Kidney cancer is often silent – until it isn’t

Kidney cancer can develop quietly, with many experiencing few or no symptoms in the early stages. In Malaysia, about 47% of kidney cancer cases are diagnosed at a late stage, when treatment becomes more difficult.

Consultant urologist and robotic surgeon Dr Lee Kheng Siang said renal cell carcinoma (RCC), the most common form of kidney cancer, has a high cure rate when found early.

“Early kidney tumours and cysts are usually silent. In most cases, they are picked up incidentally during abdominal ultrasound scans done as part of health screening,” he said.

Symptoms are more likely to appear once a tumour becomes larger. These can include pain in the abdomen or lower back, swelling in the abdomen or blood in the urine.

In more advanced cases, people may also experience fatigue, reduced appetite or unexplained weight loss.

When a kidney tumour or suspicious cyst is detected, further tests are usually needed. Lee said a contrast CT scan of the kidneys and urinary tract can diagnose cancers with an accuracy of about 95-99%.

In many cases, a biopsy is not required before treatment. “Early RCC can be cured with surgery to remove the tumour,” he said.

Depending on the size and location of the tumour, surgery may involve partial nephrectomy, where only the tumour and a small margin of surrounding tissue are removed; or radical nephrectomy, where the entire kidney is removed.

Where possible, Lee said preserving part of the kidney is generally preferred. This can be especially important for younger patients, people with only one functioning kidney, or those at risk of chronic kidney disease.

Kidney cancer surgery can be performed through open, laparoscopic or robotic-assisted techniques. The latter two approaches generally involve smaller incisions, less pain, and shorter recovery times compared with open surgery.

For larger kidney tumours, Lee said laparoscopic nephrectomy is now widely used, while open surgery is generally reserved for more complex cases.

Robotic-assisted surgery can also make it possible to preserve more kidney tissue in technically difficult cases. “It provides a three-dimensional, high-definition view and precise instruments that mimic the surgeon’s hand movements,” he said.

“This allows us to attempt complex partial nephrectomies that previously would have required removing the entire kidney.”

Robotic surgery is not automated: every movement is controlled by the surgeon, rather than by artificial intelligence or the machine itself.

The biggest challenge with kidney cancer is that feeling well does not necessarily mean there is no disease. As early tumours may not cause symptoms, Lee stressed that health screening can identify any kidney abnormalities before they become more serious.

For many, early diagnosis can mean removing only the tumour rather than the whole kidney, helping to preserve organ function while offering a better chance of long-term recovery.

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