Renal cancer

Renal cancer is a malignant tumour originating from the kidney lining. The tumour is often discovered by chance, when an ultrasound examination or CT scan of the abdominal region is performed due to some other ailment. In such cases, the patient is urgently referred to surgical treatment.

In Finland, renal cancer is diagnosed in approximately 1,000 persons annually. The time of occurrence is clearly focused on the last years of working life and retirement. The symptoms may include haematuria, pain in the side, temperature, weight loss or local symptoms caused by a metastasis, such as back pain.

The prognosis varies a lot. The prognosis of a small tumour restricted to the kidney with docile tissue type is good. The prognosis of an advanced disease with an aggressive tissue type is poor – especially if the patient’s overall condition has already weakened.

Half of all renal cancer patients die of the disease in the course of time. Surgical treatment still plays a key role in the treatment process.

Examinations at Tays

When a kidney tumour has been diagnosed and a referral has come to Tays’ urologist (urinary organ surgeon), we schedule an urgent full body CT scan and basic laboratory tests for the patient. After that, we invite the patient to an urgent treatment negotiation at the outpatient clinic.

The renal cancer diagnosis and spread assessment are typically done based on the imaging finding. In a situation open to various interpretations, the nature of the tumour may be determined before treatment with the help of a needle biopsy, which is taken by a procedure radiologist most often in ultrasound guidance.

During the treatment negotiation visit, we assess the tumour finding and plan further treatment with the patient through negotiations. Most often, the treatment involves surgery of the tumour area alone or a removal of the whole kidney. At the same time, we decide on the treatment of possible metastases.

Surgical treatment of renal cancer

A pre-visit is scheduled approximately one week before the surgery. During the visit, all preparatory measures required by the surgery are performed: the taking of blood samples, a visit to the ward and a meeting with the anaesthetist and attending urologist. A pre-visit nurse guides the patient through the events of the day.

Usually, the patient does not come in for the surgery until the morning of the surgery without having eaten anything that morning. The surgical options include the traditional open-type surgery, endoscopic surgery of the abdominal cavity or robot-assisted surgery. We plan the method of surgery case-specifically.

We remove a small tumour area by conserving the rest of the kidney, while a larger tumour requires the removal of the whole kidney. The other remaining kidney is usually able to ensure sufficient renal functioning.

If the disease has sent just one or a few metastases and the patient is in good condition, we may be able to remove these metastases during the surgery.

Pharmacotherapy of renal cancer

If cancer has spread more widely and the patient is in good condition, we only remove the cancerous kidney and refer the patient for an assessment by the cancer outpatient clinic.

In such cases, oncologists (cancer doctors) assess the situation and organise another treatment negotiation with the patient. Pharmacotherapy is launched, if it is considered beneficial to the patient.

Treatment at the ward and discharging

During the treatment at the ward, we treat pain and provide nutrition at first via an intravenous fluid drip. At the same time, the patient slowly begins to move about, under the guidance of a physiotherapist if necessary. The patient is also given post-operative injections that prevent phlebothrombosis.

After an endoscopic surgery, the patient is discharged in approximately three days from the surgery and, after open surgery, in approximately six days. If needed, treatment at the ward may be continued at the ward of the patient’s own district hospital or health centre.

The early stage recovery takes 4–6 weeks, which is usually also the length of sick leave.

Monitoring at the urology outpatient clinic

In view of possible recurrence, we monitor the patient at the outpatient clinic every six months at first and then annually. In addition to the doctor’s examination, the examinations include basic laboratory tests and, as the most important element, imaging either as a full-body CT scan or an abdominal ultrasound supplemented with lung imaging.

We monitor patients with a low risk of recurrence for up to five years, and patients with a medium or high risk of recurrence for up to ten years by gradually extending the monitoring interval. After the initial stage, the controls are conducted at the patient’s own health centre.

Division of work and treatment team

According to the mutual division of work of the urologists, some of the urologists treat renal cancer patients.

Problematic patient cases that require the collaboration of several specialities have been centralised at Tays Central Hospital. Such cases include renal cancer growing into the inferior vena cava, the surgery of which also requires a vascular surgeon.

The surgery may also require the participation of a cardiothoracic surgeon or abdominal organ surgeon.

A physiotherapist helps the patient to recover after the surgery. A rehabilitation counsellor helps and guides the patient to make individual decisions that support his/her rehabilitation and coping in everyday life. A social worker assists in the arrangement of allowance matters, among other things.

Persons in charge

Chief Physician of the Unit Juha Koskimäki
Deputy Chief Physician Jarno Riikonen
Specialist Jukka Kallio
Specialist Erik Veskimäe