There are several approaches to treating tumors in the kidneys, and the team at Levine Cancer Institute approaches each patient as an individual, working to determine the best treatment for the best outcome.
Expectant management is considered a "watchful waiting" approach and is appropriate when tumors are too small to be characterized and need to be watched via X-ray over time to see if treatment becomes necessary. Observation is also an appropriate option for elderly patients with small (less than 3 cm), tumors with slow growth rates, as renal cell carcinoma seldom spreads before reaching the size of 4 cm.
The team at Levine Cancer Institute determines which patients should be managed immediately and coordinates appropriate follow-up imaging. If it becomes necessary, patients will be treated later with one of the methods described below.
This treatment uses cold (-40 degrees C) to remove tumors of 4 cm or smaller. Depending on the tumor location, cryotherapy can be done laparoscopically (through a very small opening in the body) or percutaneously (through needle puncture of the skin).
Cryotherapy can completely destroy small tumors without the risks of a major operation.
Patients are admitted the day of the procedure and usually go home the next day, reporting minimal post-procedure pain. Percutaneous core biopsies are obtained at the time of removal to help provide a bigger picture of the diagnosis.
Laparoscopic Partial Nephrectomy
Nephrectomy is the surgical removal of the kidney; a partial nephrectomy is surgery in which only part of the kidney is removed. This minimally invasive surgery results in less pain than open partial nephrectomy, requires a smaller incision and allows for quicker recovery. The resection is guided by intra-operative ultrasound for a more complete removal of the tumor. Patients are typically discharged three to four days after the operation and are able to return to work within three weeks.
Laparoscopic Radical Nephrectomy
This minimally invasive surgical technique for complete kidney removal causes less pain than open complete nephrectomy and allows for quicker recovery. This approach is most appropriate in younger patients with an unusual, small, centrally located tumor that does not lend itself to partial nephrectomy. Patients are typically discharged three to four days after the operation.
Open Partial Nephrectomy
The traditional approach to removing small kidney tumors is still appropriate for certain technically difficult small tumor presentations in younger patients. However, recovery from a flank incision can be painful and requires four to five days of hospitalization and up to two months away from work.
Open Radical Nephrectomy
Open radical nephrectomy is no longer appropriate for any patient with a small renal tumor. This operation is now done only rarely for the patient with a renal tumor associated with significant growth into other areas of the body.