Making the Decision to Have Surgery for Kidney Cancer

You have to be healthy enough to have surgery for it to be a good choice for you. Your doctor may suggest surgery to treat your kidney cancer if any of these cases apply to you. Keep in mind that you may need other types of treatment before or after surgery, such as radiation therapy:

• The tumor is small. In this case, your doctor may suggest a partial nephrectomy. For this surgery, only the cancerous part of your kidney is taken out. Your doctor may also suggest this procedure if the tumor is larger, but you have cancer in both kidneys or if you have only one kidney, as it may allow you to keep some kidney function. It is becoming more common in people who have a tumor smaller than 4 cm or about 1-3/4 inch in one kidney only. The benefit is that you keep at least part of the kidney. The drawback is that there is a chance some cancerous cells will be left behind.

• The tumor is larger, but is only in your kidney. Surgery is the standard treatment in this case. Your doctor will recommend the type of surgery you need based on the size and location of the tumor. Your doctor may suggest a simple nephrectomy. For this surgery, only your kidney is taken out. Or your doctor may suggest a radical nephrectomy. This is the most common type of surgery for kidney cancer. For this surgery, the surgeon takes out your whole kidney, along with the adrenal gland (which is attached to the top of the kidney) and much of the surrounding fatty tissue. The surgeon is also likely to remove nearby lymph nodes. In some cases, your doctor may recommend arterial embolization. This is sometimes done the night before a nephrectomy to reduce blood loss during the surgery. Sometimes it's done without surgery to control symptoms. In cancers that appear to be contained within the kidney, your surgeon may offer laparoscopic-assisted surgery. The recovery after this surgery is usually quicker and with less associated pain than nonlaparoscopic-assisted surgery.

• You have kidney cancer that has spread to only one other area. Your doctor may suggest a radical nephrectomy and removal of nearby lymph nodes, as well as removal of the metastatic tumor.

• You have symptoms, such as pain, pressure, or bleeding from tumors that have spread extensively. Your doctor may suggest that you have surgery to remove the tumors. This is done to ease symptoms. Because it doesn't cure the cancer, it is called palliative therapy. If you can't have surgery, your doctor may recommend arterial embolization as palliative treatment. This procedure cuts off blood supply to the tumor.

If you are too ill to have regular surgery, your doctor may use other techniques to destroy tumors that are confined to the kidney. Here are two other options when surgery isn't possible:

• Cryoablation, which is the use of extreme cold to freeze and destroy cancer cells

• Radiofrequency ablation, which is the use of electrodes to heat and destroy cancer cells

Your medical team will review the surgical options appropriate to your condition. To help deal with the surgical information and remember all your questions, it is helpful to bring a family member or close friend with you to doctors' appointments. In addition, a written list will make it easier for you to remember your questions.