Kidney Cancer: New Technologies, New Treatments
In our new and ever-evolving medical realm, patients undergo more imaging to determine the cause for their complaints, and doctors are presented with more findings that need be analyzed and discussed. This happens with kidney cancer. Today, most patients will undergo an ultrasound and CT or MRI scans for varied symptoms. The scan shows what is felt to be an incidental finding of a small (<4 cm) mass in the kidney. This allows for the earlier diagnosis of these tumors.
While most of these masses are simple fluid-filled cysts, not uncommonly they are solid tumors, the majority of which are, in fact, kidney cancer. What is important to understand is that we are increasingly more knowledgeable at defining the risks for patients developing these tumors as well as the correct approach to decisions regarding their treatment.
Not so long ago, the typical standard of care was that tumors were diagnosed using only a physical exam. The tumors that were found were much larger and more advanced. In most of these cases, treatment would be removal of the entire kidney.
While surgery remains the standard curative therapy – and it continues to at times necessitate complete kidney removal – new technologies and treatment approaches allow us to spare normal kidney tissue on the same side of the tumor while being able to ‘cut’ out only the tumor.
Partial nephrectomy or kidney removal is one such method. In most cases it is performed by surgeons with the aid of a robot as in prostate cancer and other surgeries. Another way to treat the tumors is to ablate, or kill, the tumor tissue where it resides without cutting out tissue. This type of outpatient treatment is performed by a radiologist, and no operating room is needed.
The advent of minimally invasive techniques for treatment has afforded much more tailored therapy to patients. Another benefit is that the natural history of these cancers is much better understood today. This means patients may consider simple surveillance for small masses, rather than undergo more involved therapy for little potential of benefit.
Equally important and exciting are the therapies that have been developed in the last decade for those patients who are diagnosed with incurable kidney cancer. The good news is that numerous chemotherapeutic agents have been approved for use in the goal of extending patients’ lives with this potentially devastating disease.
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