• Symptoms:

Kidney cancer doesn't usually cause symptoms at first. In time, signs and symptoms may develop, including:

• Blood in the urine.
• Loss of appetite.
• Pain in the side or back that doesn't go away.
• A lump or mass in your kidney area.
• Tiredness.
• Unexplained weight loss.
• Bone pain.

 

• Risk factors:

Factors that may increase the risk of kidney cancer include:

• Older age. The risk of kidney cancer increases with age.
• Smoking. People who smoke have a greater risk of kidney cancer than those who don't. The risk decreases after quitting.
• Obesity. People who are obese have a higher risk of kidney cancer than people who are considered to have a healthy weight.
• High blood pressure. High blood pressure, also called hypertension, increases the risk of kidney cancer.
• Certain inherited conditions. People who are born with certain inherited conditions may have an increased risk of kidney cancer. These conditions may include von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis complex, hereditary papillary renal cell carcinoma and familial renal cancer.
• Family history of kidney cancer. The risk of kidney cancer is higher if a blood relative, such as a parent or sibling, has had the disease.
• Radiation therapy: Women who have been treated with radiation for cancer of their reproductive organs may have a slightly increased risk of developing kidney cancer.

• Diagnosis:

If you have kidney cancer symptoms, your healthcare provider will perform a complete medical history and physical exam. They also may order certain tests that can help in diagnosing and assessing cancer. These tests may include:

• Urinalysis: A sample of your urine is tested to see if it contains blood. Even very small traces of blood, invisible to the naked eye, can be detected in tests of urine samples.
• Blood tests: These tests count the number of each of the different kinds of blood cells, as well as look at different electrolytes in your body. A blood test can show if there are too few red blood cells (anemia), or if your kidney function is impaired (by looking at the creatinine).
• CT scan: This is a special X-ray that uses a computer to create a series of images, or slices, of the inside of your body. This test is often done with intravenous contrast (dye). People with impaired kidney function may not be able to receive the dye.
• Magnetic resonance imaging (MRI): This is a test that produces images of the inside of your body using a large magnet, radio waves and a computer.
• Ultrasound: This test uses high-frequency sound waves that are transmitted through body tissues to create images that are displayed on a monitor. This test is helpful in detecting tumors, which have a different density from healthy tissues.
• Renal mass biopsy: During this procedure, a thin needle is inserted into the tumor, and a small sample of your tissue is removed (biopsy). A pathologist will look at the tissue under a microscope to see if there are any cancer cells. Because biopsies for kidney cancer aren’t always completely reliable, your healthcare provider may or may not recommend this test.
• Bone scan: A procedure to check if there are rapidly dividing cells, such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. 

• Treatment:

Kidney cancer treatment sometimes begins with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. Sometimes medicine is given after surgery to lower the risk that the cancer will come back. If the cancer has spread beyond the kidney, surgery might not be possible. Other treatments may be recommended.

Your healthcare team considers many factors when creating a treatment plan. These factors may include your overall health, the type and stage of your cancer, and your preferences.

Surgery:

For most cancers confined to the kidney, surgery is the first treatment. The goal of surgery is to remove the cancer while preserving kidney function, when possible. Operations used to treat kidney cancer include:

• Complete nephrectomy, also known as a radical nephrectomy, involves removing the entire kidney and a border of healthy tissue around it. Nearby tissues such as the lymph nodes, adrenal gland or other structures also may be removed.

The surgeon may perform a nephrectomy through a single incision in the abdomen or side, called an open nephrectomy. The surgeon also may use a series of small incisions in the abdomen, known as laparoscopic nephrectomy.

• Partial nephrectomy involves removing the cancer and a small margin of healthy tissue that surrounds it rather than the entire kidney. This procedure also is called kidney-sparing or nephron-sparing surgery. It can be done as an open procedure or laparoscopically.

 

Ablation:

Cryoablation: During this procedure, your healthcare provider inserts a needle through your skin and into the kidney tumor. The cancer cells are then frozen with cold gas.

Cryoablation can treat small kidney cancers in certain situations. It might be used in people who have other health concerns that make surgery risky.

Radiofrequency ablation: Your healthcare provider inserts a needle through your skin and into the kidney tumor. Next, an electrical current is passed through the cancer cells to destroy them.

Radiofrequency ablation can treat small kidney cancers in certain situations. It might be used in people who have other health concerns that make surgery risky.

Radiation therapy:

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. External radiation therapy uses a machine outside the body to send radiation toward the area of the body with cancer. External radiation therapy is used to treat renal cell cancer, and may also be used as palliative therapy to relieve symptoms and improve quality of life.

Targeted therapy.

Targeted therapy for cancer is a treatment that uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.

Immunotherapy:

Immunotherapy for cancer is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off cancer and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.

Chemotherapy:

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy).

 

Palliative care:

Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A healthcare team that may include doctors, nurses and other specially trained health professionals provides palliative care. The care team's goal is to improve quality of life for you and your family.

Palliative care specialists work with you, your family and your care team. They provide an extra layer of support while you have cancer treatment. You can have palliative care at the same time you're getting strong cancer treatments, such as surgery, chemotherapy, immunotherapy, targeted therapy or radiation therapy.

Kidney cancer care at Shefa-El Orman:

At Shefa-El Orman Hospital, our experienced specialists work as a team to provide personalized care for people with kidney cancer. Other areas are included as needed, such as medical genetics, integrative medicine or palliative care.

Shefa-El Orman experts will work with you to review all of your options and recommend the treatment that best suits your needs and goals. The range of treatments offered to people with kidney cancer includes surgery, medicines, radiation therapy and minimally invasive procedures, such as cryoablation and radiofrequency ablation.

Our urological surgeons are leaders in using kidney-sparing surgery (partial nephrectomy) approaches to kidney cancer removal. Highly trained and experienced experts can accomplish kidney preservation in circumstances that otherwise might cause severely limited kidney function or the need for dialysis.

 Our highly skilled urological surgeons have perfected minimally invasive techniques in nephrectomy procedures, including partial nephrectomy to remove kidney cancer and preserve function as much as possible.

Shefa-El Orman multidisciplinary kidney cancer team cares for many people with kidney cancer each year. People who seek care at hospitals that perform many kidney cancer operations every year tend to experience fewer complications.

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1. Diagnostics:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• general clinical examination
• laboratory tests:
• complete blood count
• clinical urine test 
• kidney function test (creatinine, urea)
• blood coagulation analysis (aPTT, PT, INR)
• inflammation indicators (CRP, ESR)
• abdominal ultrasound, CT scan, MRI scan (if indicated clinically)
• guided biopsy with histological examination (if clinically indicated).
• nursing services
• consultation of related specialists
• consultation of the chief physician and all leading experts
• development of individual treatment plan

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available).

Price from: On request

Type of program: Outpatient

Expected duration of the program: 5 days

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2. surgical:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• urological examination
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators blood coagulation
• ultrasound of the urogenital system, CT/MRI of the abdomen and pelvis (if indicated clinically)
• preoperative care
• operations:
• laparoscopic nephrectomy and uretrectomy
• laparoscopic partial nephrectomy
• open nephrectomy and ureterectomy

• open partial nephrectomy.

• histologically and immunohistochemically examination of the excised tissues
• symptomatic treatment
• control examinations
• the cost of essential medicines and materials
• nursing services
• full hospital accommodation
• explanation of future recommendations

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Inpatient

Expected duration of the program: 7 days

_________________________________________________________________________________

3. Chemotherapy, targeted therapy and immunotherapy:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• CT / MRI and ultrasound scans (if indicated clinically)
• laboratory tests:
• complete blood count
• general urine analysis
• biochemical analysis of blood
• inflammation indicators (CRP, ESR)
• indicators of blood coagulation
• tumor markers (CEA, CA19-9, CA125)
• individual plan of the chemotherapy (the cost of medicines is included) the cost defined per cycle.
• symptomatic treatment
• nursing services
• control examinations
• consultations of related specialists
• recommendations for further treatment

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of previous laboratory tests and instrumental examinations. After that, you will undergo an additional examination, including laboratory assessment of liver and kidney function, ultrasound scan. Based on the received results, the doctor will elaborate the chemotherapy regimen. If necessary, related medical specialists will be involved in the elaboration of a treatment regimen (tumor board).

Chemotherapy is carried out as the daily hospital procedure, without mandatory admission to the hospital. May be oral or intravenous medications according to treatment plane. After the placement of a venous catheter, you will stay in a comfortable ward. An infusion system will be connected to the catheter, through which the required drug or a drug combination will be administered. All drugs are administered by intravenous drip, slowly, so the total duration of the infusion can be up to several hours. All this time, doctors and nurses will monitor your health condition closely.

After the course of chemotherapy, you will stay under medical supervision in the ward for a few more hours. If your general condition is good, your doctor will allow you to leave the hospital. You will receive the medical report with detailed recommendations regarding further treatment. In the future, you will be able to have a distant consultation with your attending physician and schedule the next course of chemotherapy, if necessary.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request

Type of program: Outpatient

Expected duration of the program: 3 days

_________________________________________________________________________________

4. Intervention radiology:

The program includes:

• Initial presentation in the clinic
• clinical history taking
• review of medical records
• physical examination
• laboratory tests:
• complete blood count
• biochemical analysis of blood
• TSH-basal, fT3, fT4
• tumor markers (AFP, CEA, ??-19-9)
• inflammation indicators (CRP, ESR)
• indicators of blood coagulation
• abdominal ultrasound scan, CT/MRI scans (if indicated clinically).
• preoperative care
• operative: the selection between the different types of operations according to your clinical conditions and we’ll be explained by the treating physician.
• percutaneous embolization (coiling) or chemoembolization (for one session).
• using beads or microspheres (for one session).
• Alcohol or radiofrequency tumor ablation (for one session).
• Microwave tumor ablation (for one session).
• symptomatic treatment
• cost of essential medicines
• nursing services
• elaboration of further recommendations

 

How program is carried out

During the first visit, the doctor will conduct a clinical examination and go through the results of the available diagnostic tests. After that, you will undergo the necessary additional examination, such as the assessment of liver and kidney function, ultrasound scan, CT scan and MRI. This will allow the doctor to determine which vessels are feeding the tumor and its metastases, as well as determine how well you will tolerate the procedure.

Chemoembolization begins with local anesthesia and catheterization of the femoral artery. The thin catheter is inserted through a few centimeters’ long incision of the blood vessel. The doctor gradually moves the catheter to the vessel feeding the primary tumor or its metastases. The procedure is carried out under visual control, an angiographic device is used for this. The vascular bed and the position of the catheter in it are displayed on the screen of the angiograph.

When the catheter reaches a suspected artery, a contrast agent is injected through it. Due to the introduction of the contrast agent, the doctor clearly sees the smallest vessels of the tumor and the surrounding healthy tissues on the screen of the angiograph. After that, he injects emboli into the tumor vessels through the same catheter.

Emboli are the spirals or the liquid microspheres. The type of embolus is selected individually, taking into account the diameter of the target vessel. When carrying out chemoembolization, a solution of a chemotherapy drug is additionally injected into the tumor vessel. Due to the subsequent closure of the vessel lumen with an embolus, the chemotherapy drug influences the tumor for a long time. In addition, the drug does not enter systemic circulation, which allows doctors to use high doses of chemotherapeutic agents without the development of serious side effects. Chemoembolization leads to the destruction of the tumor or slowing down its progression.

After that, the catheter is removed from the artery. The doctor puts a vascular suture on the femoral artery and closes it with a sterile dressing. During chemoembolization, you will be awake. General anesthesia is not used, which significantly reduces the risks of the procedure and allows performing it on an outpatient basis, avoiding long hospital stays.

After the first procedure, you will stay under the supervision of an interventional oncologist and general practitioner. If necessary, you will receive symptomatic treatment. As a rule, a second chemoembolization procedure is performed 3-5 days after the first one in order to consolidate the therapeutic effect. After that, you will receive recommendations for further follow-up and treatment.

Required documents

• Medical records
• MRI/CT scan (not older than 3 months)
• Biopsy results (if available)

Price from: on request (per session)

Type of program: Outpatient

Expected duration of the program: 6 days