SURGERY FOR KIDNEY AND BLADDER CANCER

Kidney cancer affects several people every year. The cancers in the urinary tract and genital tract are called genitourinary cancer. The most common of genitourinary cancer include bladder cancer, prostate cancer, kidney cancer, penile cancer and testicular cancer. Kidney cancer also called renal cancer, occurs when the kidney cells grow out of control, form clumps together to build a malignant tumour. Similarly, bladder cancer begins with urothelial cells, lining the inside of the bladder.

Kidney Cancer Surgery

Surgery is the primary treatment for kidney cancer. Based on the location and stage of cancer, surgery might involve involver removal of the entire kidney along with the tumour, or removal of cancer along with some adjacent kidney tissues. When the entire kidney is removed, its called radial nephrectomy, and when just the cancer is removed, its called a partial nephrectomy. In some cases, the adrenal gland and fatty tissues around the kidney are also removed.

  • Radical nephrectomy
    In this surgery, the affected kidney is completely removed along with the adrenal gland, fatty tissues, lymph nodes surrounding the kidney. Patients can be just fine with only one functional kidney. The surgeon could be making incisions in several places, but the most common sites are the middle of the belly, below the ribs on the same side as cancer or just at behind the kidney. Removal of the adrenal gland is a part of any standard radial nephrectomy. Still, in some cases, the surgeon allows it to stay if the cancer is in the lower part of the kidney and is at a significant distance from the gland.

    If radial nephrectomy is required, in most cases the doctors try to use any of these approaches so that the operation can be done with many small incisions instead of a single large incision.

    • Laparoscopic nephrectomy is the procedure where multiple small incision each of size around ½ inch and surgical instruments are inserted through them to remove the kidney. The Laparoscope is a long tube with a camera at its end that is inserted to allow the doctor to see inside the abdomen.
    • Robotic laparoscopic nephrectomy is the approach where the surgery is executed remotely using a robotic system. The surgeon is at a panel near the operating table to control the robotic arms while they operate. The robotic system allows the surgeon to move instruments more easily and with more precision. This is a difficult approach to learn, and hence the success of the surgery depends on the skill and experience of the surgeon.
  • Partial Nephrectomy
    In this type of surgery, only a section of the kidney is removed while the rest is left behind. This is now a preferred treatment for people with early-stage cancer. It is mostly used to remove small tumours, less than 4 cm across or the larger ones up to 7cm across. Studies reveal that long term results of these surgeries are as good as radial nephrectomy with the benefit of having a more functional kidney.

Bladder cancer surgery

It is part of bladder cancer treatment and depends on the stage of cancer.

  • Transurethral resection of bladder tumour (TURBT) is often conducted to check if there is bladder cancer and if yes, whether it has spread to the muscle layer of the bladder wall. TURBT is mostly done to cure an early stage or non-muscle invasive cancer. The goal is to get rid of the cancer cells along with nearby tissues down to the muscle layer of the bladder.

    A rigid and thin cystoscope known as resectoscope is inserted to the bladder through the urethra. The resectoscope has a wire loop at the end which removes the abnormal tumours or tissues.

  • Cystectomy is conducted when the cancer is found invasive and whole, or a part of the bladder is required to be removed. IN most of the cases, chemotherapy is used before cystectomy is conducted. Cystectomy can be of two types.

    • Partial cystectomy is conducted when the muscle layer of the bladder has been infected by cancer, but it is only at one place and is not too large. In such cases, the cancerous section of the bladder is removed along with a part of the bladder wall without taking out the bladder completely. Thereafter the hole in the bladder is closed with stitches, and the nearby lymph nodes are removed and tested for cancer spread.

    • Radical cystectomy is conducted when the cancer is larger and is not limited to one part of the bladder. The surgery involves the removal of complete bladder and nearby by lymph nodes. For men, the prostate and seminal vesicles are also required to be removed. In women, the uterus, ovaries, cervix, fallopian tubes and a tiny part of the vagina are also removed.

      In some cases, tiny surgical instruments along with a tiny video camera called the laparoscope are inserted through smaller incisions to execute the surgery. It could also be conducted using robotic arms, where the doctors sit at a panel regulating the robotic arms’ movement and performing the surgery with it.