Kidney Cancer

Who May Benefit

A consultation may be appropriate if you:

• Have a kidney mass or tumour found on ultrasound, CT or MRI, with or without symptoms
• Have blood in the urine, flank pain, or an abdominal lump that needs investigation
• Have been told your tumour is complex or “not suitable for partial nephrectomy” and want a second assessment
• Have a single functioning kidney, reduced kidney function, or tumours in both kidneys
• Have a hereditary kidney cancer syndrome or a strong family history
• Have already had kidney surgery and need surveillance or treatment for recurrence

When This Page May Not Apply

• Widespread metastatic disease where systemic therapy is the primary treatment — this is led by a medical oncologist, though surgical input may still be valuable
• Benign kidney lesions such as simple cysts, which usually need no treatment at all

Available Treatment Alternatives

The right choice depends on tumour size and complexity, your baseline kidney function, and your general health.

Robotic Partial Nephrectomy

Removal of the tumour with a margin of normal tissue, preserving the rest of the kidney. This is the preferred approach for most small and many intermediate-complexity tumours, and protects long-term kidney function.

Robotic or Laparoscopic Radical Nephrectomy

Removal of the whole kidney. Appropriate for large tumours, centrally located tumours where partial surgery is unsafe, or where the tumour involves the renal vein.

Active Surveillance

For small renal masses, particularly in older patients or those with significant other illness. Involves serial imaging, with intervention if the tumour grows or changes character.

Thermal Ablation

Radiofrequency or cryoablation for selected small tumours in patients unsuitable for surgery. Less invasive, but with a higher local recurrence rate than surgical removal.

Systemic Therapy

Targeted agents and immunotherapy for advanced or metastatic disease, delivered in coordination with a medical oncologist. Surgery may still have a role alongside systemic treatment in selected cases.

Investigations Usually Required

Before any treatment recommendation, the following are typically needed:

• Triphasic CT of the abdomen with contrast — the single most important investigation; it defines tumour size, enhancement, and relationship to vessels and the collecting system
• MRI of the abdomen — used when contrast CT is unsuitable, or to characterise cystic lesions using the Bosniak classification
• Kidney function tests — serum creatinine and estimated GFR, to understand how much function is at stake
• Split renal function scan (DTPA or DMSA) — in selected cases, to measure what each kidney contributes individually
• CT chest — for staging, to exclude spread to the lungs
• Renal mass biopsy — not routine, but useful for small masses under consideration for surveillance or ablation, or where a non-surgical diagnosis is suspected

Please bring any prior scans on CD or film. Imaging is reviewed rather than repeated wherever possible.

Important Limitations and Risks

• Partial nephrectomy is technically demanding. It carries a risk of bleeding, urinary leak from the collecting system, and, uncommonly, the need to convert to complete kidney removal during surgery. These risks rise with tumour complexity.
• Not every tumour is suitable for nephron-sparing surgery. Where the tumour is large, central, or involves the renal vein, radical nephrectomy is the safer and more effective option.
• Radical nephrectomy reduces total kidney function. Most patients with a healthy opposite kidney manage well, but the risk of future chronic kidney disease is higher.
• Ablation has a higher recurrence rate than surgical excision and often gives no definitive pathology, which limits certainty about the diagnosis.
• Active surveillance carries a small risk of progression. It is only appropriate with reliable follow-up imaging.
• Pathology can surprise. A proportion of small renal masses turn out to be benign, and a smaller proportion behave more aggressively than the imaging suggested.

What a Consultation Involves

A first consultation usually takes 30 to 45 minutes and covers:

• Your history — symptoms, other medical conditions, medications, and any family history of kidney cancer
• Review of your imaging — Dr. Ahlawat will look at the actual scans, not just the report, and explain what the tumour looks like and where it sits
• An assessment of complexity — whether the kidney can realistically be preserved, and what that would involve
• The options, side by side — partial versus radical surgery, surveillance, or ablation, with the trade-offs of each explained plainly
• Kidney function planning — what your function is likely to be after treatment
• Your questions — with time to think before deciding

Please bring imaging on CD where possible. You are welcome to bring a family member.