Surgery is the standard treatment for RCC. There are several surgical options, depending on the stage of the disease and the overall health of the patient.
Prior to surgery, most patients undergo an electrocardiogram (ECG), chest x-ray, complete blood count (CBC), and electrolyte profile with BUN and creatinine. Imaging tests (e.g., CT scan, intravenous pyelogram [IVP], MRI scan) are performed to determine the exact location of the kidneys and to detect anatomic variations (e.g., duplicated ureter, horseshoe kidneys), kidney stones, and cancer of the bladder, ureter, or other kidney.
When the tumor is small and confined to the top or bottom portion of the kidney, a partial nephrectomy (removal of part of the kidney) may be performed. This procedure also may be used to treat patients with RCC in both kidneys and patients who have only one functioning kidney.
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Radical nephrectomy is the most common treatment for RCC. This procedure, which is performed under general anesthesia, involves removal of the entire kidney and the adrenal gland. It also may include removal of surrounding tissue and nearby lymph nodes (regional lymphadenectomy), depending on how far the cancer has spread.
Radical nephrectomy may be performed through a large abdominal incision (open radical nephrectomy) or 4 or 5 smaller incisions (laparoscopic radical nephrectomy). In laparoscopic radical nephrectomy, an instrument consisting of a light and camera lens that produces magnified images (called a laparoscope) is used to allow the physician to see inside the abdomen.
Tiny instruments are inserted through the incisions and used to separate the kidney from surrounding structures (e.g., ureter, blood vessels). The physician then enlarges one of the incisions and removes the kidney. Laparoscopic radical nephrectomy takes slightly longer to perform than open surgery.
Generally, the risk for complications and blood loss during surgery is similar in both procedures. Patients who undergo laparoscopic nephrectomy may require less pain medication, usually are discharged from the hospital sooner, and often are able to resume normal activities earlier.
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