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Interventional Treatment of Cancer of the Kidney

Prevalence

Kidney cancer is the eighth most common cancer in men and the tenth most common cancer in women and it affects approximately 23,000 Americans each year. Renal Cell Carcinoma is the most common type of kidney cancer (accounting for 85% of kidney tumors), which forms in the lining of the renal tubules in the kidney that filter blood and produce urine. When Kidney Cancer spreads outside the organ, it may be found in lymph nodes, lungs, bones, liver, or the other kidney.

 

Risk Factors

- Over the age of 40

- Men are diagnosed with Kidney Cancer twice as often as women

- Smoking

- Obesity

- High blood pressure

- Long-term dialysis

- Von Hippel-Lindau Syndrome

 

Symptoms

Often, small tumors do not cause symptoms, but the increasing availability of modern imaging technology detects tumors more frequently. Some symptoms of Kidney Cancer include the following:

- Blood in the urine

- Side pain that does not go away

- Lump or mass in the side of the abdomen

- Unexplained weight loss

- Fever

- Feeling very tired

 

Diagnosis

Physicians use a variety of tests to aid in the diagnosis of cancer, including physical examination, blood tests, and imaging (CT, MRI, ultrasound, and x-ray), but final diagnosis cannot be determined until a biopsy is performed. A biopsy provides a sample of tissue for a pathologist to examine, which will help determine the type of cancer and its growth rate. A urologist and an Interventional Radiologist work together to determine the best treatment for the patient.

 

Needle Biopsy

This biopsy technique, also called an image-guided biopsy, utilizes imaging, such as fluoroscopy, CT, ultrasound, or MRI, to guide the procedure. This imaging allows the Interventional Radiologist to guide the needle to the tissue to obtain an accurate biopsy sample.

Needle biopsy is usually an outpatient procedure and patients return to normal activities after the procedure. This technique very rarely produces complications and has several advantages:

- Image-guidance allows the physician to see and avoid blood vessels and vital organs while obtaining the biopsy sample.

- Recovery time is short and patients usually return to normal activities immediately.

- Pain and scarring is greatly reduced and there is no need for stitches.

 

Treatment

Treatment for kidney cancer is meant to relieve the symptoms of the cancer, rather than reverse or cure the disease. These treatments can improve the quality of life for the patient.

 

Radiofrequency Ablation

Radiofrequency Ablation (RFA) is a preferred nonsurgical procedure because it is delivers targeted, localized treatment, which uses heat to kill the targeted tissue while leaving healthy tissue intact. This procedure does not have any systematic side effects and does not affect the overall health of the patient. It is also easier on the patient and more effective than systematic therapy. Most patients return to normal activities within a few days of the procedure.

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Figure 1 – Small cancerous tumor in left kidney (arrows)
Figure 2 – Ablation probe placed into tumor under CAT scan guidance (arrows)

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Radiofrequency Ablation is used to treat renal cell carcinoma (kidney tumors) and may be a viable option for patients who:

- Have one Kidney.

- Are not good candidates for surgery due to other medical conditions or older age.

- Have tumors of four centimeters in size or less.

- Have a family history of multiple kidney tumors.

To perform the procedure, the Interventional Radiologist guides a small needle into the tumor using medical imaging. Through the needle, radiofrequency energy is transmitted into the targeted tissue to kill the tumor by heating it, causing the dead tumor tissue to shrink.

 

How to Prepare for Radiofrequency Ablation

Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.

- Be sure to tell your doctor about all medications you are taking and any allergies you may have.

- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.

- If you will be given sedation, you may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.

- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.

- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.

- Shower or bathe the night before your procedure.

- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:

              - Eye Glasses

              - Dentures

              - Hearing Aid(s)

- You should plan to have a relative or friend drive you home following your procedure.

 

What to Expect During & After Radiofrequency Ablation

- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist will insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.

- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.

- The area where the electrodes are to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.

- A very small nick in the skin is made where the physician inserts a needle electrode and uses medical imaging to guide it to the tumor site.

- Radiofrequency energy is applied to the tumor. The electrode may need to be repositioned for large tumors.

- After the treatment, the needle electrode is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).

- Any discomfort, pain or nausea you experience will be controlled by medication.

- The entire procedure usually takes one to three hours to complete.

- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.

- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.

- Very few patients still have pain a week following treatment.

- Your physician’s staff will schedule a follow up CT, PET or MRI and a clinic appointment. The physician will review the imaging and discuss the results of the procedure with you at this appointment.

 

Benefits

- May be performed under conscious sedation or general anesthesia

- Only a small nick in the skin is made, which does not require sutures

- Can be repeated if necessary

- May be combined with other treatments

- It has no effect on blood pressure

- Can relieve pain for many cancer patients

- It is a very safe procedure with low complication rates

 

Arterial Embolization

Arterial Embolization is a procedure for patients with advanced renal cell carcinoma who have large tumors. Because these tumors may invade nearby structures, this treatment is very valuable to the patient.

For this procedure, an Interventional Radiologist guides a catheter, using medical imaging, through an artery in the groin to the renal artery that supplies blood to the tumor. The physician then injects tiny particles (about the size of a grain of sand) to block the flow of blood to the tumor, which causes the tumor to shrink from a lack of oxygen and other substances it needs to grow. Once the procedure is performed, the tumor may shrink substantially, which can improve quality of life or make the patient a candidate for surgical intervention.

 

How to Prepare for Arterial Embolization

Prior to your procedure, you will receive specific instructions for how to properly prepare for your procedure. The following information is a general guideline for what you might expect, but always follow the instructions given to you by your physician.

- Be sure to tell your doctor about all medications you are taking and any allergies you may have.

- You may be advised to stop taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) for a specified period of time prior to your treatment.

- If you will be given sedation, you may be asked to fast (not eating or drinking anything) for several hours prior to your procedure.

- Blood tests may be ordered to determine how well your liver and kidneys are functioning and to see how your blood clots.

- Female patients should always inform their physician if they are or if there is a possibility that they are pregnant.

- Shower or bathe the night before your procedure.

- Remove jewelry, nail polish/artificial nails and hairpins, but please wear the following items to the procedure if you use them:

              - Eye Glasses

              - Dentures

              - Hearing Aid(s)

- You should plan to have a relative or friend drive you home following your procedure.

 

What to Expect During & After Arterial Embolization

- You will be positioned on the examining table and be connected to monitors that track your heart rate, blood pressure and pulse during the procedure, and a nurse or technologist may insert an intravenous (IV) line into a vein in your hand to deliver sedation medication.

- The physician will discuss the procedure with you and answer questions you may have. You will also read and sign a consent form.

- The area where the catheter is to be inserted will be sterilized and draped with a surgical drape before the physician numbs the area with a local anesthetic.

- A very small nick in the skin is made where the physician inserts a catheter and uses medical imaging to guide it to the tumor site.

- When the catheter is properly placed, the physician injects the embolizing agent. Medical imaging is taken to ensure that the blood flood is blocked.

- After the treatment, the needle electrode is removed and pressure is applied to stop any bleeding. The small opening is covered with a dressing (no stitches are needed).

- Any discomfort, pain or nausea you experience will be controlled by medication.

- The entire procedure usually takes from 30 minutes to several hours to complete, depending on the complexity of the procedure.

- Following the procedure, you will spend about six hours in a recovery room to allow the puncture site to heal before you are allowed to move. You will not be allowed out of bed and will need to use a bedpan or urinal.

- In recovery, a nurse will regularly check your blood pressure, foot pulses, and the puncture site. You will be allowed to eat and drink unless you are going into surgery.

- Very few patients still have pain a week following treatment.

- Your physician’s staff will schedule a follow up CT, PET or MRI and a clinic appointment. The physician will review the imaging and discuss the results of the procedure with you at this appointment.

 

Benefits

- Only a small nick in the skin is made, which does not require sutures.

- It is a very safe procedure with low complication rates.