is kidney cancer?
tumours are named after the part of the body in which they
first start. The kidneys are large bean shaped organs that
filter the blood, removing waste products from the body. This
waste is known as urine.
the past most cases of kidney tumours are found when some
sign or symptom appears. Increasingly kidney tumours are picked
up at the time of ultrasound or CT scan for other problems.
There are as yet no screening blood or urine tests to diagnose
is it diagnosed?
in the urine (known as haematuria) is the most common sign
of a kidney tumour, but blood in the urine can be caused by
other non-cancerous conditions such as infection.
addition to a physical examination your doctor will need to
perform other tests to confirm the diagnosis. If he suspects
that you may have cancer of the kidney, your doctor will refer
you for an ultrasound scan which may be done in the hospital
or community setting. If the ultrasound scan shows anything
suspicious you will have a CT scan. This is a series of x-rays
which builds up a three dimensional picture of the inside
of the body. The scan will look at the pelvis, abdomen and
chest. It is useful to help the doctors identify the exact
site of the tumour and to check for any spread of the disease.
are CT scanners at the Yorkshire Clinic, Bradford Royal Infirmary,
St Luke's Hospital and Eccleshill Treatment Centre.
we have two kidneys it is possible to live with less than
even one complete kidney, however, you may need to have investigations
to look at the function of the remaining kidney. This information
can be obtained from blood samples, but sometimes Mr Puri
may send you for a renogram, which is a special test to determine
how well your kidneys function. This is performed at the Medical
Physics Department at the Bradford Royal Infirmary but not
every patient will need this test.
Puri will see you after you have been referred to the hospital
by your GP. You may have already had an ultrasound scan and
a CT scan before you se Mr Puri, but they will be arranged
following this visit if not. Mr Puri will then discuss your
care with his colleagues at the Multidisciplinary Team Meeting
(MDT). Surgery is the main treatment for kidney cancers.
laparoscopic nephrectomy is the removal of the kidney without
needing a major incision (wound site). This may be either
a radical nephrectomy which is the removal of the kidney and
sometimes the adrenal gland or a nephro-ureterectomy, which
involves the removal of the kidney and the ureter (the tube
that allows urine to pass into the bladder from the kidney).
It is possible that you may only need to have part of your
kidney removed but this will be discussed with you prior to
the operation the surgeon uses a telescope which contains
a camera so that he can see inside the body via a picture
on a television monitor. The surgeon always has to use more
than one entry site and you will end up with a few small wounds,
each an inch or so long and a larger wound to remove the kidney.
The surgeon can manipulate these and watch what he or she
is doing on a television screen.
personal preference is to use the "hand assisted" technique.
This allows the surgeon to place one hand in the abdomen and
using the other hand to manipulate various laparoscopic instruments.
In a hand assisted operation a small incision is made just
large enough for the surgeons hand; the kidney is then removed
through this incision.
will need to be given a general anaesthetic and the operation
can last up to 4 hours
are the benefits associated with the operation?
hope that by taking away your kidney, they'll get rid of
all the cancer. The main reason for completely removing
the cancer is to stop it from spreading to other parts of
treat and also prevent pain or haematuria (blood in the
to having "open" surgery, a laparoscopic operation
can include the following benefits:
are likely to be more comfortable and need less painkilling
medication after your operation
can usually go home from hospital more quickly, usually
between 3-5 days after the operation
usually recover from the operation more quickly
are the risks associated with the operation?
complications are unusual but are rapidly recognised and dealt
of kidney through any route can be associated with:
to bowel, spleen or important blood vessels
with any operation there is a small mortality associated with
happens before the operation?
you and the surgeon have agreed to go ahead with the surgery
you will be brought to the pre-admission clinic at St Luke's
Hospital in Bradford 2-4 weeks before your operation to ensure
that you are fit for the operation. This will include blood
tests and examinations such as a tracing of the heart rate
is important to bring a list of all your medications to this
appointment and be aware of any allergies that you may have.
will be admitted the day before your operation to Ward 1 at
Yorkshire Clinic or Ward 14 at the Bradford Royal Infirmary
where you will be welcomed and shown to your bed.
will be seen by the Surgeon who will explain the operation
again to you and ask you to sign the consent for surgery.
The surgeon will mark which kidney he will operate on. In
any case your operation site is not marked please do not hesitate
to point this out to the surgeon or nurse looking after you.
site of operation must be marked before you leave the ward.
you are unsure about any aspect of the operation, please ask
for more details from the medical or nursing staff. You will
be advised of the approximate time of your operation. You
will be seen by an anaesthetist before your operation who
will discuss the anaesthetic you will be given. They will
be interested in chest troubles, dental treatment and any
previous anaesthetics you have had. The anaesthetist will
discuss with you the different methods of controlling pain
after the operation. The most common method is a continuous
slow infusion of painkiller via a tiny plastic tube in your
back, called an ‘epidural’. The alternative is a special pump
that delivers pain-killing medication when you press a button;
this is known as ‘Patient Controlled Analgesia (PCA).
nurses will advise you as to when you need to stop eating
and drinking before surgery. This allows a period for your
stomach to empty preventing vomiting during the operation.
You will be asked to wear stockings to help prevent blood
clots and aid circulation and a cotton gown. You will also
be asked to remove or secure with tape all jewellery. You
will be accompanied to theatre by a ward nurse. Your details
will be checked several times before your anaesthetic begins.
happens after the operation?
team of anaesthetists and specialist nurses (known as the
‘Pain Team’) will see you to ensure that the pain is controlled
with the epidural or PCA. This team will visit you daily in
the first few days after your operation.
You may also have a drain in your abdomen; the
doctor will decide how long you will need to have this on
a day to day basis.
will be encouraged to get out of bed and start walking on
the day after your operation. You will not do your wound any
harm and it is important to start moving to avoid complications.
You will not be allowed to eat on the operation day but you
may be able to eat the following day.
will need to remain in hospital until you can walk freely
without pain, and can manage by yourself. We will also ensure
that you are eating normally, and that your bowels are working,
before you are discharged home.
can shower or bathe at home, although for the first few weeks
please do not keep your wounds under water in the bath for
any length of time. Your wound will be closed by a method
that may be either external clips (staples) or with internal
stitches. A community nurse from your GP surgery will monitor
your wound for signs of infection such as redness or swelling.
If this happens seek advice from your GP or nurse.
in the leg (Deep Vein Thrombosis)
is a risk that blood clots may form in the veins of the calf
during surgery (known as "Deep Vein Thrombosis").
This may lead to a swollen, tender calf. Although this is
easily treated, it can lead to further problems if the clots
break away and move up to the lungs (Pulmonary Embolus). The
stockings you are given to wear prior to surgery should be
kept on throughout your stay on the ward. You may be required
to wear them at home for a number of weeks. Please ask the
nurses on the ward and ensure that you obtain a spare pair
so that they may be washed. Your surgeon may also prescribe
daily injections during your hospital stay to thin the blood
slightly and reduce the risk of forming these clots.
the first six weeks after surgery blood clots are the most
serious potential complications. If you develop any of the
symptoms such as chest pain, shortness of breath, pain or
swelling in your leg, then call your GP or contact your nearest
Accident and Emergency Department if you are away from home.
You should tell the doctor who sees you that you have had
a Laparoscopic Nephrectomy, and are concerned about
a possible blood clot.
can eat and drink whatever you wish. Try to avoid constipation
by keeping to a diet that contains plenty of fruit and fibre.
If you do become constipated, then ask your doctor or nurse
you go home, you should avoid heavy lifting and vigorous exercise
for 6 weeks, to let the wounds heal. You should take light
exercise regularly; you should particularly exercise the calf
muscles to reduce the risk of blood clot formation. You can
drive your car when you can operate the pedals without any
up after surgery
will be seen in clinic 4 to 6 weeks after your operation
addresses and telephone numbers:
to Mr R Puri
Uro-oncology Clinical Nurse Specialist
Secretary to Mr R. Puri