Kidney Cancer Stages: A Detailed Guide
By Dr. Anup Ramani
Kidney cancer, also known as renal cancer, is a type of cancer that starts in the kidneys. The cancer is staged from Stage I to Stage IV, with higher numbers indicating more advanced stages of the disease. Staging is essential because it helps doctors determine the best course of treatment, predict the likely outcomes, and understand the extent to which cancer has spread. In this article, we will break down the different stages of kidney cancer in a question-and-answer format to provide clarity on what each stage means, treatment options, and survival rates.
What is the staging of kidney cancer?
Staging is a method used by doctors to describe the extent of the cancer. Kidney cancer is usually staged using the TNM system (Tumor, Nodes, Metastasis), which assesses:
- T (Tumor): The size of the tumor and its extent within the kidney.
- N (Nodes): Whether the cancer has spread to nearby lymph nodes.
- M (Metastasis): Whether the cancer has spread to other parts of the body.
What is Stage I Kidney Cancer?
- Stage I kidney cancer is the earliest stage of the disease.
- The tumor is small, typically 7 centimeters or less (about the size of an egg).
- It is confined entirely to the kidney and has not spread to nearby lymph nodes or other tissues.
- Treatment options for Stage I include partial nephrectomy (removing the affected part of the kidney) or radical nephrectomy (removal of the entire kidney, in some cases).
- Survival rate: The five-year survival rate for Stage I kidney cancer is approximately 90%, as it is detected early and the tumor is localized.
What is Stage II Kidney Cancer?
- Stage II kidney cancer is slightly more advanced but still localized to the kidney.
- The tumor is larger than 7 centimeters in size but has not spread to nearby lymph nodes or other tissues.
- Treatment options often involve radical nephrectomy, which includes the removal of the entire kidney.
- Survival rate: The five-year survival rate for Stage II kidney cancer is around 75% due to the larger size of the tumor and the potential for more aggressive growth.
What is Stage III Kidney Cancer?
- Stage III kidney cancer refers to cancer that has spread beyond the kidney.
- The tumor can be any size but has spread to nearby lymph nodes, blood vessels (such as the renal vein or vena cava), or surrounding tissues, including the fatty tissue around the kidney.
- Treatment options may include radical nephrectomy (removal of the entire kidney) along with the removal of affected lymph nodes and surrounding tissues, possibly including the adrenal gland.
- Survival rate: The five-year survival rate for Stage III kidney cancer is approximately 75%, as treatment can still be effective, but the spread to nearby tissues and lymph nodes makes it more challenging to treat.
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What is Stage IV Kidney Cancer?
- Stage IV kidney cancer is the most advanced form of the disease.
- At this stage, the cancer has spread beyond the kidney to other parts of the body, such as the adrenal gland, lungs, bones, liver, brain, or distant lymph nodes.
- Treatment options for Stage IV kidney cancer may include immunotherapy, targeted therapy, chemotherapy, or a combination of these, in addition to or instead of surgery. Surgery is often less effective in this stage as the cancer has already metastasized.
- Survival rate: The five-year survival rate for Stage IV kidney cancer is around 15%. However, with advanced treatments such as immunotherapy and targeted therapies, survival rates may improve for some individuals.
How do doctors determine the stage of kidney cancer?
Doctors determine the stage of kidney cancer through a combination of methods, including:
- Imaging tests such as CT scans, MRI scans, and ultrasound to assess the size and location of the tumor.
- Biopsy (in some cases) to examine the tumor cells.
- Blood tests to check for cancer markers, although imaging is more commonly used for staging.
What are the main symptoms of kidney cancer?
In the early stages, kidney cancer may not show any symptoms, but as it progresses, the following symptoms may appear:
- Blood in the urine (hematuria)
- Pain in the back or side
- A lump or mass in the abdomen
- Fatigue
- Weight loss without trying
- Fever or night sweats
- Swelling in the ankles or legs
What are the treatment options for Stage I Kidney Cancer?
For Stage I kidney cancer, treatment options are generally focused on removing the tumor. The common treatments include:
- Partial nephrectomy: Removal of the tumor along with a portion of the kidney.
- Radical nephrectomy: Removal of the entire kidney, typically performed if the tumor cannot be easily separated from the rest of the kidney tissue.
Survival rate: The five-year survival rate for Stage I kidney cancer is approximately 90% when treated early.
How is Stage II Kidney Cancer treated?
- The treatment for Stage II kidney cancer typically involves radical nephrectomy (removal of the entire kidney) due to the tumor’s larger size. In some cases, partial nephrectomy may be an option if the tumor is located in a part of the kidney that can be safely removed.
- Adjuvant therapy (additional treatment) is not usually required for Stage II, as the cancer has not yet spread to other parts of the body.
How does the TNM system help in staging kidney cancer?
The TNM system is used to stage kidney cancer based on:
- T (Tumor): The size and extent of the primary tumor in the kidney.
- N (Nodes): Whether cancer has spread to nearby lymph nodes.
- M (Metastasis): Whether the cancer has spread to distant organs or tissues.
This system helps doctors decide the most appropriate treatment plan for each stage of kidney cancer.
What are the possible side effects of surgery for kidney cancer?
Side effects of surgery for kidney cancer include:
- Pain and discomfort around the surgical site.
- Fatigue during recovery.
- Infection at the surgical site.
- Reduced kidney function if a large portion of the kidney is removed.
How is Stage III Kidney Cancer treated?
Treatment for Stage III kidney cancer involves radical nephrectomy, which may include the removal of the tumor, affected lymph nodes, and surrounding tissues, including the adrenal gland. In some cases, adjuvant therapies like immunotherapy or targeted therapies may be added to the treatment plan.
What is the prognosis for Stage III Kidney Cancer?
The five-year survival rate for Stage III kidney cancer is about 75%, depending on the extent of the tumor spread and the effectiveness of treatment. Early detection and proper treatment are key to improving survival rates.
Can kidney cancer be prevented?
While there is no guaranteed way to prevent kidney cancer, risk factors can be managed by:
- Not smoking, as smoking is a major risk factor for kidney cancer.
- Maintaining a healthy weight and balanced diet.
- Controlling high blood pressure and avoiding excessive use of certain medications like painkillers.
What is the role of immunotherapy in Stage IV kidney cancer?
Immunotherapy is a treatment option for Stage IV kidney cancer. It works by stimulating the body’s immune system to recognize and attack cancer cells. Immunotherapy drugs like checkpoint inhibitors have shown promising results in treating advanced kidney cancer and improving survival rates.
How can lifestyle changes help in managing kidney cancer?
Lifestyle changes, such as:
- Quitting smoking and avoiding alcohol.
- Regular physical activity to maintain a healthy weight.
- Eating a balanced diet rich in fruits, vegetables, and lean proteins.
- Reducing stress can improve overall health and support treatment outcomes.
What are the chances of survival for Stage IV kidney cancer?
The five-year survival rate for Stage IV kidney cancer is around 15%. However, advancements in treatment options like immunotherapy and targeted therapy have improved the prognosis for some patients with advanced kidney cancer.
What are the stages of kidney cancer in the TNM system?
In the TNM system, kidney cancer is staged as follows:
- Stage I: Tumor is confined to the kidney, less than 7 cm in size.
- Stage II: Tumor is larger than 7 cm but still confined to the kidney.
- Stage III: Cancer has spread to nearby lymph nodes or blood vessels.
- Stage IV: Cancer has spread to distant organs or lymph nodes.
Can kidney cancer recur after treatment?
Yes, kidney cancer can recur after treatment, especially if the cancer was diagnosed at a more advanced stage (Stage III or IV). Regular follow-up visits with imaging tests and blood tests are essential for detecting recurrence early.
Conclusion
Understanding the stages of kidney cancer is essential for both patients and doctors to determine the best course of treatment and set realistic expectations for the outcome. Early-stage kidney cancer has a much higher survival rate, and treatment options like surgery, immunotherapy, and targeted therapies can significantly improve survival chances. If you or a loved one is diagnosed with kidney cancer, it’s crucial to discuss your options with a healthcare provider to tailor a treatment plan based on the cancer stage and overall health condition.
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PARTIAL PENECTOMY
- Partial penectomy is done in cases where glans and distal penis is involved with carcinoma.
- Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
- Patients who develop stones in the kidney or ureter, often experience severe pain.
- This condition usually needs a procedure to remove the kidney stones.
- This procedure is called ureteroscopy and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
- The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
- The procedure takes about 40-50 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is one night and patient is discharged the next day after removal of the catheter.
- Patient has to come back after six weeks to remove the stent in the kidney.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
- Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
- This procedure is called TURP and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
- The overgrown prostate is dissolved with a laser bloodlessly.
- The procedure takes about 40 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR
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Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
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Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.
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The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
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Dr. Ramani then sits in the controlling console to perform the surgery.
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On an average, a robotic adrenalectomy takes one hour.
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The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
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A urine catheter and bag to drain the bladder is inserted during surgery.
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A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.
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Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
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The drain pipe, if kept, is removed in the room on day 2 after surgery.
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The catheter is removed on day two after surgery.
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Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).
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Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.
Heavy activities like running, weight lifting can be resumed after a month
FOLLOW UP AFTER SURGERY
Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
Local patients usually meet Dr. Ramani after two weeks to discuss report.Outstation patients are counselled on a phone consultation.
ROBOTIC SURGERY FOR BLADDER CANCER
- Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
- Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
- Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the new bladder is inserted during surgery.
- Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
- The drain pipes are removed in the room on day 3-5 after surgery.
- Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY
Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.
Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.
Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.
If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.
ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
- Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
- relatively easier but still requires significant experience to consistently deliver results.
- Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the bladder is inserted during surgery.
- A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
- The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
- Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self- sufficient.
- They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 2-3 weeks of surgery.
- Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
- Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
- Local patients usually meet Dr. Ramani after two weeks to discuss report.
- Outstation patients are counselled on a phone consultation.