Types of surgery for kidney cancer

To do this, it must be possible to remove the cancer completely. Stage 1 and 2 cancers are most likely to be curable with surgery. It is sometimes possible to cure stage 3 cancers with surgery if the surgeon can get all the cancer out. Either the whole kidney (radical nephrectomy) or just the affected part of the kidney (partial nephrectomy) can be removed.

If you have a very small kidney tumour, your specialist may offer you treatment to remove the cancer by freezing it. This is called cryotherapy.  There is a separate page on cryotherapy for kidney cancer in this section.

Radical nephrectomy

This is the most common type of surgery for kidney cancer that has not spread. The surgeon will remove the whole kidney with the tissues around it, including the adrenal gland. The adrenal gland is attached to the kidney. Some lymph nodes in the area will also be removed. The surgery is fairly major but if your cancer has not spread, this is all the treatment you will need.

Partial nephrectomy

This means removing the cancer and part of the kidney surrounding it. Some of the kidney is left behind. You may hear your doctor call this 'nephron sparing surgery'. The nephron is the filtering unit of the kidney, so this just means that you will have some working kidney left after the operation.

Nephron sparing surgery only used to be done in special cases, for example if

• Your other kidney is damaged
• You only have one kidney
• You have cancer in both kidneys

But now surgeons think this type of surgery may be enough for many patients. More kidney cancers are being found at an early stage, by accident, when you have a scan for something else. This type of treatment is most appropriate for them. Having some working kidney left behind helps to protect against future kidney problems. If your other kidney was to become damaged in any way, you would still have some working kidney left, and may be able to avoid dialysis.

If at all possible, removing part of the kidney is becoming standard treatment for anyone with a stage 1 kidney cancer. That is, a tumour less than 7cm across. In some cases, it may not be possible to have this type of surgery, even with a small tumour, because of its position within the kidney. If you are at all concerned about this, talk it through with your surgeon. Doctors are generally happy to talk through the reasons for their treatment decisions.

NICE (the National Institute for Health and Clinical Excellence) say in their document ' Improving outcomes in urological cancers', that a surgeon from a specialist urological team should look at your case if you have a small kidney tumour and are likely to benefit from this type of surgery. NICE say that treatment at a specialist centre is likely to be most appropriate for you if you are in this situation. This is complicated surgery, and the surgeon has to be experienced in doing it. There is information about research in partial nephrectomy for kidney cancer in the what's new in kidney cancer section of CancerHelp UK.

For detailed information about what will happen in hospital, look at the section on having your operation.

Doctors prefer to call this ‘minimal access surgery’ or ‘laparoscopic surgery’. It means having an operation without needing a major incision (wound site). The surgeon uses an instrument that is a bit like a telescope. This is called a laparoscope. It has a camera so the surgeon can see inside the body. The surgeon will usually make a number of small cuts through your skin. They can put the laparoscope and other small instruments through these to carry out the surgery. So you will end up with 3 or 4 small wounds, each a centimetre or so long. The surgeon can manipulate the instruments and watch what he or she is doing on the camera. It is possible for an experienced surgeon to remove a whole kidney or part of a kidney using laparoscopic surgery. The advantages of laparoscopic surgery over normal ‘open’ surgery are

• You are likely to be more comfortable and need less painkilling medication after your operation
• You can usually go home from hospital more quickly
• You usually recover from the operation more quickly

There are drawbacks. The operation may take longer, so you may be under anaesthetic for longer. In about 1 in 100 (1%) of these operations, the surgeon has to switch to regular ‘open’ surgery during the procedure. This could be because the position or size of the tumour makes it difficult to reach, or because there is difficulty controlling bleeding, for example.

In 2005 NICE (the National Institute for Health and Clinical Excellence) issued guidance on laparoscopic nephrectomy. And in 2006 they published their guidance on laparoscopic partial nephrectomy. They have decided that both these procedures are safe enough and work well enough to be used as part of NHS treatment. But they stress that you should only be offered this type of surgery for cancer if it is suitable for your individual condition. And if you do have this type of surgery, it must be done by a surgeon who has been trained in laparoscopic techniques and is experienced in using them. NICE also say that more information is needed about how well this surgery works in the long term for people with cancer.

If you are interested in having this type of surgery, talk to your surgeon. You would need a referral to a specialist urological surgeon with particular experience in laparoscopic kidney surgery.

In most cases, the operation to remove your kidney will not affect your bladder. This means you will not need a urostomy ( a bag to collect your urine). But you might need a drainage tube (urinary catheter) from your bladder for a few days after your operation.

If your surgeon is satisfied that all the cancer has been removed, you won't need any further treatment. If the surgeon is concerned that some cancer cells may have been left behind, you may need to have immunotherapy treatment. In some cases. you may be offered a course of radiotherapy.

Even if your cancer is unlikely to be cured with surgery, it may still be worth you having an operation to remove it. Your doctor may call this a palliative nephrectomy. Sometimes the primary cancer causes troublesome symptoms that can be successfully treated by removing the kidney. The kidney tumour may be causing you pain locally, or causing blood in your urine. Or you may have general symptoms such as fevers or weakness. The tumour can upset levels of chemicals in your blood, which can cause all sorts of symptoms, including sickness or drowsiness. In kidney cancer, general symptoms are sometimes caused by chemicals called cytokines that are released by the tumour. Removing the tumour can get rid of these symptoms.

Removing the cancerous kidney may also slow down the progress of the cancer outside the kidney. 2 recent clinical trials have shown that patients who have advanced kidney cancer may live longer if they have the affected kidney removed. To be suitable for this treatment you will have to

• Have a primary cancer that can be removed with surgery
• Have a kidney cancer that is causing troublesome symptoms
• Have only a small amount of secondary cancer
• Be fit enough to make a good recovery from the operation

You will either be asked to have a

• Radical nephrectomy or a
• Partial nephrectomy

This is very specialist surgery. It is becoming more common as it is possible to slow down a cancer and so give a longer and better quality of life to those with advanced cancer. In some cases, it may even be possible to cure a cancer by removing a single area of cancer spread. NICE say that your treatment should be managed by a specialist urological team if you have limited cancer spread that could possibly be removed. It is possible to have secondary kidney cancer removed from your

• Lung
• Liver
• Bone (in rare circumstances)
• Brain
• Skin

These operations are all very different from each other. And will vary depending on your particular medical situation. So it is not possible for us to give full details of these operations here. There is general information about what happens when you have surgery in this section of CancerHelp UK. You may find it worth looking at. Much of that information will be helpful to you even though you are having a different type of operation. You will have drainage tubes in different places when you wake up. What you are asked to do, and how long it takes to get better will vary, depending on the operation you have had. But otherwise it will be much the same.