Kidney cancer is often silent – until it isn’t

Kidney cancer, also known as renal cell carcinoma, often goes unnoticed until it reaches an advanced stage. In Malaysia, around half of the cases are diagnosed late, making treatment more challenging. Consultant urologist and robotic surgeon Dr Lee Kheng Siang emphasized that renal cell carcinoma, the most common form of kidney cancer, has a high cure rate when detected early.

"Early kidney tumours and cysts are typically silent," he explained, noting that they are often discovered during routine abdominal ultrasound scans.

When symptoms do arise, they are usually associated with a larger tumour. These symptoms may include abdominal or lower back pain, abdominal swelling, or blood in the urine. As the disease progresses, patients might also experience fatigue, reduced appetite, or unexplained weight loss. Upon detection of a kidney tumour or suspicious cyst, additional tests are typically necessary.

Dr Lee mentioned that a contrast CT scan of the kidneys and urinary tract can accurately diagnose cancers approximately 95-99% of the time. In many instances, a biopsy is not required prior to treatment.

Surgical options depend on the size and location of the tumour. Partial nephrectomy may be performed, removing only the tumour and a small margin of surrounding tissue. Alternatively, radical nephrectomy, which involves the complete removal of the kidney, may be necessary. Preserving a portion of the kidney is often preferred, particularly for younger patients, those with a single functional kidney, or individuals at risk of chronic kidney disease.

Dr Lee highlighted that kidney cancer surgery can be conducted through open, laparoscopic, or robotic-assisted methods. The latter two techniques generally involve smaller incisions, reduced pain, and quicker recovery times compared to open surgery. For larger tumours, laparoscopic nephrectomy is frequently utilized, while open surgery is generally reserved for more complex cases.

Robotic-assisted surgery offers several advantages, including smaller incisions, less pain, and shorter recovery times. It provides a high-definition, three-dimensional view and precise instruments that emulate the surgeon's hand movements, enabling complex partial nephrectomies that might otherwise necessitate kidney removal. The primary challenge with kidney cancer is that feeling well does not necessarily indicate the absence of disease.

Early tumours may not produce symptoms, and Dr Lee stressed the importance of health screening to identify any kidney abnormalities before they escalate. Early diagnosis can often involve the removal of just the tumour rather than the entire kidney, thereby preserving organ function and enhancing the prospects for long-term recovery.