Kidney cancer; Tumors that develop from nephrons, which are kidney cells. Renal cell carcinoma (RCC) subtype is seen in 90% of these cells, which develops from a part of these cells called the tubulus. The definitive diagnosis of which type of tumor is made only by pathological examination of the removed mass.
Tumor or mass images on ultrasonography, tomography, and MRI mostly identify kidney cancer. In other words, they are masses that can metastasize. Definitive diagnosis is made only by pathological examination of the removed mass. Rarely, non-cancerous benign masses such as oncocytoma may also be encountered.
With the development of technology and the ease of access to the physician today, it mostly occurs in ultrasonography, tomography and MR images performed for any reason or in check-ups without any symptoms. Even if there are no complaints, especially at the age of 50-60, routine controls are of great value in early diagnosis.
Pain is not expected in small and non-metastatic kidney tumors. However, side pain occurs in large kidney tumors, and widespread body pain and headache in the case of bone and brain metastases.
Familial predisposition and genetic causes aside, the most common causes of kidney cancer are smoking, hypertension, obesity and uncontrolled diabetes. Smoking and Urological Cancers
Type 1 and Type 2 Bosniak cysts, which make up the majority of kidney cysts in the population, have a very low probability of developing into cancer. Especially Type 1 cyst is almost zero. Type 2f cysts should be followed closely. Type 3 cysts, on the other hand, require surgical intervention if possible, since the rate of cancerization is around 50%. Type 4 cyst is considered direct kidney cancer and requires surgery.
Kidney tumors are not radiotherapy and chemotherapy sensitive cells. The absolute treatment for kidney cancer is surgery. Kidney cancer is operated by removing only the tumoral tissue (partial nephrectomy) in small and suitable masses, and by removing the entire kidney (radical nephrectomy) in large masses or small vascular invasive masses. Immunotherapy may also be required in metastatic patients after surgery.
The kidney is a well-blooded organ that is fed by the aorta, the main artery. Therefore, kidney tumor surgery carries some risks, including bleeding. With laparoscopic surgery, the risks are reduced by experienced urology physicians. The localization of the mass, its size, age of the patient and additional diseases will also determine the majority of the nephrectomy.
The risk is different for each patient. Your doctor will guide you in this regard. However, the risks of surgery should be ignored in kidney cancer patients who do not have chemotherapy and radiotherapy options, except in extraordinary circumstances.
Kidney masses can be performed open, laparoscopic and robot-assisted laparoscopic according to the experience of the surgeon, the facilities of the hospital and the factors of the mass. Laparoscopic kidney surgery (laparoscopic nephrectomy) is advantageous due to its safety, rapid recovery process and cheap cost. For very large masses, laparoscopic and robotic surgery is not technically possible and open surgery may be required.
If there is no unusual situation, especially in Stage 1 masses smaller than 4 cm (T1a),only the tumoral tissue is removed and the normal tissue of the kidney is preserved. This is recommended for kidney cancers up to 7 cm. The surgical procedure in which only the cancerous mass is removed without removing the entire kidney is called partial nephrectomy or nephron-sparing surgery.
In kidney masses larger than 7 cm, the general approach is to remove the entire kidney, and this operation is called radical nephrectomy. If the procedure is done laparoscopically, it is called laparoscopic radical nephrectomy.
There are some exceptions for both radical and partial nephrectomy, and the tumor diameters mentioned are not absolute.
It varies according to the size of the mass, the surgical method (laparoscopic, open or partial, radical nephcertomy?) and the stage of the disease (local or metastatic). Costs range 4000 to 8000 USD.
The abdominal cavity is entered by opening 3 or 4 holes of 1 cm each on the side of the kidney. It is inflated with gas for the abdomen with the help of a special monitore and kept at a certain pressure. Then, with the help of a camera, intra-abdominal optical magnifiers are visualized and the kidney is removed from the surrounding tissues with various hand tools, vessel ligation devices. Then, with the help of a special bag, the kidney is vacuumed and the kidney is taken out with a much smaller incision than in open surgery and sent for pathological examination.
It is performed in a similar technique to laparoscopic radical nephrectomy (kidney removal surgery). However, in patients who are suitable for the partial nephrectomy technique, only the tumoral mass is removed by preserving the normal kidney tissue. Bleeding control is achieved by applying laparoscopic repair to the remaining kidney tissue. Robot-assisted method also has a distinct advantage in partial nephrectomy.
Low-stage kidney cancer surgery usually takes between 30-90 minutes laparoscopically. Kidney cancer surgeries that have a giant mass and spread to the main vessels are major surgeries and may take more than a few hours.
An average of 3 days of hospitalization is required after open kidney cancer surgery. After laparoscopic and robot-assisted kidney tumor surgeries, rapid recovery is achieved and the discharge is usually within 24 hours.
Again in this regard, laparoscopic kidney masses surgery (laparoscopic radical nephrectomy) offers the advantage of rapid recovery. The average time to return to normal life in healthy individuals is 5-7 days. In the case of severe COPD, Heart failure, Diabetes and old age, this period will naturally be extended.
Kidney cancer can usually be cured if it is diagnosed and treated when still localized to the kidney (stage 1 and stage 2).
The 5-year survival rate is around 90% in stage 1 and stage 2 (T1 and T2) kidney cancers confined to the kidney. Especially in stage 1 kidney cancer and small size (T1a) kidney cancer, this rate approaches 100%. While 5-year disease-related survival is around 40-50% in stage 3 kidney cancer, it is around 15% in stage 4 kidney cancer.
These rates are for operated kidney cancer. Kidney cancer is a mortal disease for patients who have not been operated and treated. Considering the difference between the stages, the importance of early diagnosis is also understood.
Unfortunately, when kidney cancer metastasizes, life expectancy is significantly reduced. Although it varies according to the factors of each patient, while the average life expectancy in metastatic kidney cancer is 5-6 months without treatment, it is possible to extend this period up to 2 years with surgery and immunotherapy.
As a result, early diagnosis is very important in kidney cancer, as in other types of cancer. Even if you have no complaints at the age of 40 in the presence of smoking, obesity, hypertension and kidney cancer in the family, and at the age of 50 if there are no risk factors, I recommend you to have an abdominal ultrasonography.
Very good results are obtained with surgical treatment in early stage kidney cancer. Especially laparsocopic kidney cancer surgery is a comfortable treatment option by providing rapid recovery.
I wish you healthy days.
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