Kidney Cancer

UC San Diego Health System has pioneered novel treatments for all stages of kidney cancer.

Kidney cancer includes renal cell carcinoma (cancer that forms in the cortex, or body, of the kidney) and renal pelvis carcinoma (cancer that forms in the cells lining the urine collecting system of the kidney). The most common form of kidney cancer in adults is renal cell carcinoma. There were 65,000 estimated new cases of kidney cancer in the United States in 2012. Kidney cancer is the deadliest urologic malignancy, with approximately 14,000 deaths per year. It is the 5th most common cancer in men, and 7th most common cancer in women. (Reference: Cancer Statistics, 2012)

Common risk factors include smoking, obesity and hypertension.

Ithaar Derweesh MD

UC San Diego Health System Kidney Cancer Expertise

Led by Ithaar Derweesh, MD, and Frederick Millard, MD, the team of internationally recognized physicians and surgeons at UC San Diego Health System treats all stages of kidney cancer. We provide leading-edge therapy in an interdisciplinary setting and have pioneered novel treatments for all stages of kidney cancer. We see patients from around the world.

Kidney Cancer Stages

Stage 1 – The tumor is confined to the kidney and is less than 7 cm.
Stage 2 – The tumor is confined to the kidney and is greater than 7 cm.
Stage 3 – The tumor is entering the main kidney vein (the vena cava) or breaking through the kidney capsule (the thin skin encasing the kidney).
Stage 4 – Kidney cancer has spread to other organs.
(Reference: National Cancer Institute, National Institutes of Health)

Surgery is the mainstay of treatment for stages 1 - 3. Surgery is combined with new targeted chemotherapy treatments for stage 4 kidney cancer in appropriate patients. (Reference: Campbell, et al.)

Partial Nephrectomy at UC San Diego Health System

(Removal of part of the kidney)

Our surgeons are changing the way physicians approach this disease by removing the diseased part of the kidney and sparing healthy kidney tissue. Removing only a part of the kidney – a partial nephrectomy – preserves kidney function and quality of life. A partial nephrectomy may be appropriate for patients with small kidney masses, as well as those with larger kidney masses for whom preservation of functioning kidney tissue is critical. (Reference: Guideline for the Management of the Clinical Stage 1 Renal Mass)

Partial nephrectomy is a more difficult surgical procedure, but may offer significant benefits compared to radical nephrectomy which is removal of the entire kidney. The risk of chronic kidney disease, bone fractures, osteoporosis, erectile dysfunction and cardiac events may be reduced when the healthy portion of the kidney is saved. (Reference: Huang, et al.; Malcolm, et al.; Kopp, et al., and Weight, et al.) The UC San Diego Health System urology team has one of the highest kidney preservation rates in the country. Over 70 percent of patients treated for kidney cancer at UC San Diego Health System receive a partial nephrectomy.

There are three ways to remove the diseased portion of the kidney. UC San Diego Health System is one of the most experienced medical centers in the world in performing these three types of procedures:

Robotic Partial Nephrectomy
Robot-assisted partial nephrectomy surgery is a special form of minimally invasive surgery that uses the da Vinci® Surgical System. (Read more about robotic surgery.) UC San Diego Health System is a leader in this innovative and minimally invasive treatment for kidney cancer. (Reference: Stroup, et al. and Viprakasit, et al.)

Kidney SurgeryOpen Partial Nephrectomy
Some partial nephrectomies, whether because of tumor size, location or prior patient surgical history, may need to be performed by open nephrectomy.

UC San Diego Health System surgeons are some of the most experienced in performing complex open partial nephrectomy for large kidney tumors, when preservation of kidney tissue is necessary. Open partial nephrectomy may be appropriate for retaining kidney function because of pre-existing kidney disease, bilateral kidney tumors or for patients who have only one functioning kidney.

UC San Diego Health System surgeons and physicians are developing new techniques to shrink large tumors with targeted chemotherapy to enable kidney preservation when necessary, even in advanced disease. (Reference: Silberstein, et al.) We are also developing new technologies to minimize damage to healthy kidney tissue during the procedure in order to maximize the benefit of kidney preservation. (Reference: Kopp, et al.)

Single-Incision Laparoscopic Partial Nephrectomy

A new form of minimally invasive surgery to treat kidney cancer is single-incision laparoscopic partial nephrectomy. In this procedure, the surgeon makes one incision in the belly button to remove the cancerous part of the kidney. UC San Diego Health System was the second center in the world to report performing this procedure. Known by the acronym LESS (laparo-endoscopic single-site surgery), the procedure has been shown to be less painful than traditional laparoscopic partial nephrectomy. (Reference: Bazzi, et al.)

 

Radical Nephrectomy at UC San Diego Health System

(Removal of the complete kidney)

In some cases, especially for larger tumors, removing the entire cancerous kidney, known as radical nephrectomy, is the preferred treatment option. UC San Diego Health System offers a variety of surgical approaches for total kidney removal.

Kidney ScanMinimally Invasive Radical Nephrectomy
Minimally invasive surgery for total kidney removal includes traditional laparoscopic radical nephrectomy, single-incision laparoscopic nephrectomy and robot-assisted radical nephrectomy:

  • Laparoscopic radical nephrectomy has become the mainstay of minimally invasive treatment for total kidney removal in appropriate patients. The procedure has well documented benefits for improved recovery and less pain medication requirements with equivalent cancer outcomes to open radical nephrectomy. (Reference: Bazzi, et al.)

  • Single-incision laparoscopic radical nephrectomy involves placing all of the surgical instruments to perform the procedure and a tiny video camera through one small incision in the naval. For appropriate patients, it provides outcomes similar to traditional laparoscopic radical nephrectomy, and may provide even further benefits in terms of healing, recovery and reduction in pain medication requirements.

    UC San Diego Health System was one of the first centers in the world to develop this procedure. We have also reported using this procedure for kidney tumors involving the vena cava and for advanced kidney cancer. (Reference: Kopp et. al.)

  • Robotic laparoscopic radical nephrectomy involves use of the da Vinci® Surgical System for removal of the entire kidney and may be appropriate in select patients. (Read more about robotic surgery.)

Open Radical Nephrectomy
In some cases, whether due to tumor size, location or the patient’s prior surgical history, open surgery may be necessary to remove the entire kidney. UC San Diego Health System surgeons are experienced in performing open radical nephrectomy for a variety of indications including high-risk patients, such as those with a tumor extending into the inferior vena cava or into the heart itself. In these cases, UC San Diego Health System relies on its interdisciplinary team of urologic surgeons, cardiac surgeons and transplant specialists. (Reference: Stroup and Derweesh)

NOTES
UC San Diego Health System’s minimally invasive surgeons are advancing scarless surgical techniques, including natural orifice transluminal endoscopic surgery (NOTES). Drs. Derweesh and Horgan have been pioneering scarless and single-incision laparoscopic surgery. NOTES involves removing damaged or diseased organs through natural openings in the body. Interested patients may be able to enroll in a clinical trial for this procedure.