In disseminated (metastatic) disease, it has been demonstrated that survival and quality of life is 2,5 times better in favor of patients treated with surgical removal plus immunotherapy than those who were not operated or were not eligible for surgery and could be treated only with immunotherapeutic agents.
Surgical removal of cancerous kidney in metastatic disease not only controls discomforting local symptoms but also allows better therapeutic advantages of immunotherapy.
In metastatic disease, patient’s immune system has to function properly in order for medical oncologic therapy to be beneficial. Kidney cancer hampers one’s immune system; thus, surgical removal of the diseased kidney facilitates refreshment of immune system and helps to fight against malignancy. Unfavorable effects related to kidney cancer may subside after surgical removal.
Is Surgery Suitable for All Patients With Advanced Disease?
- Surgery for metastatic kidney cancer is a difficult and risky operation; thus, it should be performed by experienced surgical teams and in well-equipped medical facilities
- Preoperative evaluation must disclose dissemination to brain and liver
- Patient’s medical status must be suitable for this exhaustive surgery
- No sarcomatous elements must exist if a previous biopsy has been performed
Cancers Of Renal Pelvis and Ureter
These are the cancers that develop from the part where urine is collected (Renal Pelvis) and transported to bladder through a tube-like organ (Ureter).
Symptoms and Diagnosis
The most important and only symptom of this disease is blood in urine (Hematuria). This may be visible or may be discovered in urinalysis. In addition, there may be flank pain on the affected side.
Diagnosis; CT Urography, Cystoscopy (Visualization of the interior of bladder by inserting special instruments in order to see bloody urine draining from the affected side) and Ureterorenoscopy (URS: Visualization of the entire ureter and inner part of kidney on the suspected side by insertion of special instruments are the means for diagnosing cancers of ureter and renal pelvis. A biopsy can be performed during these procedures.
Treatment
Treatment of this disease differs from the abovementioned kidney cancer. The kidney and ureter are completely removed surgically along with a cuff of bladder on the affected side. The bladder part where the ureter is attached is removed because following surgical removal the disease may recur in up to 70%.
Postoperative Course
After discharge we follow the patients at certain intervals by cystoscopies as stated in the treatment section to discover and treat appropriately any recurrence in the bladder.
Role of Chemotherapy
In cancers of renal pelvis and ureter chemotherapy is initiated if distant organ metastases are encountered on follow up or a cancerous dissemination is found in lymph node specimens removed during surgery.
What to Do If Cancer If Cancer Recurs in Bladder on Follow-up?
As stated in Bladder Cancer Section we perform an endoscopic surgical process and remove the tumor and have refer the specimen to pathologic evaluation. If pathology reveals invasion of bladder muscle by cancer (T2 High Grade) Radical Cystectomy, surgical removal of bladder, prostate and seminal vesicles along with lymph nodes must be performed. Patients who are not eligible for this extensive surgery are referred to radiotherapy.
If pathology confirms a tumor not invading muscle layer of bladder, intravesical drug administration and periodic cystoscopies are performed on follow-up.