Treating kidney cancer when you can’t afford to lose a kidney

One of the biggest problems with kidney cancer (also known as renal cell carcinoma or RCC) is removing it. Obvious, you say.

However, the reason is not what you might think.

 The surgical options for resecting (cutting-out) kidney cancer are well-developed and usually pretty straightforward. The kidney containing the tumor is removed (nephrectomy) or just a part of the kidney might be removed if the tumor is small (partial nephrectomy). All of this is just fine– as long as you have a second kidney that is normal and can pull duty for the one you are about to lose. But some people don’t have this option due to chronic kidney disease from diabetes or high blood pressure.

Two cancers in the right kidney (arrows)-- oh my. You are looking at a CT "slice" (cut section of the human body) from the patient's feet looking toward the head.

Two cancers in the right kidney (arrows)– oh my. You are looking at a CT “slice” (cut section of the human body) from the patient’s feet looking toward the head.

Years of these conditions can lead to so much kidney damage that these patients cannot afford to lose even a part of one kidney– They risk permanent renal failure and may need kidney dialysis treatment for the rest of their lives.

 The patient in this picture has 2 kidney cancers in his right kidney (arrows) and has no options for surgery due to long-standing kidney disease and poor function. What are his options?

renal cryo

Several “cryoprobes” inserted through the back. The tips are guided into the tumors using guidance from CT scanner images

  1. Remove the kidney and probably start dialysis treatments three times per week for the rest of his life. This is very difficult for families’ finances/schedule and for the patient’s sense of well-being
  2. Do nothing and hope the cancers grow slowly and don’t spread. This is unlikely to happen.
  3. Perform regional tumor therapy consisting of needle-puncture and ablation (destruction) of the tumors only, while preserving as much of the kidney as possible. This option was chosen for this patient to treat his cancer in a way that maximized tumor destruction but minimized risk of permanent renal failure. 
Grey fuzzy blobs (“iceballs”–white arrows) surround the bright needles that are embedded into the kidney cancers

Figures 3 (right) and 4 (below) show the “Cryoprobes” inserted into the tumors with guidance by a CT (computed tomography) scanner. “Ice-balls” (white arrows)  form as the freezing process envelopes the tumors. This treatment takes about 2 hours and involves admission overnight. Post procedure pain is minor and goes away in less than a week with pain medications or just Advil/Tylenol.

 By the way, the patient’s renal function dropped slightly after the procedure but returned to baseline about a week later and he requires no dialysis. To monitor how successfully we killed these tumors, we repeat a CT or MRI scan in about 3 months. If some tumor remains alive, further treatment is considered and is generally easier and safer than the first procedure.

About emwalser

Dr. Walser is an energetic leader with an outstanding track record as a clinical and translational investigator. He will play a vital role in ensuring that our imaging services continue to flourish. As an internationally renowned interventional radiologist, his clinical interests are wide-ranging and include the use of ablation therapy to treat small tumors of the liver and kidney as an alternative to traditional open surgery. For example, he developed a new program of laser ablation of tumors using magnetic resonance imaging (MRI) guidance. His investigational efforts focus on developing interventional procedures using MRI to treat and diagnose patients without the use of harmful ionizing radiation. Using MRI, ultrasound, and CT technology, Dr. Walser has developed advanced protocols and techniques to image cardiovascular disease non-invasively. Dr. Walser has published extensively in peer-reviewed journals including the Annals of Thoracic Surgery,Annals of Surgery, and Cardiovascular and Interventional Radiology, as well as book chapters, abstracts and letters. He is a reviewer for many prestigious journals and has lectured throughout the world regarding cancer treatment and minimally invasive surgical management. He is a member of several important professional organizations including the American Board of Radiology (examiner), American College of Radiology, American Roentgen Ray Society, and Radiological Society of North America. As an educator, Dr. Walser has been very active in teaching and has mentored numerous residents and fellows. Dr. Walser earned his medical degree from UTMB in 1988. He completed both his diagnostic radiology residency training (1992) and interventional radiology and body imaging fellowship training (1993) at the Indiana University Medical Center. He began his professional career as an Assistant Professor and Chief of Diagnosis in the Department of Radiology at UTMB. After leadership service at other institutions including the St. Paul Medical Center in Dallas and Mayo Clinic in Jacksonville, Dr. Walser returned to UTMB in 2011.
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