A kidney (renal) mass can develop as a fluid-filled sac arising from the kidney (cyst) or as a solid mass. The team at Affiliated Urologists may recommend the following treatment options to effectively mitigate non-cancerous and cancerous kidney (renal) masses.
Arterial Embolization
Arterial embolization, also known as renal artery embolization, is a minimally invasive procedure performed on patients diagnosed with kidney cancer. This procedure is an effective and invaluable treatment option for patients with advanced renal cell carcinoma tumors that have invaded nearby structures and veins. Patients with these progressive tumors are not usually considered candidates for surgery, so alternative treatment options are necessary to improve their long-term survival. During arterial embolization, an interventional radiologist makes an incision in the groin area before inserting a catheter into a major artery. The catheter is fed through the artery until it reaches the renal artery, which supplies blood to the kidney and nearby tumor.
Once the catheter is in place, the physician injects solid particles and liquid agents into the artery. This process helps block the flow of blood, oxygen, and other vital nutrients to the kidney and its tumor, which helps it shrink over time. If the tumor shrinks to a suitable size, the patient may be ready for surgery. Arterial embolization is a unique therapy that may be used in conjunction with other cancer treatments such as cryoablation, radiofrequency ablation, and nephrectomy.
Targeted Therapy with Anti-Angiogenic Agents
Targeted therapy using anti-angiogenic agents, also called angiogenesis inhibitors, helps prevent the formation of new blood vessels, which can encourage the growth and spread of cancerous tumors. Anti-angiogenic agents interfere with the angiogenesis process, which binds signaling molecules to receptors on the surface of normal endothelial cells. This binding system initiates the survival of new blood vessels. Fortunately, anti-angiogenic agents have an opposite effect on this process, and they work by blocking any signaling activities. While there are some angiogenesis inhibitors only available for the treatment of glioblastoma, there are a number of other anti-angiogenic agents that can be used with supplementary cancer drugs to treat some colorectal cancers, non-small cell lung cancers, and renal cell cancers.
The following anti-angiogenic agents have been approved by the FDA to treat various cancers, including kidney cancer: sorafenib (Nexavar), sunitinib (Sutent), pazopanib (Votrient) everolimus (Afinitor). These cancer-fighting drugs do not kill tumors, but they do help stop their growth. As a result, patients may receive anti-angiogenic agents in conjunction with other cancer treatments such as chemotherapy and radiation therapy to effectively terminate cancerous tumors.
Thermal Ablative Techniques (Cryoablation and Radiofrequency Ablation)
Ablative techniques for kidney cancer include cryoablation and radiofrequency ablation. Both therapies use cell destroying properties to effectively target and kill cancerous tumors while preserving nearby, healthy tissue. While surgery is considered the main treatment for kidney cancer, patients may be either too sick to undergo a surgical procedure, or they have advanced stages of renal cell carcinoma that cannot be operated on safely. As a result, thermal ablative techniques or cryotherapy may be used to destroy kidney tumors. Cryoablation is a minimally invasive procedure that uses extreme cold to destroy tumors. During the procedure, a hollow needle is inserted into the tumor before cold gasses are introduced to the tip of the probe. An ice ball is then created and sent into the tumor to damage its cancerous tissue(s).
For patients undergoing radiofrequency ablation, a thin needle is placed into the tumor using ultrasound guidance. When the probe is in the correct position, the physician turns on a portable machine to emit high-frequency radio waves. As the radio waves travel through the machine, they quickly turn into heat lesions that damage cancerous tissue. Both therapies are performed as outpatient procedures, using local anesthesia and intravenous sedation to minimize the patient's discomfort.
Robotic Surgery (Da Vinci Partial and Radical Nephrectomy)
A partial or total nephrectomy is a robotic-assisted, minimally invasive procedure designed to remove some or all of the kidney. This procedure removes a benign mass or cyst that is causing pain to the patient, as well as a mass in the kidney that may be cancerous. Because this is a minimally invasive procedure, patients are at a lower risk of surgical complications compared to open nephrectomy procedures. Using the da Vinci approach, the surgeon operates a device with robotic arms. These arms have the same function as a surgeon's hands, but they are able to bend in all directions and fit into smaller incision sites. As a result, patients experience a shorter hospital stay, less pain, and less bleeding. The physicians at Affiliated Urologists are certified experts of the da Vinci robotic surgery and believe it can be a safe and effective treatment method for patients.
For this procedure, patients should avoid consuming food and beverages to minimize surgical complications with the anesthesia. Patients should be aware that they might be asked to quit using tobacco products in the weeks prior to surgery. On the day of surgery, patients should avoid blood thinning medications and be bathed or showered. We recommend not wearing any lotions or perfumes, which can irritate the skin. Diagnostic imaging prior to the surgery will determine whether or not the patient needs the entire kidney removed.
To begin the nephrectomy procedure, the patient is given general anesthesia and put to sleep. Then, the patient is put into position and the surgical site is sterilized with an antiseptic solution. The robotic system allows surgeons to make several small incisions as it utilizes 3D technology to provide the surgeon with an inside view of the body. If the patient is undergoing a kidney-sparing procedure or a partial laparoscopic nephrectomy, the surgeon carefully removes the tumor or cystic mass that is causing pain. The healthy tissues surrounding the kidney are then mended back together and the incision is sutured. In a robotic radical nephrectomy, the entire kidney, as well as some surrounding tissues, are separated from the ureters and removed. Patients may need to wear a catheter to drain urine after the procedure.
While recovering from the nephrectomy, patients may need to stay in the hospital for several days. Patients may be given antibiotics, pain relieving medications, and a stool softener to reduce discomfort. Patients should always handle the incision site with care. It must be carefully washed and gently patted dry. Following the procedure, the mass removed from the kidney will be sent to a pathologist for testing. If the mass is found to be cancerous, patients may need to have additional blood tests or imaging done. In some cases, additional cancer treatments may be necessary if tumors have spread to other parts of the body. If patients notice any rash-like symptoms, fever, or blood in their urine, our physicians urge them to call Affiliated Urologists immediately.
Open Radical Nephrectomy
An open radical nephrectomy procedure is performed if the patient is not a candidate for laparoscopic or robotic-assisted surgeries. If a renal mass is detected, a patient may undergo an open radical nephrectomy to remove a cancerous tumor, test a mass that may be cancerous, or treat a painful cyst. This procedure treats renal masses by removing the kidney entirely. While this procedure does carry certain risks, it does not significantly impair quality of life.
In preparation for this procedure, patients should ask their Affiliated Urologists physician any questions they may have about their surgery. They may be required to have imaging tests and blood work done in order to determine the scope of the mass and whether or not the entire kidney needs to be removed. The physician will ask patients to avoid food and non-clear liquids before the procedure to reduce the risk of complications. Patients should not smoke or take blood-thinning medication before coming in for their scheduled surgery.
The procedure begins by putting the patient under general anesthesia and sterilizing the surgical site. Depending on the surgeon's preferred approach, an incision may be made in the middle or side of the abdomen. Muscle and tissue are carefully put aside and examined for signs of metastasized cancer. The kidney is then separated from the ureters and removed using nerve-sparing techniques. Sometimes the adrenal glands just above the kidneys are removed too. The blood vessels supplying blood to the kidney are closed and the patient's incisions are sutured close. The patient is then taken to a separate room to recover. Depending on the renal mass, this procedure can take several hours to perform.
Because this is an open surgery, patients may need to stay at the hospital for just under a week to heal. At the hospital, patients may be given a course of antibiotics and pain medications, and the staff will monitor the kidney(s) throughout the patient’s stay.
After being discharged, patients will continue to recover for a few weeks at home. They should stick to a healthy diet and drink plenty of fluids to promote wound healing. Patients should not lift heavy objects or do any form of strenuous activity. All sutures and surgical dressings should be handled with care and gently cleansed regularly. Patients may be asked to return to Affiliated Urologists to ensure the mass has been successfully removed. If cancer is still found in the body, additional treatments can be discussed. If patients have difficulty breathing, a fever, or experience excessive bleeding, blood in their urine, or any other sign of complication, patients should call Affiliated Urologists immediately.
