Getting diagnosed with kidney cancer is scary, but you should remember that kidney cancer is one of the most treatable cancers in urology and is most treatable when caught early. Many patients diagnosed with kidney cancer make a complete recovery with minimally invasive surgery that usually needs no follow-up chemotherapy or radiation.
Getting the right diagnosis, staging and treatment is essential to the patient’s favor and having a specialist that knows kidney cancer is imperative. Not every urologist will be able to be a kidney cancer specialist. Dr. Vikas Singh is that specialist. He is a Senior Consultant Urologist and Genito-Uro Oncologist at Kokilaben Dhirubhai Ambani Hospital, Nipania, Indore, with more than 15 years of experience.
Whether you have just heard the news about a mass found on an ultrasound, or are dealing with a more advanced diagnosis, Dr. Vikas Singh will support you every step of the way and make the recommendations he genuinely believes will be most beneficial to you.
The kidneys are bean-shaped organs that are important for filtering the blood and producing urine. Each of them is made of millions of filtering units that are called nephrons. These units and the cells that line the collecting system of the kidney, are prone to having cancer.
Kidney cells mutate and cause DNA alterations. This makes kidney cells grow abnormally. Defectively grown kidney cells can cause tumors which can later spread throughout the whole body. Being diagnosed with kidney cancer is often a surprise. Other tests, like CT scans and ultrasounds, meant for other purposes, can reveal kidney cancer in someone before they show any symptoms. If detected in the early stages, kidney cancer can be treated. If it has not yet caused symptoms, the prognosis is more favorable and it is more amenable to treatment.
A cancer diagnosis is not as dismal as it may seem. Early stage (Stage I) kidney cancer is usually confined to the kidney and is of a size smaller than 7cm. In this case, the prognosis is great and the five year survival rate is over 92% with surgery. These patients have a long and meaningful prognosis, which is possible through the combination of the right specialist and the right diagnosis along with the right treatment.
While there are a number of varieties of kidney cancer, Renal Cell Carcinoma (RCC) accounts for 85-90% of them. RCC develops from the lining cells within the tiny tubes (tubules) of the nephron, which filter the blood.
Transitional Cell Carcinoma (TCC), or Urothelial Carcinoma of the Upper Urinary Tract, originates from the cells that line the renal pelvis and ureter. Unlike Renal Cell Carcinoma (RCC), TCC originates from the urothelium, a type of epithelium that also makes up the bladder, and thus cannot be said to arise from renal epithelium proper.
TCC of the renal pelvis behaves more like cancer that originates in the bladder as opposed to renal cancer. Like bladder cancer, TCC of the renal pelvis tends to be multifocal, with multiple primary tumors present in various parts of the urinary tract. Once TCC of the renal pelvis is diagnosed, there is a high likelihood of recurrence in the bladder. For muscle invasive forms of TCC of the renal pelvis, a multimodal surgical and chemotherapeutic plan is necessary. The surgical treatment is a nephroureterectomy, the complete removal of the kidney along with the ureter and a portion of the bladder. Dr. Vikas Singh specializes in laparoscopic surgeries.
Wilms tumor, also known as nephroblastoma, is the most common type of kidney cancer in children. Most patients are diagnosed before the age of 5 years. Wilms tumor is an embryonal cancer and occurs due to under-differentiated cells during the embryogenesis of the kidneys. Wilms tumor is known to respond well to treatment. With the help of modern multimodal therapy, which includes surgery, chemotherapy, and in some cases, radiation therapy, the cure rate is >90%.
Children who are suspected to have Wilms tumor can present with an abdominal mass, abdominal pain, hematuria, or hypertension. For the management of Wilms tumor, Dr. Vikas Singh works with the pediatric oncology team at Kokilaben Hospital. Dr Singh is involved in the surgical management and the multimodal therapy for all pediatric patients with Wilms tumor.
Renal sarcoma is an extremely rare kidney cancer believed to originate from the renal stroma as opposed to renal parenchyma. Among renal sarcoma, clear cell sarcoma is the most frequent subtype, and is noted to be the most aggressive and has propensity to metastasize to bone. Renal sarcomas typically require urgent clinical intervention and the first line in managing them is surgical resection, followed by adjuvant chemotherapy and possibly radiation. It is quite uncommon to encounter renal sarcomas, however, as a uro-oncologist, Dr. Vikas Singh has the capacity to manage these complex tumours in a multidisciplinary team.
Not all kidney growths mean cancer. Other than kidney cancer, some other benign kidney tumors exist with easily observed resemblance. These include:
The main factor influencing the prognosis of renal cancer and the conceivable treatment pathways available, is the cancer’s staging. Staging is the determination of whether the renal cancer is suspected to be contained to the kidney, has spread to surrounding tissue and structures, or has metastasized to other organs.
The kidney cancer and its spread, is classified using the TNM (Tumour-Node-Metastasis) System. The brief overview is as follows:
Stage | Tumour Description | Lymph Nodes / Organs | 5-Year Survival Rate (Approximate) |
Stage I | Tumour up to 7cm, confined entirely within the kidney capsule | No spread to nodes or organs | 92–95% |
Stage II | Tumour larger than 7cm, still confined to the kidney | No spread to nodes or organs | 79–85% |
Stage III | Any size; may extend into renal vein or inferior vena cava (IVC) | Spread to nearby regional lymph nodes | 53–65% |
Stage IV | Tumour has grown beyond Gerota’s fascia (outer kidney covering) | Distant metastasis – lungs, bones, liver, brain | 8–12% (improves with targeted therapy) |
Stage 1 – Tumour Confined to Kidney (Less Than 7cm)
Stage I kidney cancer is highly curable. The cancer remains in the kidney and is still within its covering, the renal capsule. Tumors that are under 4cm (classified as T1a) are treated with nephron-sparing surgery. This means that the surgeon removes the cancerous growth, but the rest of the kidney is preserved. For tumors between 4 and 7cm (T1b), a surgeon is still expected to prefer a partial nephrectomy to a radical nephrectomy, which is the complete removal of the kidney. Dr. Vikas Singh is able to perform both of these surgeries in a laparoscopic fashion so that patients undergo surgery with minimal, keyhole-sized, incisions rather than a large scar across their abdomen.
Stage 2 – Tumour Larger Than 7cm Still in Kidney
Stage II kidney tumors are above 7cm and still contained in the kidneys. Radical nephrectomy is the standard treatment. This is where the entire kidney and surrounding fatty tissue (Gerota’s fascia) are laparoscopically removed. In certain situations, a partial nephrectomy may also be performed. This may include when the patient has a solitary kidney, bilateral tumors, or chronic kidney disease.
Stage 3 – Cancer Spread to Nearby Lymph Nodes
Stage III kidney cancer is diagnosed for tumors that involve the renal vein and/or the inferior vena cava, and that have metastasized to surrounding lymph nodes. The primary treatment is still surgery, but for Stage III cancer it is already very complex. Tumor thrombus that extends to the IVC makes this surgery a multispecialty case that would require a combination of surgical urology and additional cardiac and/or vascular surgery. Following surgical treatment, targeted agents, sunitinib and/or pazopanib, are considered post-surgical therapies in this case for high-risk Stage III cancer.
Stage 4 – Cancer Spread to Other Organs (Metastatic)
Stage IV kidney cancer refers to cancer that has metastasized to distant organs. This can be in the lung, bones, liver, the adrenal glands, or the brain. In the past, Stage IV predicted poor prognosis for patients. However, now patients can benefit from targeted therapies (sunitinib, cabozantinib, axitinib) and from forms of immunotherapy (nivolumab, pembrolizumab, ipilimumab) that work in the combination immunotherapy regimens. These combination therapies can provide permanent remissions, and even complete remissions for patients that have advanced renal cell carcinoma.
Stage IV patients can also benefit from the removal of the cancerous kidney tumor. This is called a cytoreductive nephrectomy and can be offered to patients with a low burden of metastatic disease and/or in good health. The complexity of this situation is requiring a sophisticated and multidisciplinary approach to nephrectomy. Dr. Vikas Singh is present for these multidisciplinary tumor board reviews to treat patients on a case-by-case basis.
The most significant indicator of kidney cancer is called Haematuria in the medical field, which is essentially blood in the urine. Consequently, urine may appear to the naked eye as pink, red, or brown, or it may not be visually apparent at all, but may be present in large numbers in a microscopic urine sample. Importantly, the presence of blood in the urine due to kidney cancer is often not associated with pain. Therefore, it is painless. While it is a medical legal, urgent, and urological emergency that should be investigated as a matter of urgency, including the performance of a CT scan of the kidneys and the urinary bladder, painless haematuria in a person feeling otherwise well is usually painless.
It is estimated that at least five or even more of the patients diagnosed with Renal Cell Carcinomas will have had painless haematuria at some time during the course of the illness. Therefore, it is very possible to have painless haematuria associated with many of the Renal Cell Carcinomas and not have blood in the urine associated with the cancer. Never, ever, assume, it is a urinary tract infection.
Anyone who has an ache or discomfort in the flank (the area along the side of the body more or less between the lower ribcage and the hip) that is persistent and dull, is not musculoskeletal in nature, and has lasted weeks or months should undergo diagnostic imaging of the kidneys. Unlike an acute, colicky, nephritic-type pain from a kidney stone that is often related to movement and is more of a short-lived episodic pain, renal cancer pain is persistent and deep. and is also non-colicky. The pain is due to the kidney cancer and is associated with a growing tumor which distends the outer renal capsule, or occupies space and distorts adjacent structures in the area.
Significant weight loss with no dietary changes is often associated with fatigue and malaise and can act as a predictor of a detail disease like kidney cancer. Malignancies can change one’s metabolism leading fatigue and some unexplained weight loss from a change in diet. Kidney malignancies alter one’s metabolic functions and lead to various symptoms and weight loss. Malignancies ultimately lead to unexplained weight loss changes and fatigue and thus should be reasoned for a urinary system function changes and initiate a diagnostic to find the underlying cause.
An abdominal or flank mass that is solid, firm, and asymptomatic, and has recently increased in size warrants prompt imaging. Historically, before a routine use of ultrasound, many kidney cancers were first noted as palpable masses, which meant that many of these cancers were quite advanced. Currently, most kidney tumors are noted on imaging before they reach a size that can be palpated. However, a small group of patients, typically with large or aggressive tumors, or those who are non-compliant or who are not in touch with the healthcare system, may present with a palpable mass as the first finding.
There are many well-documented advantages to laparoscopic and robotic surgery for nephrectomies compared to open procedures. Dr. Vikas Singh is proficient in both radical nephrectomy and nephron-sparing partial nephrectomy for cancer treatment using these techniques.
Minimal Blood Loss & Smaller Incisions
In laparoscopic and robotic kidney surgery, the intraabdominal space is accessed through 3 to 4 small keyhole ports (usually 5mm to 12mm) instead of large flank or abdominal incisions. The intraoperative blood loss is substantially lower than in open surgery since laparoscopic and robotic tools help visualize blood vessels that can be isolated and controlled prior to being divided. This is particularly true in robotic and laparoscopic partial nephrectomy, where the blood supply of the kidney is controlled and the renal tumor is removed followed by a closure of the renal parenchyma. The renal robotic system is able to trim the blood loss caused by light warm issues due to time ischemic kidney uses flexibility in space and tremor filters.
Faster Recovery & Shorter Hospital Stay
Traditional open kidney surgery leaves a large muscle-cutting flank incision that is not present in laparascopic and robotic kidney cancer surgery. This significantly reduces the recovery time after the surgery. Patients are largely out of the hospital in a fraction of the time after laparascopic and robotic surgery: 2-3 days for laparascopic radical nephrectomy and 2-4 days for robotic partial nephrectomy. The same surgery is not only invasive, but makes the recovery time 5-10 days for an open surgery. Resuming daily activities as well as work comes far sooner: 2-3 weeks after robotic and laparascopic, and 4-8 weeks after open surgery. The faster recovery reduces the overall cancer treatment burden for the patient and their family.
Better Surgical Precision & Outcomes
Robotic surgery can do more for a partial nephrectomy than other methods. For the precision required of a surgeon, magnified, three-dimensional, instrumental, and wristed vision helps let Dr. Vikas Singh remove the kidney cancer tumor and spare healthy kidney tissue, using the least margin for a healthy tissue removal.
Suitable for High Risk & Elderly Patients
Many kidney cancer patients are older and have conditions like cardiovascular disease and diabetes that can complicate traditional open surgical procedures. Shorter anesthesia time, minimal blood loss, smaller incisions, and an overall less invasive experience make lap and robotic surgery much safer than traditional procedures when considering surgery for these patients. Dr. Vikas Singh has many successful experiences in performing minimally invasive surgery for patients in their 70s, 80s, and beyond.
The treatment of kidney cancer is an important intervention for a patient. At the very least, all patients undergoing treatment ought to be informed of the possible risks and side effects for each modality:
Yes, especially at an early stage. Surgical intervention at Stage I leads to a cure in over 92% of patients and the majority will not need further treatment. Many Stage II and Stage III cancers can also be surgically resected with the same outcome. Stage IV kidney cancer will be more challenging to control, but the prognosis can also be improved with modern immunotherapies and extended control of the cancer. The best outcome can also be delivered with the early detection of kidney cancer.
Radical nephrectomy is the surgical procedure for the total resection of the kidney with a margin of its surrounding fatty tissue (Gerota’s fascia) and, in some cases, the associated adrenal gland. Nephron- sparing surgery (~partial nephrectomy) involves the tumor’s total resection with a margin of the surrounding healthy tissue. Nephron- sparing surgery is considered the gold standard for renal tumors < 7cm; nephron sparing surgery is favored for the preservation of renal tissue and subsequent renal health for the patient as chronic kidney disease is a complication of nephron- sparing surgery. Dr. Vikas Singh has conducted many laparoscopic procedures and recommends partial nephrectomy for all appropriate patients.
For the majority of kidney cancers, especially clear cell RCC, regular chemo and the mainstay of chemo-radiotherapy are marginally effective for primary kidney tumours. The primary and potentially curative treatment for localized kidney cancer is surgery. For metastatic or advanced disease, tyrosine kinase inhibitors and immunotherapy (checkpoint inhibitors) are the standard systemic treatments. Radiation therapy may be used for selective cases, notably pain or progressive neurological problems due to metastatic cancer in the bones or metastatic cancer in the brain.
Yes, people all over the world live normal and healthy lives with one kidney. After one kidney is removed, the body’s other kidney will filter and increase its capacity over time. With the body adjusting, the eGFR will slightly decrease, but it will still be at a level that is good for a patient to live with. Some precautions that are advised to be taken are to always be hydrated, monitor blood pressure, monitor blood sugar for diabetics, and to avoid hard medications for kidneys. After a nephrectomy, patients should check their kidney functioning and blood pressure at least once a year.
There are major differences in both the speed of growth and spread of different types and grades of kidney cancer. Low-grade clear cell RCC tumors may grow less than 1mm in a year, while high-grade tumors grow much faster. Often, Stage I tumors discovered incidentally through medical imaging are slow, localized tumors. Most of these tumors take longer than the time it takes to schedule and perform the surgery to spread beyond the kidney, but it still is a poor reason to delay treatment once a diagnosis has been made. The growth and spread of these tumors can not be estimated and some tumors grow and spread more rapidly than expected.
Yes, for small kidney tumors (usually <2 to 3 cm), especially for older patients or some with medical comorbidities where surgery carries higher risk, active surveillance with 3 to 6 month imaging with CT or MRI scans, is an accepted management approach. This is because small kidney tumors rarely, if ever, give rise to metastasis or, on the whole, most small kidney tumors have a tendency to be slow growing. Treatment is warranted if the tumor begins growing aggressively, or surpasses a size threshold. Dr. Vikas Singh considers active surveillance to be an appropriate management option, and during the period, maintains, meticulous oversight within the context of the management approach.
Modern systemic therapies for advanced renal cell carcinoma consist of multiple targeted agents like sunitinib, pazopanib, cabozantinib, axitinib, everolimus, lenvatinib and multiple immunotherapy checkpoint inhibitors. Examples of combination immunotherapy approaches are, nivolumab plus ipilimumab or pembrolizumab as well as axitinib. They have improved outcome in the first-line treatment of metastatic clear cell RCC with long-lasting remissions in a substantial portion of patients. These therapies have improved availability in India with the Kokilaben Hospital oncology program. Dr. Vikas Singh partners with medical oncologists in planning and supervises systemic therapy for referred patients.
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