Diagnosing Kidney Cancer

These tests confirm the presence or absence of cancer. If cancer is detected the tests also show whether it has spread to other parts of the body. These include:

Ultrasound Scans

Computerised Tomography (CT) Scan

Magnetic Resonance Imaging (MRI) Scan

Cytoscopy

Biopsy

The different Stages of Cancer

The presence of cancer, once confirmed by medical tests is given a stage. The stage identifies the extent to which the cancer is spread in the body. TNM system is used to stage kidney cancer. It consists of three numbers:

T (tumour) - It describes the size of tumour. It has a scale from 1 to 4 depending on the size of the tumour.

N (node) - It describes if cancer cells are present in the lymph nodes. It has a scale from 0 to 2 depending on whether the cancer has spread to nearby lymph glands.

M (metastases) - marked as 0 or 1 depending on whether the cancer has spread to other parts of the body or nearby organs.

Coping with the diagnosis

At aastha Kidney Hospital we understand it can be a very difficult coping if you have been diagnosed with cancer. The news may be very difficult to digest. Once the initial shock of realising you have cancer has waned, a number of emotions might take over. It is common to experience sadness, confusion, denial, guilt, anger and stress. For some they may have severe anxiety, fear about the future and depression. During such times support of family and friends makes a huge difference. Talking to a psychiatrist or other people which are going through the same can help considerably. 

The experienced doctors and trained nursing staff at Aastha Kidney Hospital specialises in dealing with all aspects of cancer. The warmth and emotional support extended by them at the hospital along with proper medical care is a great encouragement available whenever you need.

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What are the different types of Kidney Cancers and their symptoms?

Renal or kidney cancer usually affects adults in their 60s or 70s with very rare cases of people having this cancer under the age group of 50. This cancer can be cured if it is timely diagnosed at the very early stages.  However, it is not possible to cure it if it has reached a stage where it has spread beyond the kidney.

Different types of Cancer

Renal Cell Cancer

This cancer starts to grow in the lining of the tubules which filter the blood to make urine. Tubules are the smallest tubes inside the nephrons. 

Renal Cancer is of different types:

Clear cell

Papillary

Chromophobe

Other rare types of renal cancer include carcinoma of collecting ducts and renal medullary carcinoma.

Transitional Cell Cancer (TCC) of Kidney or Ureter

The transitional cells that make up the lining of the renal pelvis, ureter, bladder and urethra have a special ability to change shape and stretch when urine flows in or out through the genitourinary tract. This cancer rarely begins in the kidney or the ureter.  It most commonly occurs in the bladder.

Wilms’ Tumour

This tumour affects children. During pregnancy the kidneys develop early on and sometimes cells that were supposed to transform into mature kidney cells fail to do so, staying altogether as very immature cells. In most cases these cells mature by the time child is 3 or 4 years old. But in certain rare cases these immature cells fail to turn into mature kidney cells. These causes these cells to go out of control leading to cancer known as Wilms’ Tumour. 

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Ever thought a Kidney Stone can be removed without making even a single cut in the body?

Retrograde Intrarenal Surgery (RIRS)

RIRS is the latest technology in removal and management of kidney stones that extends the frontiers of medical sciences beyond contemplation. Progressive innovations in techniques together with recent advancements in flexible ureteroscopes with the advent of digital technology, refinements of endo-urological devices and advancement in holmium laser technology have been very impressive. Where at one point an open surgery with a very long period of recovery was the only option, research introduced minimally invasive procedures with very fast recovery phase and finally today, we stand at a point where not a single cut in the body is made for treating kidney stones. RIRS becomes a reasonable alternative to percutaneous lithotomy even for stone larger than 2 cms.

Who can perform RIRS?

RIRS is performed by an urologist (endourologist) with specialized expertise in performing this procedure.

How is RIRS performed

Not a single cut in the body is made and the problem is solved!

A spinal or general anaesthesia is administered for ease. The surgeon then inserts a fibre optic endoscope to view the inside of a kidney, going from the urethra (urinary opening) into the bladder and from there into the ureter reaching finally inside the urine collecting part of the kidney.  Once the scope is in place, the surgeon then starts either fragmenting or evaporating the stone using 100-Watt Coherent holmium laser probe. The surgeon may also choose to remove the stones manually with small forceps even. When stone fragments appear to be less than 2 mm the procedure is considered terminated and no attempt is made to remove all debris physically however, the larger stone pieces are removed using a litho catch basket. The advantage of Holmium Laser is its ability to fragment stones of all compositions with precision. A stent is then placed if needed, which is removed after a week by flexible cystoscopy. A catheter is left in place for a day after the procedure. Patients are generally admitted on the same day of the treatment and are discharged next day, which means only 24 hours of hospitalization is required.

RIRS Indications:

•    Ureteric or kidney stones
•    Tumours of ureter and kidney
•    Stricture of urinary tract

Advantages of RIRS

•       Can be done in patients of bleeding diathesis and gross obesity
•       Can be done in any age group
•       Less chances of bleeding
•       Less invasive (Low-risk procedure)
•       Stricture and stone can be tackled at same time
•       Stich less and incision less surgery
•       Lesser pain - faster recovery - Minimum hospitalization
•       Stone clearance rates are very high
•       Both ureteric and renal stones can be tackled at same time
•       Small kidney tumors can also be tackled 

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Laparoscopic Pyeloplasty

UPJ obstruction meaning Ureteropelvic junction (UPJ) obstruction is a blockage at the point where part of the kidney attaches to one of the tubes that carry urine from the kidney to the bladder (also called ureters scientifically). This blocks the flow of urine out of the kidney.

 Causes of Ureteropelvic junction (UPJ) Obstruction

1. Congenital Condition                                                                                                                     This may be present when the baby is growing in the womb, therefore a baby may have it when its born as congenital condition. A narrowing may be seen in the renal pelvis (part of the kidney) and the ureter (the tube that carries urine from kidney to the bladder). These days however, in majority of cases this can be detected through ultrasound tests during pregnancy.
2. Abnormal blood vessel over the ureter
3. Older children and adults may have scar tissue, infection or prior treatments for a blockage or stone in the kidney.

Prognosis

An obstruction in the ureter detected early on goes a long way in preventing further damage to the kidney. However, a UPJ obstruction diagnosed before or immediately after birth might actually improve on its own.

The obstruction may lead to serious consequences and damage to kidney if diagnosed later in life. However, present treatments offer long term solutions. Laparoscopic Pyeloplasty having the best long term success.

Likely Complications

1.    Deterioration or permanent loss of kidney function (kidney failure).

2.    Kidney stones or infection may occur in the affected kidney, even after treatment.

The Treatment - Laparoscopic Pyeloplasty

This is a reconstructive surgery to correct the narrowing, blockage or scarring of the ureter at a point where it leaves the kidney. The procedure takes 3-4 hours to perform and is carried out under general anaesthesia. Following the surgery, a stent is put in place for healing and to support and protect the pyeloplasty repair.  This is removed 4-6 weeks following the surgery by the doctor. You should expect to be in the hospital for around three days depending on your recovery rate. At Aastha Kidney Hospital we have specially skilled surgeons who have performed over 50, 000 surgeries. The Hospital devotes itself to committed healthcare with rapid, accurate diagnosis and immediate, effective treatment for a wide range of urological and genital problems for both males and females.

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Laparoscopic Nephrectomy

This surgery is done to remove the diseased or cancerous kidney. As opposed to traditional open surgery involving a 15 cm incision, this is a minimally invasive procedure carried out with very tiny 1 cm cuts plus a 4-6 cm cut to remove the diseased kidney.

Why is a Nephrectomy required?

There may be several reasons why a kidney may have to be removed. A kidney may be partly working and being left in place could be a basis for infection or pain, at times the kidney may have incurred damage or there may be a cancer present the usual treatment for which is to remove the kidney. Where there is a kidney cancer present at times it becomes necessary to remove the adrenal gland as well that lies above the kidney. Also in certain cases of kidney cancer (transitional kidney cancer, TCC) there is a high risk of reoccurrence of cancer in the ureter. This might involve another surgery to remove the ureter. The doctor will discuss the reasons with you if a kidney has to be removed.
With your other kidney functioning normally you can easily manage a healthy lifestyle without major changes.

The risks and side effects

Every operative procedure carries some risk associate with it however, these are small in comparison to not carrying out the operation. Although these complications are well recognised, the majority of patients do not have problems after a procedure.

Occasional risks

An infection may occur where the incision was made requiring further treatment. If the wounds are red or inflamed you would need to see the doctor.

Rare risks

The surgery may cause bleeding that requires blood transfusion or the surgeon may have to carry out an open surgery if visibility using keyhole technique is difficult. This occurs in five per cent cases.
During the procedure the lung cavity may be entered, but this can be repaired without any further incision.

Very rare risks

Injury to the adjacent organs may be caused causing the surgeon to move to open surgery.
Issues with anaesthetic or heart and blood vessels complications may occur requiring admission to ICU. Such complications may cause a chest infection, stroke, blood clots or a heart attack.
How long does the operation take?
Every case is different however, on an average the procedure takes about 2-3 hours.

Before the operation

A pre operative assessment is carried out to sort out any health issues that might delay the surgery.  The surgeon will review your medical history as well as any outside reports, records, and outside X-ray films (e.g. CT scan, MRI, sonogram). Also you are advised to bring along any medication you take on daily or ad-hoc basis.

After the operation

You will be in the recovery room where the nursing staff there will look after you until you are ready to return to your ward. You will be on an intravenous drip until you are in a position to drink fluids normally. Although you can have some oral fluids fairly soon after the operation, you will be able to drink normally and eat something light by the next day. While you are returned back to your ward you will have a drainage tube (catheter) put in place to drain urine from the bladder. This allows the nursing staff to have an assessment of the quantity of urine excreted within first 24 hours of the surgery. This is usually removed with two days post surgery. However, in case the ureter is also removed the catheter is left in place for a longer duration to allow for healing to take place. Post surgery it is quiet normal to experience shoulder tip pain or wind like pain in the abdomen. This is because during the surgery the surgeon uses gas to inflate the abdominal cavity so he can better see the kidney. This is easily treated with simple painkillers. The wounds have dissolvable stitches and are dressed regularly changing dressing only if they are heavily soiled and become looses. Most patients are also given injections post operatively on a daily basis to prevent blood clots. In cases where a person may be more prone to a higher risk of clots injections are continued for up to 4 weeks.

Getting out of bed

You will be encouraged to get up and about as soon as possible, usually the day of surgery. This is to prevent complications such as a chest infection, pressure sores or a deep vein thrombosis (clot in the leg veins).
By day two you should be out of bed for most part and also be able to walk short distances. Once the catheter is  removed and you are able to pass urine satisfactorily you shall be discharged.

At Home

You are advised to do light walking while refraining from lifting anything heavy or driving for at least 2-4 weeks after the operation. A healthy diet containing ample fruits and vegetables is good to keep your bowels regular. You can return to your office when you feel fit. In most cases one can return back to full physical activity with 3-4 weeks after the surgery. However, in case of an open surgery it may take up to 8-10 weeks. 

The benefits of this minimally invasive procedure

This minimally invasive approach has the advantage of improved cosmetic look, reduced pain, blood loss, shorter hospital stay and fewer post operative complications as compared to conventional open surgery with similar cure rates.

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Laparoscopic Cholecystectomy

Gall Bladder is  located in the upper right half the stomach, is a small pouch that fills up with bile (used to break down fat) produced by the liver. Before meals it is filled with bile almost the size of the pear and after meals it lays empty and flat. Gall bladder if removed in a health individual causes no significant problem, however there may be a small risk of  fat mal-absorption or diarrhea.
Cholecystectomy is the name of a fairly common procedure used to remove gall bladder stones.

Why remove the Gall Bladder? 

Sometimes substances (cholesterol and bile salts) that make up bile in the gall bladder can crystallize due to an imbalance and form stones which can be very painful. A person may not realize they have stones because the stones don't really cause any symptoms, however, very less frequently they may block the flow of bile causing irritation in the gall bladder (acute cholecystitis) or pancreas (acute pancreatitis). These conditions can make a person feel

    Sudden and intense pain in the stomach
    Feeling sick or nausea
    The skin and also the white area in the eye may become yellow 
    Abdomen may feel bloated
    Occasionally fever

 

Laparoscopic Cholecystectomy is a procedure performed under general anesthesia. Small cuts are made in the abdomen to access the stones and remove them. This is fairly comfortable and common procedure where a person recovers very quickly resuming a normal life within two weeks. Usually a person can leave the hospital the very same day or the next day The scars are also very small in comparison to an open surgery.

The liver still produces enough bile the same way to digest the fat, however, it doesn't get stored in the gall bladder but leaks into the stomach directly and continuously.

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Dialysis : What is it?

The procedure is used when the kidneys stop working therefore instead of sending blood to kidneys, dialysis diverts  blood to a machine that works just like the kidney and cleanses the blood by removing waste products and excess fluids from the blood.

When is there a need for dialysis?

If the kidneys are not working properly, because there may be advanced chronic kidney disease or kidney failure or they kidneys may not be able to clean the blood properly. With the kidney's not working properly this may lead to high levels of toxins in the blood. If not addressed in time this may lead to dangerous levels of unwanted substances in the blood and also be fatal. Dialysis filters these unwanted substances, before kidney failure or malfunction lead to serious consequences .

How long does a person need to be on dialysis?

This depends on the medical condition of the person. Where a kidney failure is temporary, timely dialysis can help a person recover without causing irreparable  damage to the kidney. However, in most cases a person with kidney failure would require a kidney transplant, although that may not be possible right away. So until a suitable donor kidney becomes available dialysis will be needed. Nevertheless, in situations where a major surgery is not possible because a person's current state of health may not permit a major operation like a kidney transplant, dialysis would be indispensable for the rest of their life.

What happens during Dialysis?

Haemodialysis

This is the most common type of dialysis that usually most people are aware of. The procedure takes about four hours and is carried out three times a week. A needle is inserted in the arm and thereafter the blood flows through it into a machine which purifies it and the pure blood is then sent back into the body through another tube injected in the arm. 

Peritoneal dialysis

Peritoneal dialysis filter blood by using the inner lining of the abdomen (the peritoneum) as a filter, rather than a machine. The peritoneum is similar in structure to a kidney containing thousands of tiny blood vessels making it a useful substitute to filtering blood.
At the beginning of the treatment a catheter is permanently inserted into the abdomen by making a small incision near the belly button. This is left there in place permanently.

Fluid is pumped into the peritoneal cavity through the catheter which sucks out the impurities and excess fluids from the blood while it is passing through the tiny blood vessels in the lining of the peritoneum.  The used fluid is drained and replaced with fresh fluid every few hours usually takes about 30-40 minutes, repeated around four times a day. 

How to choose which type of dialysis is suitable for me?

While on dialysis you can lead a normal life if you are fit otherwise.Whether it is swimming, driving, working or going on a holiday. Being on haemodialysis gives a person four treatment free days a week, but the sessions lasts longer and a person may have to go to the hospital each time. The procedure can cause itchy skin and muscular cramps. It is suitable in cases where a person is in a poor state of health or unable to perform peritoneal dialysis on his own due to some reason such as being visually impaired or having dementia. Peritoneal dialysis can be done at home even while you sleep and doesn't need frequent hospital visits,  however it needs to be done daily. It's usually suitable in children under 2 years of age, adults without serious heart conditions or cancer and people with limited kidney function. The procedure can put a person at the risk of developing an infection in the thin membrane that surrounds the abdomen.

Being on dialysis doesn't fully compensate for loss of kidney function because not having fully functional kidneys places a significant strain on the body.   

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