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.

How can we detect early prostate cancer?

small prostate caThis is a high-resolution high-strength magnetic resonance (MRI) image of the prostate gland below the bladder. Notice the 6 mm dark spot to your left (white arrow on the right side of the prostate). This represents an early prostate cancer confined to the gland. Often, these small cancers can be treated with lasers and no surgery.






High tech prostate imaging, biopsy and treatment: UTMB now offering MRI-guided prostate evaluation and therapy


Cross sectional MRI view of prostate gland with needle guide in the rectum preparing for biopsy

 UTMB is proud to introduce a complete MRI solution for analysis, planning, biopsy and possible non-surgical ablative treatment of prostate cancer. The advanced imaging capabilities and biopsy tools allow state-of-art imaging and intervention for men experiencing persistently elevated PSA (prostate specific antigen) levels suspicious for prostate cancer.

 This new paradigm for evaluating and treating men with prostate cancer is a cooperative effort of the UTMB radiology and urology departments. The diagnostic MRI requires no special preparation and no rectal instruments and is highly sensitive and specific for focal cancers in the prostate gland. The prostate biopsy, done at a different setting, involves MRI-guidance and tissue sampling of areas of the prostate gland considered suspicious by the previous diagnostic MRI. Continue reading