Advances in the Management of Sporadic and Hereditary Kidney Cancers

By Jonathan Coleman, MD,

Thursday, February 19, 2015

Over the past few decades, the incidence of kidney cancer and tumors of the renal pelvis have increased steadily in the United States. Although the reasons for this rise aren’t fully understood, it’s clear that the majority of the increase has been seen in people with small tumors representing very early malignancies or, in some cases, completely benign neoplasms.

Surgical management approaches and techniques have adapted to keep pace with this changing landscape and to effectively balance contemporary understanding of the biologic risks that these tumors pose with the need to optimize quality of life.

Conservative management strategies have been developed to successfully control disease, preserve organ function, and avoid aggressive procedures. In addition, approaches that are carefully tailored to each patient have become available as a result of advances in cancer genetics and characterization of hereditary cancer syndromes.

At MSK, our multidisciplinary program in kidney and renal pelvis malignancies is designed to incorporate the latest technologies in surgery and genomics into the daily care of our patients and the management of their disease. In this highly collaborative environment, we have seen great progress in less invasive treatments for patients with these malignancies and have been successful in expanding our active surveillance program to appropriately selected patients.

In partnership with colleagues and researchers throughout MSK, we’re investigating:

  • genomic profiling of tumors from surgically derived specimens and biopsies;
  • incorporating medical therapies to facilitate rapid recovery of renal function following surgery;
  • integrating near-infrared imaging for intraoperative identification of fluorescently labeled tumor deposits; and
  • new kidney-sparing procedures for renal pelvic cancers.

Hereditary Kidney Cancer Syndromes

Physicians have long recognized the challenges of identifying, screening, and long-term management of hereditary kidney cancer syndromes. (1) Individuals with these diseases are more likely to exhibit multifocal and bilateral tumors, rendering kidney-preserving techniques all the more critical.

At MSK, we often recommend active surveillance of small tumors for patients with hereditary kidney cancer. We are able to safely remove the malignancies through partial nephrectomy if growth is observed. This approach also can be used for patients with sporadic kidney tumors and small renal masses.

Our comprehensive program is staffed by a multidisciplinary team of physicians, nurses, and others who understand the nuances of caring for these patients. State-of-the-art laboratories conduct screening, and genetic counseling is available for patients and family members with known or suspected hereditary cancers.

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Minimally Invasive Approaches

Advances in surgical instrumentation have helped us transition to the use of less invasive, organ-sparing surgical techniques for removing tumors and preserving function; when performed by MSK surgeons, outcomes for patients are similar for open and minimally invasive techniques. (2) (3)

Minimally invasive surgery with robotic assistance can be used for highly complex procedures, including the removal of multiple tumors, large cancers, and tumors with vascular invasion (including tumor thrombus involving major blood vessels). (4) (5) These procedures have been developed through the combined expertise of a multidisciplinary team of surgeon specialists skilled in both open and minimally invasive procedures. We offer careful presurgical evaluation of each patient, with detailed testing of functional renal capacity, nutrition, and metabolic function — and a focus on identifying the appropriate surgical approach for each patient in order to achieve the best possible outcome.

To help patients transition to home, we developed a postoperative clinical pathway for open and minimally invasive surgery that incorporates patient-centric convalescence care, early ambulation, and nutrition guidelines. This approach enables more than 80 percent of our patients to comfortably return home the day after surgery. (6)

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