KIDNEY TUMOR

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What You Should Know About Kidney Tumor

What is kidney cancer?

Many different types of cancer can develop in the kidney. We divide these cancer types into 2 groups as benign and malignant. The most common mass in the kidney is simple kidney cysts. Kidney cyst is a benign mass and completely different from cancer. Most of the time, kidney cysts that occur by chance never threaten human life. Patients with kidney cysts panic unnecessarily and seek treatment. In fact, kidney cysts often do not even require treatment, just monitoring is almost always sufficient.

Kidney cancer is a malignant mass and unlike kidney cysts, it can pose a threat to human life. Kidney cancer usually occurs between the ages of 50 and 70. It is seen 2-3 times more in men than in women.

Symptoms of kidney cancer:

Mass in the kidney area

ache

Anorexia

general illness

weight loss

repetitive high fever

high blood pressure (hypertension)

anemia (anemia)

If the cancer has spread, findings related to the organ it has spread can be seen. E.g

If it has spread to the lungs, cough, shortness of breath, bloody sputum may be present, as well as bone pain in patients with bone spread, headache, paralysis, loss of consciousness in patients with brain spread.

These complaints may be a symptom of kidney cancer or may be caused by other problems such as infection. People with these complaints should definitely see a urologist. Usually, early cancer does not cause pain. Therefore, it is important to see the doctor without feeling pain. Cancer diagnosed early is curable.

Diagnosis of kidney cancer

Research and physical examination by the doctor about the patient’s complaints and history is the first step towards reaching the diagnosis. In the examination, it is investigated whether there is abnormal stiffness or a mass in the region that fits the kidneys, especially in the abdomen. A blood and urine test can then be done. Occult blood can sometimes be detected in the urine in patients with kidney tumors. The patient’s complaints, history, and the doctor’s initial evaluation findings are very important for determining further investigations. Ultrasonography is very useful for determining whether there is a tumor in the kidney. If a kidney tumor is shown or suspected in the images obtained in these examinations, computed tomography (CT) examination should be performed.

CT OR MRI shows the condition of the kidney, shows whether the mass is a cyst or a tumor, its spread and whether there is enlargement of the lymph nodes around the kidney. A chest X-ray scan, PET, and sometimes a bone scan may be done to determine the stage of the disease.

Treatment of kidney cancer

Treatment of kidney tumor is determined by the patient’s age, general health status, and the extent of spread (stage) of the cancer.

Surgery is the standard method in the treatment of kidney cancers. Depending on the stage, size and number of the cancer, either the kidney, adrenal gland and surrounding membranes and fat layers can be completely removed (radical nephrectomy) or only partially removed (partial nephrectomy), depending on the stage, size and number of the cancer. Surgical technique can be determined by the surgeon with an open operation or a closed method called laparoscopic. If the remaining kidney is normal, removal of the diseased kidney does not cause any problems in terms of kidney functions. Depending on the surgical technique, the patient can usually be discharged from the hospital shortly (3-4 days) after the operation. After leaving the hospital, you can easily resume normal daily activities. Then, according to your doctor’s recommendation, you should return to the hospital to be re-evaluated. In addition to the evaluation of your general condition after the operation, this control is absolutely necessary in order to plan the future state of your disease. This control examination is the best time to share all the details of your disease with your doctor.

The removed samples are examined by pathology method and the type, character and extent of spread of the tumor are determined. This both confirms the diagnosis and gives information about the spread.

If the cancer is in the Gerota sheath, most patients do not need any additional treatment. If the tumor has protruded beyond the sheath or is present elsewhere, additional post-surgical treatment will be required.

When the surgical decision is made, such operations can now be performed laparoscopically or robotically. In very small masses (under 3 cm), even if a tumor is suspected, in some cases, it may not be removed and followed up. Another treatment alternative in recent years for kidney masses smaller than 3 cm is the destruction of tumor cells using energy sources. The tumor mass is destroyed by using various heat sources with microwave, radiofrequency, cryoablation methods. Especially in liver tumors, the treatment applied in recent years can also be done for kidney masses without harming kidney functions.

This treatment is especially suitable for the elderly, lung or heart etc. It is applied to patients who cannot afford the surgery due to problems. It can also be tried at a younger age, in people who do not want to have surgery. The measurement, size, content of the mass and the general condition of the patient are combined and the patient is informed about which one to apply. In this respect, it is important to know that there is such a treatment alternative.

Robotic Surgery in Kidney Tumor Treatment

The gold standard in the treatment of localized kidney tumors is surgical resection.

In recent years, there has been a trend towards partial nephrectomy in cases. The reason for this trend is the fact that chronic renal failure is more common in patients who underwent radical nephrectomy, even if other renal functions are normal pre-operatively, and therefore, the desire and aim of preserving renal functions as much as possible.

 The use of the da Vinci system (Intuitive Surgical Corporation, Sunnyvale, California, USA) is increasing, especially in radical prostatectomy. Possible advantages of robot-assisted laparoscopic surgery over laparoscopy; Robot-assisted laparoscopic radical and partial nephrectomy is laparoscopic and open nephrectomy.

Technique: Robot-assisted laparoscopic nephrectomy is performed under general anesthesia. The anesthesia team should be alert for the effects of CO2 insufflation and pneumopertonium, such as oliguria and hypercarbia. The basics of surgical dissection in robot-assisted laparoscopic nephrectomy are similar to the laparoscopic method. In the transperitoneal method, the patient is placed in the lateral position (45 -60°), and the pneumoperitoneum is created by entering with a Veress needle as in the laparoscopic method. Then, the robot-assisted laparoscopic arms and the necessary ports for the assistant are placed and the surgery is started.(17)

Robotic Surgery

(Robot Assisted Minimally Invasive Surgery):

The operation is performed over the robotic arms sent to the target anatomy through incisions made on the patient’s abdominal wall. One of the incisions is used for the camera that sends a 3D HD, real, simultaneous view of the operating field to the surgeon’s console. The surgeon manages the robotic instruments using his console. In this way, it reaches very narrow areas and has the chance to perform maneuvers that cannot be done by human hands. In addition, it eliminates the hand tremor problem experienced in laparoscopic surgery and can perform rotation maneuvers that laparoscopic instruments cannot. The 3D HD image quality provided to the surgeon is one of the features that distinguishes robotic surgery from laparoscopic surgery. In robotic radical nephrectomy surgery, it feeds the kidney and carries the dirty blood in the kidney.

After the vessels are identified and closed, the connection of the kidney with these vessels and the ureter is cut. The kidney, which is separated from the surrounding tissues, is removed from the body and the operation is terminated. In robotic partial nephrectomy surgery, after the tumor area is determined and marked with an instant ultrasound image during the operation, thanks to a feature offered by the da Vinci Robotic Surgery System, the vessels that feed the kidney and carry the dirty blood from the kidney are closed for a short time. After the tumor is separated from the kidney and the removed area is closed, the blood inlet and outlet in the veins are opened. The operation is terminated by removing the tumor from the body. The very small incisions made in robotic surgery allow the patient to return to his daily life faster after the surgery.

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