World Kidney Day

World Kidney Day

Until relatively recently, a diagnosis of kidney cancer automatically meant the removal of the kidney. While this remains the 'gold standard" treatment, especially for the larger cancers, Australian urologists are increasingly using a range of new and emerging treatments which allow some cancers to be successfully treated without losing a kidney, or kidney function.

In Australia kidney cancer (or renal cell carcinoma) is the eighth most common form of cancer and the number of cases continues to grow as the population ages, and as more cases are detected incidentally during routine scans.

'These unexpected, early discoveries are often of smaller tumours which in recent years, Urologists have been able to treat successfully without removing the entire kidney," says the Urological Society of Australia and New Zealand's spokesperson on Urological Cancers, Professor Mark Frydenberg.

Most commonly this is achieved by what's known as a partial nephrectomy – a surgical approach that can be done by open, laparoscopic (or keyhole) surgery - or more recently - by robotic surgery.

'This allows removal of the tumour, with equivalent survival rates compared to the loss of the entire kidney. By preserving the rest of the kidney, the likelihood of long term renal insufficiency is reduced. This is of major benefit to the patient as by reducing the risk of chronic renal disease, we reduce their risk of vascular and heart disease as a result," says Professor Frydenberg.

Cryotherapy is another emerging treatment for kidney cancers which involves freezing the tumour to extreme, sub-zero temperatures to kill it, leaving the rest of the kidney intact. This is usually done under direct vision using laparoscopy (keyhole) surgery.

At the other extreme is radio-frequency ablation which destroys the tumour by heating it to extreme temperatures. This is usually done as an outpatient procedure, without surgery, by inserting probes to heat the tumour via a CT scan or ultrasound.

Another targeted treatment, currently being trialled in Sydney is SIRT (Selective International Radiation therapy) which involves sending radioactive material in small microspheres directly to the tumour via its blood supply. This treatment, developed in Australia, is used to treat liver tumours, with the current trials underway to determine whether it can be safe and effective for renal cancers. Early results have been promising.

In Melbourne, another trial looking at very precise forms of radiotherapy to accurately treat tumours is also being trialled, once again in an attempt to treat the tumour without damaging the rest of the kidney. However, as with prostate cancer, the latest thinking suggests some kidney cancers may require not treatment at all.

'Some kidney cancers may remain small and non-aggressive and may not threaten patients' lives. Older patients or those for whom surgery is not desirable, with these smaller kidney cancers, may require no active treatment and instead have their tumour monitored with CT scans or ultrasound, only requiring treatment if the tumour grows or begins to cause symptoms," says Professor Frydenberg.

'A Urologist will consider carefully the patient's individual case, and weigh up the issues including the size of the tumour, the age of the patient and any other underlying medical conditions, before determining whether all, or part of the kidney should be removed – or whether it can be safely monitored," says Professor Frydenberg.