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Fact sheet Localised Cancer

Introduction

Our series of fact For more information relating These fact sheets are meant as an sheets have been developed to help to other aspects of kidney cancer introduction only and are not meant you understand more about kidney please see our other fact sheets: to be a substitute for your doctor’s cancer. This fact sheet provides • Kidney Cancer or healthcare professional’s advice. information about localised kidney • Diagnosis and Types Always consult your doctor or cancer. Localised kidney cancer is of Kidney Cancer healthcare professional for cancer that has not spread from the • Support for Kidney Cancer more advice. kidney to the other parts of the body. • Advanced Kidney Cancer • Advanced Kidney Cancer – Dealing with the side effects of medication: targeted therapy • Kidney Cancer – Make the most of your visit to the doctor

How is localised kidney Active surveillance cancer treated? Strange as it may seem, in some of kidney function associated with Once you have been diagnosed with people with small kidney tumours having a kidney surgically removed. localised kidney cancer your doctors (less than 3cm), the first best This is particularly important if you will discuss with you your treatment treatment is observation, or active are older or have other significant options and the expected results. The surveillance. Active surveillance medical problems. most common treatment for localised involves closely monitoring the kidney kidney cancer is surgical removal. tumour with regular scans and visits Active surveillance is a good However, other options are available. to the doctor. No treatment is given option for small tumours. Your treatment options will depend unless the tumour gets larger. on your general health and the stage People who choose active surveillance of kidney cancer. All treatments have Surveillance is a common option with their doctors must continue to benefits and side effects, which need for small tumours. This is because have regular follow-up care, in case to be discussed with your doctor sometimes a small tumour may be the cancer starts to grow. before you make any decisions. benign (not cancer). Also, if it is cancer, small cancers grow slowly The most common treatment and are unlikely to spread elsewhere. for localised kidney cancer Surveillance may help avoid an is surgical removal. operation or the side effects of other treatments. It also avoids the loss

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Surgery

With a larger cancer or a growing If one kidney, or part of a kidney, Most people are able to live cancer in the kidney, surgery is is removed, the remaining kidney quite normally with just one usually the first choice of treatment. gets bigger and heavier. It works functioning kidney. Surgery to remove a kidney is called harder and usually provides up a and it is done by a to 75% of normal kidney function specialist surgeon called a urologist. rather than the expected 50%.

Surgery may either remove a part of the kidney, a partial nephrectomy, or the whole kidney, in which case it is called a radical nephrectomy.

Partial nephrectomy A partial nephrectomy is recommended if the cancer is small Remaining (usually less than 4cm) and in a healthy tissue position in the kidney that is easy to Tumour Tumour get to by the surgeon. The aim is to removed remove the part of the kidney that has been affected by the tumour, and leave as much of the healthy kidney as possible. The remaining part of the kidney can continue to do its work.

Radical nephrectomy If the cancer is larger or has started to spread to the local lymph nodes then the whole kidney is usually Ureter and removed. A small part of the ureter Tumour blood vessels cut to remove and the surrounding fatty tissue is kidney and normally removed as well. This is tumour known as a radical nephrectomy. The adrenal gland and near-by lymph nodes may also be removed.

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How will the surgery be done? camera (laparoscope) are put through can be magnified up to 10 times. The Both partial and radical these cuts to do the surgery. The improved view and more advanced can be performed camera gives a high-quality image of tools gives the surgeon more as open or laparoscopic surgery. the operating area on a video monitor. precision and control.

Open surgery Robotic assisted nephrectomy People who have laparoscopic A large cut (incision) is made in the Another way of doing laparoscopic surgery generally have less pain after abdominal wall so the surgeon can surgery is using a surgical robot the operation, a quicker recovery and access the kidney and tumour directly. system. Robotic assisted laparoscopic therefore a shorter stay in hospital. surgery is similar to traditional However, laparoscopic surgery is Laparoscopic surgery laparoscopic surgery except that the specialised and only available in some Laparoscopic surgery is also known as surgical instruments are attached hospitals. Not all kidney cancers are keyhole surgery or minimally invasive to robotic arms which the surgeon suitable for laparoscopic surgery. surgery. Small cuts (incisions) are controls from a work station. This Your surgeon can advise if this is made in the abdominal wall. Long method of surgery gives the surgeon an option suitable for you. thin surgical instruments and a small a 3D view of the operating area that

What should I do What should I expect before the surgery? after the surgery?

You should discuss with your doctor How long you stay in hospital will kidney is functioning properly. A nurse exactly what you need to do before depend on what type of surgery you will normally remove your catheter the your surgery. In general you will be had (open or laparoscopic) and any day after surgery and you will be able told not to drink, eat or smoke 6 hours other medical conditions you have. to pass urine normally again. Removal before the operation. If you are taking On average it will be around 3–7 days. of the catheter is painless. any medication you should tell your doctor. You may need to stop taking You will have an intravenous (IV) drip You might experience some pain it for a few days before the operation. that is used to give you fluids and where you had the operation for medications. You may also have other up to 6 weeks. If you are in pain tubes coming out of your abdomen ask your doctor for some medication to drain any waste fluids. to help control it.

For a few days after the surgery you After having surgery you should will also have a urinary catheter. A expect to feel fatigued. You will urinary catheter is a small tube that feel more tired than normal, have drains urine from your bladder out no energy and find it difficult to through your urethra and into a bag. concentrate. The fatigue can last It is there to make sure your other from 6 weeks to a year after surgery.

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What should I do when I get home from hospital?

Most people make a rapid recovery Things you can do to help You need to go back to see your after their surgery but every person manage fatigue: doctor straight away if you: will recover differently. Follow the post- • Get plenty of rest • Develop a fever operative recovery instructions you • Ask family or friends to help out • Have severe blood loss were given when you left the hospital. with every day activities such as cooking and cleaning especially In general for the first 4–6 weeks in the first few weeks after surgery after your operation you should: • Take short naps during the day • Drink plenty of water – • Get outside for some gentle 1–2 litres a day exercise. • Do not lift anything heavy and avoid strenuous exercise If you are working, it is recommended • Shower as normal that you make arrangements for an • Discuss any medications appropriate amount of time off work with your doctor to recover. This is usually a minimum of • Driving is usually allowed a week 6 weeks before returning to light duties. or two after surgery (depending on the type of surgery you had).

What happens next? Follow-up care

Follow-up care is the care you It is important to talk with your You will then see your doctor about receive after finishing your treatment. doctor about the possibility of the every six months during the first few Follow-up care looks for whether cancer returning at this appointment. years after surgery, and then once a the cancer has returned (recurrence) Understanding your risk of recurrence year after that. At some point you may and the development of other and the treatment options may help choose to be followed up by your GP. health problems. you feel more prepared if the cancer does return. Like most cancers, At each appointment your doctor will When you leave the hospital after the chance of kidney cancer check to make sure that the cancer surgery you will be given an outpatient returning is highest soon after has not recurred or metastasised, appointment to see your doctor. This treatment; the longer away from and monitor your overall health. You will be a few weeks after you have the treatment the more chance may have a physical examination and returned home from hospital. At this the cancer has been cured. tests such as blood tests or scans. first appointment, your doctor will Because you will have had one kidney tell you the results of the surgery and or part of a kidney removed, you will discuss with you the plan for the rest need to have your kidney function and of your care. Your doctor may also blood pressure monitored for the rest organise some further tests. of your life.

What happens if the cancer returns?

If the cancer does return after You will need to have more tests For more information about treatment the original treatment it may come to get as much information about options available for recurrence back in the same place (called a the recurrence as possible. After see our fact sheet Advanced local recurrence), nearby (regional testing is done, you and your doctor Kidney Cancer. recurrence), or in another place will talk about your treatment options. (distant recurrence).

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Are there any treatment options apart from surgery?

Although surgery is the treatment Stereotactic body Radiofrequency ablation (RFA) of choice for localised kidney cancer, radiotherapy (SBRT) and microwave ablation there are other treatment options Radiotherapy uses high energy X-rays Ablation is a word used to describe available. These might be useful if you: to kill cancer cells. Stereotactic body the destruction of body tissue. • Are older and might have radiotherapy (SBRT) is a specialised Radiofrequency ablation and difficulty with surgery or form of radiotherapy that uses precise microwave ablation use energy waves postsurgical recovery high dose radiation. to essentially cook and destroy the • Have medical conditions cancer. Ablation is generally done which might prevent surgery SBRT is non-invasive (no cuts or via a needle inserted into the kidney • Have one kidney injections are needed). Because it is through the skin (percutaneous). It can also be done using open or • Have tumours in both kidneys, precise, and only targets the kidney laparoscopic surgery. Only tumours or a family history of multiple cancer, there is limited damage to less than 4cm in size can be treated kidney tumours the surrounding healthy tissues. Side effects can occur, the most by ablation. Side effects include pain • Have a cancer that has come and fever, which can be treated with back (recurred) after surgery common of which is fatigue. SBRT is a specialised procedure and not medications. • Do not want to have surgery. available at all hospitals.

Ablation Stereotactic body radiotherapy • Generally done as an • Generally done as an outpatient procedure outpatient procedure • An intravenous (IV) drip is • You will need between 1-5 inserted in a vein treatments • Local anaesthetic is given • An intravenous (IV) drip is and you may be given some inserted in a vein medicine to make you feel a little sleepy • A CT, MRI or PET scanner is used to locate the exact • A needle is inserted into the position of your kidney tumour using a CT scanner to locate the exact • You will need to stay very still position of the tumour. The so a specialised ‘blanket’ is radiofrequency or microwaves put over you to reduce your are passed down the needle movement. into the tumour.

Cryotherapy Cryotherapy uses cold energy to destroy cancer cells. Cryotherapy is not widely available in Australia.

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Who can I contact for more support & information?

Both Kidney Health Australia and Kidney Health Australia Cancer Cancer Council offers reliable the Cancer Council offer a free and Support & Information Service cancer information and support to confidential service for further Kidney Health Australia provides anyone affected by cancer, including support and information. support and information for kidney patients, carers, families, friends, and cancer patients, their families and healthcare professionals. They can carers in a variety of different ways. connect you with others who have been through a similar experience Free call: 1800 454 363 and link you to practical, emotional [email protected] and financial support in your area. kidneycancer.org.au forum.kidney.org.au Free call: 13 11 20 cancer.org.au

This is intended as a general For more information introduction to this topic and is not about kidney or urinary meant to substitute for your doctor’s If you have a hearing or healthcare professional’s advice. or speech impairment, All care is taken to ensure that health, please contact the information is relevant to contact the National the reader and applicable to each Relay Service on our free call Kidney Health state in Australia. It should be noted that Kidney Health Australia 1800 555 677 or Information Service recognises that each person’s relayservice.com.au experience is individual and that (KHIS) on 1800 454 363. variations do occur in treatment For all types of services and management due to personal ask for 1800 454 363 Or visit our website circumstances, the healthcare professional and the state one kidney.org.au to access lives in. Should you require further information always consult your free health literature. doctor or healthcare professional.

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What does that word mean?

Abdomen – The part of the body Incision – A surgical cut. Radical nephrectomy – The surgical between the chest and the hips. removal of the whole of the kidney. It contains the bladder, bowel, liver, Laparoscope – A small tube with If the cancer has spread to the adrenal kidneys, gall bladder, pancreas, spleen a video camera which is used to gland, surrounding fatty tissues and stomach. see structures in the abdomen and and lymph nodes they may be pelvis during laparoscopic surgery. removed as well. Active surveillance – A treatment plan that involves closely monitoring Laproscopic surgery – A method Recurrence – Return of the the kidney cancer but not giving of surgery where the operation is cancer after treatment. any treatment unless the tumour done using thin surgical instruments gets larger. It is used to avoid or and a laparoscope inserted through Robotic surgery – A type of delay surgery or other treatments small incisions in the abdominal wall. laparoscopic surgery where the in certain circumstances. Also known as keyhole or minimally surgical instruments are attached to a invasive surgery. robotic arm that the surgeon controls. Follow-up care – Care given to a patient over time after finishing Open surgery – The traditional type Stereotactic radiotherapy (SBRT) – treatment for a disease. Follow-up of surgery. A large incision is made A specialised form of precise, high care involves regular medical in the skin and tissues for the surgeon dose radiotherapy used to treat check-ups, which may include a to insert the instruments and get tumours in the body. physical examination, blood tests direct access to the operation field. and scans. Follow-up care looks for Urologist – A doctor who specialises the development of other health Partial nephrectomy – Surgical in treating diseases of the urinary problems and recurrence of cancer. removal of the tumour only, tract. If you need to have surgery the healthy kidney tissue is for your kidney cancer your urologist left untouched. Also known will do the operation. as nephron-sparing surgery.

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