For the lion's share of kidney cancers, surgery remains the top recommendation for initial treatment.
- Complete kidney removal
Known as radical nephrectomy, this procedure removes the kidney in its entirety, as well as a margin of healthy nearby tissue, and associated lymph nodes. If cancer has invaded the adrenal gland, it will be removed as well. Open surgery requires a single, large incision through which the kidney is removed. The laproscopic and robotic alternatives are less invasive and uses several smaller incisions, tiny surgical tools and a video camera for guidance.
- Tumor removal
This is called a partial nephrectomy, and it involves removing only the tumor and a small margin of surrounding healthy tissue. It's also known as a nephron-saving procedure in that it leaves the kidney functionally intact. ., If oncologically safe, it is always preferable to leave as much health kidney tissue in place as possible, because it lessens the risk of later complications. A partial nephrectomy can performed laparoscopically, robotically, or as an open surgery.
- Removal of the testicles
Known as orchiectomy, this surgery immediately reduces testosterone levels in the body. On par with hormone therapy in terms of effectiveness, orchiectomy lowers testosterone levels more quickly, when time is of greater concern.
- Removal of the prostate
Radical prostatectomy removes the prostate gland, a portion of surrounding healthy tissue, and sometimes the nearby lymph nodes. No matter how it's performed, radical prostatectomy runs the risk of causing urinary incontinence and erectile dysfunction. All options should be thoroughly discussed with your doctor to make sure you understand the risks and benefits of each. There are several ways of approaching this surgery:
- Abdominal incision
Known as retropubic surgery, an incision is made in your lower abdomen to access and remove the prostate.
- Incision between the anus and scrotum
Perineal surgery requires an incision between the anus and scrotum to facilitate removal of the prostate. Compared to an abdominal incision, this technique results in quicker recovery times because it doesn't involve major surgery into the abdominal cavity. The downside is that it requires a separate abdominal incision to access the lymph nodes.
- Laparoscopic prostate removal
This is a minimally invasion technique in which a series of small incisions are made in the abdomen. These incisions allow the insertion of a thin tube with a video camera (laparoscope) placed on its end. Guided visually by the laparoscope, other specialized surgical tools are passed through the openings to remove the prostate and nearby lymph nodes. Laparoscopic surgery offers the advantages of abdominal surgery, but with a quicker recovery time.
Your doctor may choose to perform this surgery with robotic assistance. Surgical instruments are attached to a robotic arm. Movements are made by the surgeon remotely, while viewing a video monitor. The robotic arm allows for greater precision than is possible with manual surgery.
- Freezing prostate cancer cells
Known as cryosurgery or cryoablation. Using X-ray imaging for guidance, super-cooled nitrogen gas is pumped to the tumor site with a specialized needle freeze and kill the tumor's cancer cells. A second heated gas is then administered to return the area to normal body temperature. Cryoablation is a procedure undergoing an evolution, with the hope that newer forms will increase its effectiveness and reduce side effects.
- Heating prostate cancer cells
In a procedure called radiofrequency ablation, a special needle is inserted directly into your prostate tumor. X-ray imaging is used for guidance. An electrical current is applied through the needle and into the cancer cells. The heat generated causes the tumor to cauterize. Research on this technique is still incomplete, and it's usually only offered to poor surgery candidates, and those with easily accessible tumors.
Known as radical inguinal orchiectomy, the primary treatment for testicular cancer is surgical removal of the affected testicle. Removal is accomplished by way of an incision made in the groin, through which the testicle is extracted. You also may choose to have a prosthetic testicle inserted. A general anesthetic is administered prior to surgery to keep you comfortable. As is the case with all surgeries, there is an attendant risk of pain, bleeding and/or infection, which are usually easily managed.
- Retroperitoneal lymph node dissection (RPLND)
It may also be necessary to remove the lymph nodes in your groin, known as retroperitoneal lymph node dissection. This procedure can be performed after knowing the pathology of the testis. It is more commonly done for nonseminomas and rarely is performed for seminomas usually after failure of other forms of treatment. The procedure has been traditionally performed as an open procedure, however nowadays it can be successfully performed with laparoscopic and robotic techniques Preservation of ejaculatory nerves running from the lower part of the abdomen is a high priority, but not always possible. If nerves are severed, you may have difficulty ejaculating, but erectile function is usually spared.
Often, removal of the affected testicle is the only treatment required for early-stage testicular cancer. You'll be scheduled for a series of follow-up exams that will likely include further blood testing and CT scans to make sure your cancer has not returned. Appointments are usually scheduled every few months at the start, tapering off over time. Depending on the type, stage and progression of the cancer, your doctor may recommend addition therapies.
At stages II and III, in which cancer has spread deeply into the bladder wall, complete bladder removal may be necessary. Known as a radical cystectomy, this procedure typically removes the entire bladder and surrounding lymph nodes.
- Tumor removal
When the cancer is confined to the inner layers of the bladder, the TURBT procedure (transurethral resection of bladder tumor) is often recommended. Aided visually by a cystoscope, the doctor passes a small wire loop up the urethra and into the bladder. An electrical current is sent through the wire loop, which is used to burn away whatever cancer cells are found. In lieu of the wire loop, laser therapy or specialized cutting tools can be used to remove the tumor. You might experience a few days of painful or bloody urination after the TURBT procedure, but the effects are usually short-lived.
- Partial bladder removal
Referred to as a segmental or partial cystectomy, only the portion of the bladder that contains the cancer is removed. This is a procedure that works nicely for well defined malignancies in areas of the bladder that can be easily accessed. Segmental cystectomy is only used when the overall function of the bladder won't be compromised. Of course, any surgery of this kind carries a certain level of risk for infection or bleeding. After the surgery, you may experience more frequent urination because the size of the bladder has been reduced.
- Complete bladder removal
For men, this also means removal of the prostate and seminal vesicles. This will cause infertility, but sexual function can often be preserved by avoiding damage to the nerves necessary for an erection.
For women, radical cystectomy normally includes removal of the uterus, ovaries and perhaps part of the vagina. This too will cause infertility, and may cause the premature onset of menopause in women of child-bearing age.
- Reconstructive surgery
After complete bladder removal, several options exist to create an alternate path for urination. Each method has individual merits as well as drawbacks. You will need to evaluate the options in light of your overall health, type of cancer and personal preferences.
A urinary conduit (tube) can be created that funnels output from the kidneys to an opening in the abdomen, using a small piece of intestine. Urination is achieved by the use of a pouch (urostomy bag) worn outside the body, and strapped to the abdomen.
A section of intestine is used to fabricate a small reservoir to hold urine within the body. This is known as a cutaneous continent urinary diversion. Urine is drained from the reservoir by way of a catheter, inserted through a newly created hole in the abdomen. Urine can then be drained as needed, several times per day.
A surgically created bladder-like structure (neobladder) is created from a small length of intestine and placed within the abdomen. It is then connected to an intact urethra, allowing normal urination. You may have trouble completely emptying the neobladder, and may need to use a catheter to complete the drainage.Back to Top
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