Treatment

Treatment

Treatment for your kidney cancer will depend on the size and location of the tumour and this will depend on the size and location of the tumour and this will be discussed with you. The most common treatment is surgery to remove the affected kidney. Often the adrenal galnd above the kidney is removed aswell and sometimes the surrounding lymph nodes.

Patients often worry how they will manage with only one kidney. In fact it is possible to lead a completely normal life, as the remaining kidney will take over all the work normally shared between the two kidneys.

Surgery

You will gradually start to feel stronger as each day goes passed after your operation. Once you are eating and drinking normally and all the tubes are removed you will be able to go home. This is usually between 3- 5 days for key hole surgery and 5- 7 days for open surgery.

Nephrectomy

This means that the whole kidney, surrounding fat and usually the adrenal gland is removed.

Parital Nephrectomy

This involves removing part of the kidney.

 Nephro-ureterectomy

This involves removing the kidney and the tube that goes into the bladder (the ureter)

Laproscopic Surgery.

This involves removing the kidney by key hole surgery. This is not appropraite in every case but may lead to a faster recovery and shorter stay in hospital.

Surgery when the cancer has spread

Sometimes you may be offered surgery even if the cancer has already spread to another part of the body. Sometimes this can be done to reduce symptoms such as blood in the urine or pain.The Consultant will be able to help you to decide whether this is the best option for you.

From time to time when we receive the final result , it becomes apparent that what we thought was a cancer is actually a benign condition.

Arterial Embolisation

This treatment involves injecting a gelatin sponge or similar material into the main blood vessel that flows into the kidney. This results in the tumour being starved of food and oxygen. The procedure is usually performed under a local anaesthetic. It will not cure the cancer but may shrink the tumour so that surgery can be performed . This treatment is also useful if you are having problems with bleeding and the kidney is too large to remove.

Pre-Operative Care

You will be asked to attend the hospital for routine checks. This is usually done in a pre assessment clinic a week or so before your operation. This involves:

• Blood tests
• ECG
• Chest xray
• Urine test
• Blood pressure
• Physical examination

Post Operative Care

• Drink plenty of fluids, beween 2-3 litres per day and increase further if your urine becomes deeply red like claret.
• Heavy work and strenuous exercise should be avoided for four weeks, as this could cause some bleeding for example: Lifting shopping bags, laundry baskets and suitcases, vacuuming, gardening and mowing.
• It is important that you do walk as much as you feel able to as this helps prevent blod clots (DVTs) forming in your legs.
• Do not drive for four weeks; you must be able to do an emergency stop safely without causing discomfort.
• Sexual intercourse can be resumed when you want to
• Your bowels should be opened regularly; take a laxative if your motion is hard.
• The wound sutures (stitches) are usually dissolvable so do not need to be removed; otherwise they will be removed prior to discharge or arrangements made with the District Nurse to do so. Bruising or slight redness of the wound is normal, but if it oozes, bleeds or feels hot then please arrange to see your GP.
• An after lunch sleep is recommended.
• You may return to work after four to six weeks.

These are basic guidelines. Each person recovers at a different rate therefore "listen" to your body and if you are feeling tired or uncomfortable you are probably doing too much.

Pain Control

If you have open surgery you are likely to experience pain or discomfort for the first week. If you have keyhole surgery the discomfort should be less. It is important to tell your doctors or nurses if you have feel any pain as there are lots of drugs that can make you feel more comfortable. Pain killers work best if you take them regularly so don't suffer in silence. You may be given a PCA (Patient controlled analgesia) which is a machine with a button that can be pressed as and when you feel pain. It is often best to have pain killers before you attempt to mobilise.

Sometimes people are given painkillers into the spine (epidural) for the first day after surgery. These can be very effective. A very fine tube will be taped onto your back. It willbe connected to a pump which can give  a continuous dose of pain relief. If this is not sufficient and you are still experiencing pain then please tell your nurse.

Eating and Drinking

After you have any surgery to your abdomen, the bowel often stops working for a short while. Until it starts again you will not be able to eat or drink. At first you will be given clear fluids only. Once you are able to drink again the drip in your hand ,that will supply you with enough fluids after your operation, will be removed.When the doctor is sure that your bowel is making gurgling noises and is working normally then you will be able to move on to more solid foods. Usually people are eating within 2 days after this type of surgery.

At first your nurse will keep a close eye on your urine output. She will check to make sure that your catheter is draining properly. If you produce enough urine then your catheter can be removed. You will need to still collect your urine in urine bottles to ensure that the remaining kidney is working properly.

Wound Care

Your wound is normally stitched with internal dissolvable stitches so you don't have to worry about having them taken out.

It is important to keep the wound clean. Try to have a shower every day. Soaking in the bath is not advisable uintil the wound has healed, this is usually a couple of weeks after your operation.

Keep an eye on your wound. If it becomes red and sore or swollen then please contact your GP. It may be that you have an infection.

If you feel hot or shivery or generally unwell, or your urine becomes cloudy or smelly, this could also be a sign that you have an infection, so please go and see your GP.

Complications of Kidney Surgery

Surgery in the 21st century is remarkably safe. For kidney surgery a general anaesthetic is requires often with an epidural anaesthetic which is good for postoperative pain relief.

The overall chance of dying from surgery to the kidney in Oxford is less than 1% (in a series of 1000 patients). This is dependent on may factors including the nature of the kidney tumour and general health of the patient. 

Occasionally heavy bleeding can occur during the course of the operation which may require a blood transfusion.

Occasionally organs next to the kidney such as the spleen, liver intestines or pancreas may be affected by the cancer or damaged at the time of surgery and additional procedures and operations may be required.

Damage to the lining of the lung (pleura) which lies close to the kidney can lead to a collapsed lung. This is treated by a tube which is placed through the skin and into the lung. This is called a chest drain and it allows the lung to expand. It is usually removed within a few days.

In some cases these complictions require admission to the intensive care unit (ITU). In exceptional circumstances this can lead to death.

Wound hernias occasionally occur after any type of surgery and may require additonal treatment (surgical repair). Long term pain, numbness and tingling in the wound occur from time to time.

General Risks of Surgery

The following potential complications can occur after any type of surgery. They are more likely to occur in people who smoke, or who already have heart or lung disease, amd in older rather than younger patients. Again it should be stressed that these do not happen often but when they do are serious and potentially life threatening and may need treatment on the intentsive therapy unit (ITU).

Deep vein thrombosis (DVT or clots in the legs) which can dislodge and become dislodged in the lungs causing a pulmonary embolism (PE). This causes serious breathing problems. DVT and PE will require some months of treatment with warfarin, a blood thinning drug. If you have had previous DVT or PE, you are at greater risk of developing another one following surgery.

Stroke, leading to temporary or permanant loss of the ability to use an arm or hand or the ability to walk and talk.

Heart attack (myocardial infarction) or other heart problems may occur as may problems related to the anaesthetic.

Septicaemia (blood poisoning) may require some days of intravenous antibiotic treatment (antibiotics into a vein).

Wound, chest or unrinary infection requiring antibiotic treatment.

How will I feel when I get home?

Although you should take it easy for 4- 6 weeks after your operation we would advise you to walk around regularly as you are still at risk of developing blood clots in your legs. Ensure that you take regular pain relief so that you are comfortable when taking gentle exercise. Paracetamol is usally strong enough to deal with the pains that you may experience.

You should avoid strenuous or heavy lifting. If you don't this could result in a hernia developing.

Newer Treatments

These treatments are often offered to patients that are not suitable for conventional treatments such as, surgery.

RFA- Percutaneous Radiofrequency Ablation

This involves the insertion of eletrodes through the skin and into the kidney. An electrical current is then passed through the electrodes into the tumour. The heat from the current destroys the cancer cells. 

Cryotherapy

This involves inserting probes into the kidney and passing a coolant through them. This freezes and detstroys then cells surrounding them. The side effects of this type of treatment are less severe than a kidney operation but may include pain, bleeding and infection.

HIFU- High Intensity Focused Ultrasound

This is a new treatment currently nder investigation at the Churchill Hospital. It is the first research trial of its kind outside of China. The treatment has been successfully used there to treat cancer and involves directing high intensity ultrasound at the cancer.At present patients are being asked if they are willing to undergo HIFU the week before surgery to remove the kidney cancer. This is so doctors can examine the kidney after it has been removed to see what effect HIFU has had on the cancer.

The hope is that in the long term this may avoid the need for surgery in some patients.

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