Kidney cancer

Main types

• Clear cell RCC - about 70% of cases.
• Papillary RCC - about 15%.
• Chromophobe RCC - about 5%.
• Other and rare subtypes - including hereditary syndromes where bilateral or multiple tumours are more common.

Presentation and diagnosis

• Incidental imaging finding is the most common presentation in Australia.
• Less commonly, visible blood in the urine, flank pain or a palpable mass.
• Diagnosis is on dedicated multiphasic renal CT or MRI; biopsy is used in selected cases but is not routine for clearly surgical tumours.

Staging

Staging uses tumour size (cT1a to cT4), local extension (venous involvement, perinephric fat invasion) and spread to lymph nodes or distant sites. Chest imaging and sometimes bone scan or FDG-PET are added for higher-stage tumours.

Management options

• Active surveillance - for small, indolent renal masses in older or co-morbid patients, or where biopsy has shown very low-grade disease.
• Ablation (cryoablation, radiofrequency, microwave) - for selected small tumours.
• Partial nephrectomy - standard of care for most small renal masses - see robotic partial nephrectomy.
• Radical nephrectomy - when partial is not feasible - see robotic radical nephrectomy.
• Systemic therapy for metastatic disease, increasingly combined with cytoreductive surgery in selected cases.

Role of robotic surgery

Robotic access is particularly suited to partial nephrectomy, where precise reconstruction of the kidney after tumour removal determines the long-term functional result. Published series consistently show lower blood loss, shorter hospital stay and equivalent oncologic control compared with open partial nephrectomy.^4,7 For radical nephrectomy, robotic access has its clearest incremental value in complex cases - hilar tumours, venous extension, or previous abdominal surgery.