Epidemiology and Incidence
Kidney cancer accounts for 2-3% of all malignancies, with a higher incidence in westernized countries. It is more common in men and it has a peak incidence between 60 and 70 years of age.
The main risk factors for kidney cancer are: smoking, obesity, antihypertensive therapy and family history of kidney cancer.
Symptoms, Diagnosis and Staging of Kidney Cancer: CT / Magnetic Resonance and Bone Scintigraphy
The use of increasingly refined diagnostic techniques has led to a more frequent and early diagnosis of renal cancers (smaller tumors). The classic triad of symptoms: flank pain, macrohematuria (blood in the urine) and palpable abdominal mass, is encountered rarely in today’s clinical practice. Most of the kidney masses are asymptomatic and not palpable except in case of advanced disease; this means that more than 50% of them are discovered incidentally during exames ordered for other reasons. Paraneoplastic syndromes can be found in 30% of patients with symptomatic disease. The most common ones are: cachexia, hypertension, weight loss, pyrexia, neuromyopathy, amyloidosis, polycythemia, anemia, impaired liver function, hypercalcemia. Finally, a small part of patients shows symptoms related to metastases (bone pain or persistent cough).
The traditional approach in diagnosing kidney cancer is based on ultrasound, CT or magnetic resonance imaging. Ultrasound is often used as the first evaluation. It is useful for distinguishing cystic lesions from solid ones or for monitoring the growth and structure of a cyst. However, its diagnostic accuracy is low for tumors smaller than 3 cm in diameter (67-79%).
CT and magnetic resonance imaging (which must be performed with and without infusion of contrast medium) provide information on the shape and functioning of the kidneys, the tumor, its location, the involvement of the renal vessels, the involvement of lymph nodes and the state of the adjacent organs.
Bone scan is a diagnostic investigation that provides information about any bone involvement (skeletal metastasis) and is indicated in patients with bone pain or in certain cases for disease staging.
Treatment: Partial Nephrectomy and Robotics Radical Nephrectomy in Centers of Excellence
The treatment of choice for localized kidney cancer is represented by surgery, which guarantees the best oncological results. This can be aimed at removing only the sick part of the kidney whenever technically feasible. In centers of excellence, robotic surgery now represents the approach of choice. Robotic surgery provides a visual magnification of up to about 10 times and with three-dimensional vision. This provides the surgeon with a greater knowledge of the depth of field, which is not possible for example with the classic laparoscopic technique. The robotic intraoperative vision allows one to distinguish the smallest anatomical details and to reach a level of precision which is superior to what can be obtained with classical open surgery. Other advantages of robotic surgery are the reduced hospital stay and recovery times relative to open surgery.
Patients with advanced kidney cancer or metastatic disease can benefit from surgical treatment when associated with a multidisciplinary approach: the removal of the main tumor (debulking) along with novel anti-angiogenetic treatments and/or immunotherapy.