Kidney Cancer

What is Kidney Cancer?

The kidneys are a pair of bean-shaped organs located at the back of your body, just deep to the lower ribs.

Kidney cancer, also known as renal cell carcinoma (RCC), is a kidney tumour that arises.  It is among the top 10 commonest cancers in Singapore amongst males, and accounts for 3% of all cancers in adults.

Who gets Kidney Cancer?

  • Lifestyle causes
  • Occupations and chemical causes
  • Genetic syndromes and family history

Certain lifestyles and environmental exposures can increase the risk of having kidney cancer, e.g. cigarette smoking doubles the risk, and the risk increases with heavy smoking. Obesity and hypertension are also risk factors.

Occupational exposure to certain chemicals, e.g. cadmium, herbicides; as well as underlying medical conditions such as chronic hepatitis C infection, chronic kidney disease/renal failure also predispose one to kidney cancer.Genetic syndromes and a family history of kidney cancer also increase the risk of developing RCC. These genetic syndromes include von-Hippel Lindau (VHL) syndrome, hereditary CC, hereditary papillary renal carcinoma, Birt-Hogg-Dube syndrome, as well as tuberous sclerosis.

What are the Signs and Symptoms?

Th classic triad of flank pain, blood in the urine  (haematuria) and a palpable flank mass only occurs in 10%. Other  common symptoms include weight loss, fever, night sweats, malaise, and a left varicocele  (swelling near the left testicle) in males.

What Investigations are required?

A Computed Tomography (CT) scan is required to assess the size and extent of the tumour, and whether it has spread to other organs (metastases).

Blood tests are required to assess the kidney function,  look for electrolyte abnormalities that may be caused by the tumour, and assess overall health status of the patient.

In selected cases, tumour biopsy may be required to confirm the diagnosis or guide treatment strategies.

What are the Treatment Options?

This depends on the extent of disease at diagnosis.

Localised disease:

Surgery: Partial Nephrectomy

Partial nephrectomy involves removal of part of the kidney containing the cancer, leaving the remnant kidney intact, thereby avoiding the loss of the affected kidney Small tumours are amenable to partial nephrectomy, which preserves the patient’s kidney function.

Surgery: Radical NephrectomyRadical nephrectomy involves removal of the entire kidney with the tumour, and is indicated for large tumours where partial nephrectomy is not feasible. In patients with a healthy kidney on the other side, they can continue to live a normal life after removing the affected kidney.

Ablative therapyAblation uses either heat or freezing to destroy cancer cells.  This is usually  performed using a needle inserted through the skin  (percutaneous).

This is for small tumours and is usually performed as a day surgery procedure or requires an overnight stay in hospital for observation post-procedure.

Percutaneous ablation may be performed under local anaesthesia or sedation; whereas laparoscopic ablation is performed under general anaesthesia, similar to a surgical procedure.

There may be a need for repeat ablation sessions if the tumour cannot be completely ablated in a session, or if the tumour recurs.

Active SurveillanceAs the name implies, this treatment plan requires regular imaging at defined time intervals in the form of either ultrasound, CT, or MRI scans to monitor the progression of the kidney tumour.

This is an option for small tumours in  frail, elderly, or patients with multiple medical conditions, where the risks associated with treatment are significant.

With increase in tumour size, there is the option of opting for treatment before progression to metastases.

The overall risk of disease progression to metastases is 2% for these small tumours with no treatment.

Advanced or metastatic disease:

If the disease has spread beyond the kidney,the treatment options include:

A) Nephrectomy

In some patients, nephrectomy may still be beneficial in controlling the disease. Suitability for surgery is highly variable from patient to patient. Your urologist will provide advice on the best course of treatment.

B) Systemic treatment

This involves taking medications that alter your immune system. Your medical oncologist will advise you on the treatment options.

You may download the PDF version from: Patient materials – Kidney Cancer.