Kidney cancer is the 6th most common cancer in the UK, with around 14,500 new cases diagnosed every year.
Although kidney cancer can develop at any age, it is more common in people aged over 60. Factors that can increase the risk of kidney cancer include smoking, excess body weight, high blood pressure, a family history of kidney cancer and certain long-term kidney conditions.
It’s important to seek medical advice and support if you’re concerned about your risk of kidney cancer or have symptoms of kidney cancer. Here, we’ll explore its symptoms, diagnosis and the role of robotic surgery in kidney cancer treatment.
Types of kidney cancer
Around 8 in every 10 cases of kidney cancer are renal cell cancer (RCC), also known as renal cell carcinoma. This refers to cancer that develops from cells lining the kidney’s tiny tubes, known as renal tubules, which help process filtered fluid and produce urine.
There are different types of RCC. The most common type is clear cell RCC, followed by papillary RCC. Rare types of RCC include chromophobe RCC, collecting duct carcinoma and renal medullary cancer.
Kidney cancer can also develop outside of the renal tubules, specifically in cells called urothelial cells that line the tube that carries urine out of the kidneys (ureter) and the funnel-like structure that allows urine to flow into the ureter (renal pelvis). This type of cancer is called upper urinary tract urothelial cancer and is treated differently from RCC.
Lastly, in a very small minority of cases, kidney cancer starts in the kidney’s soft tissues, such as fibrous tissue, muscles, nerves and blood vessels. This is called kidney sarcoma.
Symptoms of kidney cancer
Most types of kidney cancer don’t cause any symptoms in the early stages. This means early-stage kidney cancer is often picked up during a scan for an unrelated condition.
As kidney cancer progresses, a common symptom is blood in your urine (haematuria). This may not be persistent and can come and go or occur only once. Although there are other causes of blood in urine, such as a urinary tract infection, a kidney stone or an enlarged prostate, this symptom should always be investigated to rule out kidney cancer.
Other less common symptoms include persistent pain or discomfort in your side or back, or a lump in the side of your abdomen.
In advanced stages of kidney cancer, symptoms include:
- Fever without an obvious infection
- High blood pressure
- Loss of appetite
- Night sweats
- Unexplained weight loss and fatigue
A blood test may also reveal high calcium levels, a low red blood cell count and abnormal liver results.
Getting a diagnosis
If you’re concerned that you have symptoms of kidney cancer, see your GP. They will ask about your symptoms and medical history and may perform a physical examination. They may then refer you for a blood test, urine test and/or imaging test.
An ultrasound scan may be used initially, but a CT scan is usually needed to examine a suspected kidney tumour in greater detail and to find out whether it has spread.
CT scans are often performed using a special dye called contrast, which is injected into a vein. An MRI scan may be recommended when a CT scan does not provide enough information or when a CT scan with contrast is unsuitable.
In some cases, particularly when the diagnosis is uncertain or when different treatment options are being considered, a needle biopsy may also be advised. This involves collecting a tissue sample using a needle.
When is surgery for kidney cancer needed?
In cases where kidney cancer has not spread beyond the kidney, surgery is often the recommended treatment to remove the cancer, while preserving as much healthy kidney tissue as possible.
However, not every small kidney tumour needs immediate surgery. Depending on its size and appearance, your age, health and preferences, active surveillance or treatments such as thermal ablation may sometimes be appropriate.
When kidney cancer has spread beyond the kidney, treatment usually involves immunotherapy, targeted medicines or a combination of treatments. Surgery may still be considered in certain cases to relieve symptoms or as part of an individual treatment plan.
Partial nephrectomy vs total nephrectomy
A partial nephrectomy removes the tumour and a small amount of surrounding kidney tissue, while preserving the rest of the kidney. A radical nephrectomy removes the whole kidney and surrounding fatty tissue. Nearby lymph nodes or the adrenal gland may also be removed if there is concern that the cancer involves these areas.
Whenever possible, a partial nephrectomy is preferred to help preserve healthy kidney tissue and kidney function. This can reduce the risk of developing or worsening chronic kidney disease, particularly in people who already have reduced kidney function or other risk factors.
Benefits of robot-assisted nephrectomy
A nephrectomy can be performed using open surgery or minimally invasive keyhole surgery. Open surgery involves a larger cut, while keyhole surgery uses several small cuts through which a camera and specialised instruments are inserted.
Robot-assisted surgery is a form of keyhole surgery. The instruments are held by robotic arms but remain completely controlled by the surgeon, who sits at a console beside the operating table. The system provides a magnified, high-definition 3D view and highly flexible instruments, which can help the surgeon perform precise movements in a confined space.
Compared with open surgery, a robot-assisted approach typically involves smaller wounds and may result in less pain after surgery, less blood loss and a shorter hospital stay. Many individuals go home after 1 or 2 nights and gradually return to their usual activities over the following 2–6 weeks, although recovery times vary according to the operation and the individual.
At selected Spire Healthcare hospitals, surgeons use the da Vinci® robotic surgical system. During some partial nephrectomy procedures, the surgeon can also use an ultrasound probe to identify the tumour’s location and its boundary with the surrounding healthy kidney tissue.
Robot-assisted partial nephrectomy is now widely used because the magnified 3D view and highly flexible instruments can help the surgeon remove the tumour while preserving as much healthy kidney tissue as possible, particularly in technically complex cases.
However, the most appropriate approach depends on the size and position of the tumour, your health and the experience of your surgical team. Conventional laparoscopic or open surgery may still be recommended in some cases.
