Kidney Cancer Treatment: Symptoms, Surgical Methods and Life Expectancy

Renal cell carcinoma accounts for approximately 3% of cancers seen in adults. In previous years, this disease usually presented itself in advanced stages, with a palpable mass or severe pain; today, thanks to advanced imaging technologies (ultrasound, MRI, tomography), it can be detected much earlier, when it is still the size of a ‘small chickpea’.

In this guide, you will find everything from the causes of kidney cancer and its insidious symptoms to ‘Kidney-Sparing Surgery’ (Partial Nephrectomy), which removes only the tumour rather than the entire kidney, and new-generation immunotherapy treatments that utilise the body’s defence system.

What is Kidney Cancer and How Does it Develop?

The kidneys are vital bean-shaped organs located on either side of the lower back that filter blood to produce urine. Kidney cancer begins with the uncontrolled growth of cells in kidney tissue.

The most common type is Renal Cell Carcinoma (RCC). However, there are also different types, such as ‘Transitional Cell Carcinoma (TCC)’, which originates in the collecting ducts where urine is stored.

Benign Cyst or Cancer?

Not every mass found in the kidney is cancerous.

  • Simple Cysts: These are filled with fluid and do not become cancerous.
  • Solid Masses: These are masses containing tissue. Approximately 80-90% of these have the potential to be malignant (cancerous) and require treatment.

Risk Factors: Who is at Risk?

Although the exact cause is unknown, certain factors significantly increase the risk:

  1. Smoking: Doubles the risk of kidney cancer. The risk decreases over time when smoking is stopped.
  2. Obesity: Excess weight increases the risk by causing hormonal changes.
  3. High Blood Pressure (Hypertension): It is a risk factor even if it is controlled with medication.
  4. Dialysis Patients: Cystic kidney structure and cancer development are common in those undergoing long-term dialysis treatment.
  5. Genetic Factors: Individuals with a family history of kidney cancer or those with genetic disorders such as Von Hippel-Lindau (VHL) syndrome are at high risk.

Symptoms of Kidney Cancer: The Body’s Warning Signs

In medical literature, kidney cancer is referred to as the ‘Tumour of the Internist’ because it can present with symptoms that appear very different and unrelated (high blood pressure, fever, anaemia).

Klasik Üçlü Belirti (GenClassic Triad of Symptoms (Usually Seen in Advanced Stages):ellikle İleri Evrede Görülür):

  1. Blood in the Urine (Haematuria): Urine appearing tea-coloured, pink or red. It may be painless.
  2. Side pain: Persistent dull pain in the flank region.
  3. Palpable Mass: A palpable hardness felt during abdominal examination.

Other General Symptoms:

  • Unexplained weight loss.
  • Persistent fatigue and weakness.
  • Recurrent high fever (without infection).
  • Swelling in the legs and ankles.
  • Anaemia.

Important Warning: Early-stage kidney cancer usually causes NO symptoms. Therefore, check-ups and routine ultrasound scans for those over 40 can be life-saving.

Diagnostic Methods: Is a Biopsy Performed?

Unlike prostate or breast cancer, needle biopsy is not always the first option for kidney cancer. This is because advanced imaging techniques can determine whether the mass is cancerous with over 90% accuracy.

  1. Ultrasound: This is the initial screening test. It distinguishes between a cyst and a solid mass.
  2. Computed Tomography (CT): This is the gold standard. It clearly shows the size of the tumour, its vascularisation, and whether it has spread to the lymph nodes.
  3. Magnetic Resonance (MR): Used in individuals who are allergic to the contrast agent used in tomography or in cases where there is suspicion of vascular spread.
  4. PET-CT: It is generally used to determine whether cancer has spread to other parts of the body (such as bones or lungs).

Kidney Cancer Treatment Methods

The treatment plan is determined based on the size and stage of the tumour, the patient’s age and general health.

A. Cerrahi Tedavi (Altın Standart)

The most effective treatment for kidney cancer is the removal of the tumour tissue from the body.

1. Partial Nephrectomy (Kidney-Sparing Surgery)

It is the standard treatment for tumours smaller than 4 cm (sometimes up to 7 cm) today.

  • Objective: Only the cancerous tumour is removed, leaving the healthy part of the kidney in the patient.
  • Advantage: Kidney function is preserved. The risk of future heart disease or dialysis is reduced.
  • Application: Can be performed as open, laparoscopic or robotic surgery.

2. Radical Nephrectomy (Removal of the Entire Kidney)

If the tumour is very large, located in the centre of the kidney, or has spread to the main blood vessels, the kidney is removed entirely along with the surrounding fatty tissue and sometimes the lymph nodes.

B. Surgical Techniques: How are they performed?

1. Robotic Surgery (Da Vinci) – State-of-the-Art Technology

Robotic surgery offers significant advantages, particularly in partial nephrectomy (removal of only the tumour) operations.

  • 3D Imaging: The surgeon sees the tumour and blood vessels magnified 10-15 times.
  • Mobility: The robot’s arms have greater manoeuvrability than the human hand, allowing the kidney to be sutured very quickly and without leakage after the tumour has been removed.
  • Rapid Recovery: As the procedure is performed through small incisions, there is minimal pain and the patient is discharged within 1-2 days.

2. Laparoscopic Surgery

It is performed through 3-4 small incisions made in the abdomen. It is much more comfortable than open surgery. It is often preferred in standard nephrectomies (removal of the entire kidney).

3. Open Surgery

It may still be the safest method for tumours containing very large clots that have spread to the main veins (Vena Cava).

C. Non-Surgical Treatment Methods (Ablation)

It is used for small tumours in patients who are too old to undergo surgery or who have additional illnesses.

  • Cryotherapy (Freezing): The tumour is killed by inserting a needle into it and freezing it.
  • Radiofrequency Ablation (Burning): The tumour is burned using heat energy.

D. Advanced Stage (Metastatic) Kidney Cancer Treatment

If the cancer has spread to the lungs, bones or liver, surgery alone will not be sufficient. Chemotherapies used in the past are ineffective in kidney cancer. Modern medicine now comes into play:

1. Smart Drugs (Targeted Therapies)

These are tablet-form drugs that prevent cancer cells from forming blood vessels and feeding (Tyrosine Kinase Inhibitors). They shrink the cancer and prolong life.

2. Immunotherapy

It is the greatest revolution of recent years. It activates the body’s own immune system (T cells) to attack cancer cells. Even in advanced-stage patients, a complete response (complete disappearance of the tumour) can be observed.

Life After Treatment: Living with One Kidney

Patients’ greatest fear is the question, ‘Can I live with only one kidney?’

  • Answer: Yes, absolutely. If the other kidney is healthy, a single kidney can meet 100% of the body’s filtration needs.
  • Important Considerations:
  • Drink plenty of water.
  • Reduce salt intake.
  • Avoid unnecessary use of painkillers.
  • Protect yourself from high blood pressure and diabetes.
  • Nutrition: No special diet is required, but a balanced diet rich in fruit and vegetables is recommended.

Stages of Kidney Cancer and Survival Rates

  • Stage 1: The tumour is less than 7 cm and confined to the kidney. The 5-year survival rate is between 95% and 100%. Treatment usually results in a cure (complete recovery).
  • Stage 2: The tumour is larger than 7 cm but is still within the kidney.
  • Stage 3: The tumour has spread to major blood vessels or nearby lymph nodes.
  • Stage 4: The cancer has spread to distant organs (lungs, bones, etc.). The combination of immunotherapy and surgery has significantly extended survival time at this stage.