procedure used to remove a small sample of cells (biopsy) from a suspicious area of your kidney. The sample is tested in a lab to look for signs of cancer.

 

Staging of kidney cancer

Once you have been diagnosed with kidney cancer, the doctor will determine the stage. Staging tests for kidney cancer may include additional CT scans or other imaging tests your doctor feels are appropriate. The stage of the cancer is determined by the following markers:

  • Stage I – Tumor is confined to the kidney. The size of a tumour may be up to 7 cm in diameter.
  • Stage II – Tumor is confined to the kidney. The size of a tumour is larger in diameter than in Stage I.
  • Stage III –  Tumor extends beyond the kidney to the surrounding tissue and may also have spread to a nearby lymph node.
  • Stage IV – Cancer has spread to organs outside the kidney, to multiple lymph nodes or to distant parts of the body, such as the bones, liver or lungs.

Staging is extremely important because kidney cancers at different stages are treated differently. If the staging is not done correctly, your doctor may not be able to decide on the best treatment.

 

Risks

Complications of kidney cancer surgery depend on the procedures you choose. These may include:

  • Bleeding
  • Infection
  • Blood clots in the legs
  • Hernia
  • High blood pressure
  • Chronic kidney disease
  • Damage to internal organs and blood vessels
  • Leakage of urine into the abdomen (partial nephrectomy)
  • Further surgery

 

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your doctor prior to the procedure.

 

Before the procedure

  • Your doctor will explain the surgical procedure to you. Ask any questions that you might have about the procedure – If you will need a partial or a complete nephrectomy; whether you are a candidate for laparoscopic nephrectomy; etc.
  • You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Ask your doctor if you will possibly need a blood transfusion. If the doctors think a transfusion might be needed, you might be asked to donate blood beforehand.
  • Your doctor will go through your full medical history and additionally may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
  • Notify your doctor if you are sensitive to or are allergic to any medications, latex, tape, and anaesthetic agents (local and general).
  • Notify your doctor of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
  • Notify your doctor if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
  • Notify your doctor if you are pregnant or suspect pregnancy.
  • It is important that your bowels be empty when the surgery is performed. You must follow your doctor’s instructions on dietary changes and liquid intake on the days leading up to surgery.
  • A day or two before the procedure, your doctor
  •  may give you a bowel preparation that includes laxatives and enemas.
  • You will be asked to fast for eight hours before the procedure, generally after midnight.
  • You may receive a sedative prior to the procedure to help you relax.
  • You may meet with a physical therapist prior to your surgery to discuss rehabilitation.
  • Stop smoking, as smoking can delay wound healing and slow down the recovery period.

Based on your medical condition, your doctor may request other specific tests or examinations.

 

During the procedure

Nephrectomy is the surgical removal of the kidney. Procedures may vary depending on your condition and your doctor’s practices.

Generally, the surgery follows this process:

  • You will be asked to remove clothing and put on a hospital gown.
  • An intravenous (IV) line may be started in your arm or hand.
  • You will be positioned on the operating table.
  • A urinary catheter may be inserted.
  • The surgery will be performed while you are asleep under general anaesthesia. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
  • The skin over the surgical site will be cleansed with an antiseptic solution.
  • Depending on the stage of your cancer and overall medical condition, the surgeon       may perform:
  • Open nephrectomy – The surgeon will make an incision along your side or on your abdomen — usually between the lower ribs on the side of the affected kidney. The surgeon may need to remove a lower rib to gain better access to the kidney.
  • Laparoscopic nephrectomy – This is a minimally invasive procedure, wherein the surgeon will make a few small incisions in your abdomen to insert wand-like devices (laparoscope) equipped with video cameras and small surgical tools. The surgeon makes a somewhat larger opening if your entire kidney needs to be removed.
  • Radical nephrectomy – The surgeon will remove the whole kidney, the fatty tissues surrounding the kidney and a portion of the ureter (the tube connecting the kidney to the bladder). The surgeon may remove the adrenal gland that sits atop the kidney if a tumour is close to or involves the adrenal gland.
  • Partial nephrectomy – It is also called kidney-sparing surgery. The surgeon will remove a cancerous tumour or diseased tissue and leaves in as much healthy kidney tissue as possible.
  • Regardless of the type of procedure you have, some tissue and lymph nodes will be sent to a laboratory for analysis.
  • The incision will be closed with stitches or surgical staples.
  • A drain may be placed in the incision site to remove fluid.
  • A sterile bandage or dressing will be applied.

 

After the procedure

In the hospital

Nephrectomy requires a stay in the hospital from 1 to 7 days depending on the method of surgery used. After the surgery, you will be taken to the recovery room for observation. The staff will monitor your blood pressure, pulse, alertness, pain or comfort level, and your need for medications and give you medicine for pain. When they are sure that you are stable, you will be transferred to a room in the hospital.

The first day after surgery you will receive clear liquids and will advance to a regular diet as you tolerate it.

Although deep breathing and coughing may be painful because the incision is close to the diaphragm, breathing exercises are important to prevent pneumonia. You will be encouraged and helped by the nursing staff to get out of bed on the first or second day after your operation and help you start walking soon after this.

At home

Once you are home, it is important to keep the surgical area clean and dry. Your doctor will give you specific bathing instructions. The stitches or surgical staples will be removed during a follow-up hospital visit.

You will be given prescriptions for pain medication and possibly an antibiotic. Be sure to take only recommended medications.

Notify your doctor to report any of the following: Fever; redness, swelling, bleeding, or other drainages from the incision; increased pain near the incision; and numbness and/or tingling sensation at the surgical site.

You will have to avoid contact sports, heavy lifting or any other strenuous exercise that may put pressure on your abdomen. If you must pick something up, bend with your knees, not your waist: stoop to pick up the item. Avoid driving till you are on pain medication. Your doctor might suggest some other activity restrictions.

Your dietician will advise you on the diet if there are any changes. You will generally be advised to avoid foods that cause gas or constipation. Increase roughage in your diet. Drink plenty of fluids and pass urine regularly; this will help look after your remaining kidney.

Your doctor may give you additional or alternate instructions after the procedure, depending on your particular situation.

 

Recovery

Recovery time after this type of surgery varies but generally, you should feel improvements from between 2 to 3 weeks. This may take longer where the surgery has been more complex. The wound may be sore for this time and can take up to 8 weeks to heal fully.

Getting back to work will depend on the type of job that you do. Please ask your surgeon if you are unsure.

Walking will help your general recovery by strengthening your muscles, maintaining your blood circulation (thus preventing blood clots), and helping your lungs remain clear. However, you need to check with your doctor before you start lifting weights or doing abdominal exercises after your surgery to reduce your risk of complications.

Your doctor will give you a better idea of when you can expect to get back to your normal routine.