Overview
Renal cell carcinoma is the most common type of kidney cancer. It occurs when cancerous cells grow in the tubules, which are small tubes in the kidney that filter and clean blood. Renal cell carcinoma is a collection of different types of tumours, each with their own identifying factors, rather than one single entity.
Symptoms
In general, tumours in the kidney are discovered either during routine screening or when patients experience symptoms due to the size or location of the renal cell carcinoma. Early stage renal cell carcinomas are typically asymptomatic. Common symptoms in later stage renal cancer include blood in the urine, pain between the upper abdomen and back and anaemia. Less commonly, patients experience weight loss, high blood pressure, or recurring fever.
Diagnosis
A number of tests can help doctors diagnose renal cell cancer and assess the stage of the cancer. Imaging techniques include ultrasound, CT, MRI and PET.
In most cases, a biopsy is necessary to determine the type of cancer and its aggressiveness. The tissue samples are commonly obtained by way of image-guided interventional techniques.
Treatment
There are a number of possible treatment options, including the surgical removal of all or part of the affected kidney. Traditionally, this involved removing the whole kidney, but removing part of the kidney has recently been shown to be effective in some patients.
There are also interventional techniques which can be used to treat renal cell carcinoma, such as percutaneous (through the skin) thermal ablation. In this procedure, an interventional radiologist uses image guidance to insert a needle directly into the tumour and then destroys cancerous cells by delivering radiofrequency energy, microwave heat, extremely cold gas or a high-voltage direct current.
Some tumours are hypervascular, meaning that the amount of blood vessels in the tumour is higher than average. These tumours are especially hard to remove. For patients suffering from a hypervascular tumour, a procedure called transarterial chemoembolisation (TACE) may relieve pain and suffering. This procedure involves delivering a cancer-killing drug directly to a tumour whilst also depriving it of its blood supply, thus destroying the tumour.
When should renal cancer be treated by interventional radiology?
Interventional radiology treatment of renal cell carcinoma is beast suited for small tumours with a diameter of less than 4 cm. These tumours rarely metastasize and the treatment is curative. In small renal cell cancers the tumour specific survival after interventional radiology treatment requires surgery. Larger tumours may also benefit from interventional radiology procedures, e.g. embolization for haematuria (blood in the urine).