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Our kidney cancer program focuses on each patient as a unique individual. We aim to choose the best therapy through an experienced team of surgeons, medical oncologists, pathologists, and radiologists.
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Diagnosed With Kidney Cancer
We understand the anxiety that a diagnosis of kidney cancer can bring to the patient and their family. The most important thing one can do is to learn about this disease and enlist the help of an experienced team of physicians.
Johns Hopkins Studies
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*(Guzzo TJ, Pierorazio PM, Schaeffer EM, Fishman EK, Allaf ME. The accuracy of multidetector computerized tomography for evaluating tumor thrombus in patients with renal cell carcinoma. J Urol. 2009 Feb;181(2):486-90; discussion 491. Epub 2008 Dec 19.)
This is an example of a patient who has a right kidney tumor. The tumor extends into the vena cava all the way to the heart (right atrium). Such precise pictures can be obtained using multidetector CT scans.
For select patients with vena cava involvement, surgery could be life saving. This type of surgery is very rare and is best approached at centers of excellence (watch video clips). At Johns Hopkins we take a multi-disciplinary approach to these cases. Depending on the extent of the tumor, a team is assembled that may consist of a general surgeon, vascular surgeon, cardiothoracic surgeon, and a specialized anesthesiologist. The anesthesia team is critical during these operations and routinely perform intraoperative transesophageal echocardiogram (TEE) to monitor the tumor during the operation. TEE is a special ultrasound that is placed in the patient’s esophagus and monitors the tumor that sits within the vena cava. This is important as part of the tumor or a blood clot on it could dislodge and result in a pulmonary embolus (clot in the lung) which can be deadly. Keeping an eye on this area allows the surgical team to be updated on the status of the tumor much like a GPS machine in your car.
*(Alejo JL, George TJ, Beaty CA, Allaf ME, Black JH 3rd, Shah AS. Novel approach to recurrent cavoatrial renal cell carcinoma. Ann Thorac Surg. 2012 May;93(5):e119-21.)
A kidney tumor extending into the renal vein but NOT the vena cava. The tumor is extracted and the vena cava is closed.
A kidney tumor is
extending into the vena cava. The tumor is extracted with the wall of the vena cava to ensure complete removal.
A patch is then sewn onto the vena cava to close it properly.
courtesy of Dr. James Black, MD
In general, for these operations the kidney is dissected and the renal artery (artery feeding the tumor) is promptly controlled. Now that there is no new blood coming into the tumor, we assess how "high" it goes-- is it just in the vena cava, or into the liver veins, or all the way into the heart? This is usually performed by the surgeon but our anesthesia team uses a specialized ultrasound that monitors the tumor and can evaluate the extent of the tumor accurately. This real-time intraoperative transesophageal ultrasound can confirm that the tumor has been removed and can also alert the surgeon of additional tumor that the surgeon may not be able to see or feel.
A. A transesophageal ultrasound picture showing the tumor in the vena cava and extending into the heart.
After the extent of the tumor is define, the blood flow to the area is interrupted and the vena cava is opened. The tumor is extracted and the vena cava is then reconstructed. In rare situations the vena cava is grafted (see above) or in even rarer situations it can be tied off completely. Blood flow through the vena cava is then resumed and the procedure is terminated.