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Sunday, May 11, 2008

Surgery for kidney cancer

Surgery is often the only treatment that is needed. The most appropriate type of surgery for your situation will depend on the size of the cancer and whether or not it has spread, as well as your age and general health. It is important to discuss any operation fully with your surgeon before you have it.

Nephrectomy (removal of the kidney)

The most common type of surgery for kidney cancer is a nephrectomy. The surgeon removes all of the affected kidney and some surrounding tissue. This operation usually involves a cut (incision) made between the lower ribs on the side of the tumour. The surgeon may also remove some, or all, of the lymph nodes close to the kidney to check whether they contain cancer.

It is possible to live a completely normal life with just one kidney; it will do the work usually shared by two kidneys. But, removing a kidney is a big operation and so you need to be reasonably fit. This means that this type of surgery isn’t suitable for everyone. In some cases people who aren’t fit enough to have standard surgery may be able to have an operation using one of the newer surgical techniques that are being developed, such as keyhole surgery.

Partial nephrectomy

Instead of taking out all of the kidney, the surgeon will sometimes only remove the tumour and the part of the kidney surrounding it. This is called a partial nephrectomy or nephron-sparing surgery and it is usually only possible if the tumour is smaller than 4cm.

A partial nephrectomy may also be used if it is important to try to keep the affected kidney, for example if you have only one kidney or have kidney disease. It may also be used if you have an inherited form of kidney cancer that increases your risk of cancer developing in the other kidney.

Keyhole surgery

In some situations, it may be possible to have keyhole or laparoscopic surgery to remove some, or all of your kidney. In this type of surgery only small openings are made instead of one larger cut (incision). The surgeon uses a special instrument called a laparoscope to see and work inside the belly (abdomen).

The laparoscope is a thin tube with an eyepiece at one end and a light and a magnifying lens at the other. It is put into the abdomen through a small cut in the skin. Generally about three small cuts and one larger cut are needed for the operation. The larger cut is usually made close to the belly button and is used to remove the kidney.

The main advantage of this type of surgery is that it leaves a much smaller wound and so has a shorter recovery time. Keyhole surgery may be used for some people, who would not have been fit enough to have an operation otherwise.

The chances of curing kidney cancer appear to be as good with keyhole surgery as with bigger operations. However, the techniques haven’t been used for long enough to be absolutely sure of this.

Keyhole surgery should be carried out by surgeons with specialist training and experience in using laparoscopic techniques. So, if it is suitable for you, and you choose to have this type of surgery, you may need to travel to another hospital to have the operation.

Surgery when the cancer has spread

Secondary tumours (or metastases) can develop if cancer cells break away from the original tumour (the primary) and travel in the bloodstream or the lymphatic system. The cells may settle and begin to grow in a different part of the body, forming a new tumour.

If the cancer has already spread to other places in the body (metastatic or secondary cancer) it may still be worth having the kidney with the cancer removed. If the tumour in the kidney is causing symptoms such as pain or bleeding, or if it is affecting the balance of chemicals in your blood, taking it out may relieve this.

Although this operation will not usually be able to cure the cancer, it may help other treatments to work better and so may help you to live for longer. However, these possible advantages need to be weighed up against the effects of having a major operation. Deciding whether to go ahead with an operation in these circumstances can be very difficult. It is important that you discuss the advantages and disadvantages with your doctors when making up your mind.

Rarely, surgery may be used to remove small secondary tumours in another part of the body. This is very specialised surgery. It is generally only possible if the cancer has spread to a limited area – usually just to one place in the body. It is also important that you are fit and healthy enough to cope with the operation. Removing a secondary cancer may help to slow down and control the cancer for longer. Occasionally it may be used to try to cure the cancer.

Embolisation

If surgery to remove the kidney isn’t possible because of your general health or because the tumour is too large, it may be possible to block off the blood supply to the tumour. This is called embolisation. A thin plastic tube (catheter) is put into a blood vessel in your groin. Then, using x-ray pictures as a guide, the surgeon threads the catheter upwards until the tip is in the artery that carries blood to the kidney. A substance is then injected through the catheter into the kidney. This will block the blood supply to the kidney and so cut off the supply of oxygen and nutrients to the tumour.

Embolisation is usually done to try to shrink the tumour and to help control symptoms such as bleeding.

After your operation

After your operation you will be encouraged to start moving about as soon as possible. This is an essential part of your recovery. If you have to stay in bed, the nurses will encourage you to do regular leg movements and deep-breathing exercises.

When you get back to the ward you will have a drip of fluid and salts going into your vein until you are able to eat and drink normally. You will probably have drainage tubes from the wound to stop any excess fluid collecting, and so help the wound to heal. The tubes will only be needed for a short time and will be taken out before you go home.

Usually you will have a small tube (catheter) draining urine from your bladder into a collecting bag. This will save you having to get up to pass urine. The catheter is usually removed after a couple of days.

You will be given painkilling drugs regularly, to control any pain. If you still have pain, it is important to let the ward nurse know. They can have the type or dose of painkillers changed to something that is more effective for you.

How long you need to stay in hospital after your operation will depend on the type of surgery you have had. The time can range from 4–10 days depending on the type of operation and on your general health and fitness. Many people like to know how soon they will be able to get back to doing normal things, like shopping, gardening, playing sport or going to work. This will vary depending on the surgery you have had and on you as a person. Your doctor or nurse will be able to advise you.

Before you leave hospital you will be given an appointment to attend an outpatient clinic for a check-up about six weeks after your surgery. This is a good time to discuss any problems you may have after your operation.

Via: http://www.cancerbackup.org.uk

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