How Are Kidney Tumors Treated?

How Are Kidney Tumors Treated?

Kidney tumors, masses formed in the kidney, arise from the proximal tubule epithelium. Various genetic and environmental factors play a role in its formation. Smoking, alcohol, hypertension and drug use are some of these.

With the widespread use of imaging methods in the last 20 years, masses can be shown when they are small in size and early diagnosis can be made. While they used to be defined as the typical triad of pain, bleeding, and abdominal mass, today they appear incidentally on ultrasonography or tomography when there are no complaints. Therefore, check-up examinations every 3 years after the age of 40 and every 2 years after the age of 50 are important for early diagnosis.

Kidney masses are classified according to their size. Masses up to 4 cm in size are in the T1a class and are considered to be in the lowest stage. Those whose size is between 4-7 cm are in the T1b class, and those larger than 7 cm are in the T2 class. Depending on the relationship of the mass with surrounding tissues, factors such as vascular involvement, involvement of fatty tissues around the kidney, penetration of Gerota’s fascia, and adrenal gland involvement become important in staging.

Treatment for small kidney masses, especially those up to 4 cm and diagnosed early, is provided by partial nephrectomy surgery, in which the mass is removed and the remaining part of the kidney is preserved. The fact that the mass is in the cortex of the outer shell of the kidney and grows outward makes the process easier. For masses located in the medulla, inner part of the kidney and close to its vessels, surgery may be a little more difficult and may result in the removal of half or the entire kidney.

Similar treatment is applied for masses between 4-7 cm in size. Again, the location and its relationship with the surrounding tissues are evaluated and it is decided whether partial or radical nephrectomy will be performed. Sometimes the decision may change during surgery. A seemingly easy process may become difficult, or a seemingly difficult process may be completed easily. Therefore, consent for radical nephrectomy is obtained from the patient before surgery. Even if the decision for partial nephrectomy is made, radical nephrectomy may be decided rather than risking bleeding that could threaten the patient’s life.

Radical nephrectomy can be performed laparoscopically or robotically. Radical nephrectomy can also be performed with open surgery. Closed surgeries have advantages such as smaller incisions, less muscle cutting during the incision required to remove the kidney, easier and faster wound healing, and faster return to daily life.

Partial nephrectomy can also be performed open or laparoscopic/robotic. Partial nephrectomy ensures that the entire kidney is not removed, the remaining kidney continues to function, and that the patient is healthier and can survive the treatment more easily in the face of future kidney diseases. In partial nephrectomy, the mass can be removed together with its capsule, or if the capsule is not visible, some tissue can be cut from the kidney and the mass can be removed. The remaining kidney part is closed with stitches on itself, and auxiliary substances are usually placed in between to facilitate healing and reduce bleeding. These can be seen in subsequent tomography follow-ups.

If there is no suspicious or specific mass on preoperative imaging, there is no need for lymph node dissection. If detected during surgery, hilar region lymph nodes are also removed. Again, if there is no adrenal gland involvement in preoperative imaging, the adrenal gland is preserved and not removed during the surgery.

The type of tumor is determined in the pathology report after the surgery, and depending on the type, periodic follow-up and sometimes additional treatments are required. A typical tumor would most likely be Clear cell carcinoma. Other types are different types such as papillary, chromophobe. Different life expectancies can be discussed depending on the type.

About 20% of small kidney masses are benign. There is also a larger, benign type that can be recognized by imaging with its typical wheel appearance. Apart from this, in suspicious cases, a kidney biopsy may be considered.