A kidney cancer is a qualitative change of the organ cells, resulting the pathological proliferation of its tissues.
Due to the spread of the tumor process, the contralateral kidney, ipsilateral regional lymph nodes, adrenal glands, bones and liver are usually affected.
In approximately 95 percent of cases kidney tumors are malignant. That is why it is able to penetrate into other organs and tissues, impairing its functions and provoking tumor intoxication.
About 85-90% of malignant kidney tumors are renal cell carcinoma that grows from the kidney own tissues (proximal nephron tubules). The remaining percentage are tumors of the renal pelvis.
Serious risk factors are obesity, arterial hypertension, chronic renal failure. Persons, who exposed with asbestos and tannins, also have a high risk of kidney cancer. In smokers of both sex groups, the risk of kidney cancer increases by 30%. The peak incidence is in the age over 50 years.
As a rule, the tumor grows in a centimeter during the year. Without the necessary treatment, cancer leads to death. However, if a tumor is detected before metastasis to the tissue of other organs, it is possible to cope with it completely.
Symptoms of a kidney cancer
The development of a kidney tumor may be accompanied with the appearance of blood in the urine, dull pain in the lumbar region, an increase of blood pressure. However more often the disease proceeds without symptoms and is detected with an ultrasound examination accidentally. The tumor can be felt on palpation of the abdomen, when it reaches a large size.
Diagnostic of a kidney cancer
If kidney cancer is suspected, the initial test is an ultrasound examination, which allows to determine the size and location of the tumor.
The stage of distribution and structural features are assessed using multislice computed tomography (MSCT) of the abdominal organs and retroperitoneal space.
MSCT is performed before and after the patient receiving a special contrast drug that actively accumulates in the tumor. On the image tumor, metastases and affected lymph nodes are visible due to its greater accumulation of a contrast
In the Department of Urology at Sechenov University histological assessment in case of diagnosed kidney cancer is appointed in exceptional cases, because of radiation methods (ultrasound, MSCT) are quite informative, and information about the morphological structure of the tumor in this case is not significant.
For diagnostic and treatment, we choose effective and gentle methods for the patient, but aggressive tactics in relation to cancer.
For the first time in Russia, 3D-modeling was applied in the treatment of a kidney tumor in our clinic: the construction of a virtual picture based on the computer processing of MSCT of the affected organ. The technology has opened up new opportunities for assessing the structure of the tumor, its location and proximity to large vessels.
Recently this assessment is carried out for all patients of the clinic with a diagnosed kidney cancer. It allows the surgeon to choose the best method of treatment and perform an organ-preserving operation to preserve and improve the organ as much as possible.
In some cases, magnetic resonance imaging (MRI) is performed to identify the structure of a complex tumor in detail. Possible bone metastases are examined with scintigraphy of the bones of the skeleton (osteoscintigraphy).
Accumulative and excretory functions of the kidneys are assessed using radioisotope computer research (nephroscintigraphy). This assessment is necessary if the tumor has been removed along with the organ in order to ensure that the non-malignant kidney functions properly.
Treatment of kidney cancer
The Department of Urology at Sechenov University is one of the leading centers in the world specializing on the treatment of kidney cancer. Under the professor Y.G. Alyaev leadership scientific work on the creation of new methods of diagnostic and treatment of tumors, based on its location, stage of spread and other features of the disease is conducted.
Practice shows that in 95 percent of cases a minimally invasive laparoscopic surgery is possible. As a rule, it is used for partial nephrectomy. The removal of affected part of kidney along with the tumor is performed. Surgical intervention is performed with an endoscopic instrument through several incisions up to 2 cm. It takes about 2-3 hours to perform such an operation, and the recovery period does not exceed 5-7 days.
Organ-preserving tactics are especially relevant for pathological processes in two kidneys at once (synchronous cancer). Without one kidney a person can live without much difficulty, but without both - he needs programmatic hemodialysis: regular blood purification using synthetic kidney machine.
As a rule, an open operation is chosen by a consultation of doctors in the case of a complex tumor, when as a result of its deep germination, the entire kidney must be removed (nephrectomy). This manual is performed through the abdominal incision up to 20 cm and allows the surgeon to remove especially large tumors.
Renal artery embolization is used to cut of the tumor feeding. The blood supply of the tumor focus is blocked with a coil that winds up through the femoral vessel. Due to lack of oxygen and nutrients from the blood, the tumor stops growing and decreases.
The method is applied shortly before the operation to remove the kidney, if it is necessary to reduce a large tumor, or for severe inoperable patients to slow the progression of the disease.
Recently, a new minimally invasive technology of cryo- and radio frequency ablation is being developed. The damage of tumor cells is achieved, respectively, with freezing or «cauterization». The allowance is performed without surgery, through a needle with a diameter less than a ballpoint pen. In difficult cases, when the tumor is hidden and it cannot be reached with a needle, the operation is performed under laparoscopic control. The technology is effective in case of small renal mass up to 4 cm.