Sunway city: Renal cell carcinoma, or kidney cancer, is a silent disease that often goes undetected until its later stages, says a local urologist. Urologist and kidney transplant surgeon at Sunway Medical Centre (SMC), Sunway City, Dr Murali Sundram Mikaail Abdullah, highlighted that Malaysia records about two kidney cancer cases per 100,000 people annually, translating to roughly 700 cases in a population of 35 million.
According to BERNAMA News Agency, Dr Murali elaborated that the disease typically affects older adults, particularly those over 50, and is more common in men, especially those who are overweight or smokers. Other high-risk groups include patients with kidney failure on dialysis and individuals with a family history of kidney cancer or certain genetic disorders.
Dr Murali explained that in the early stages, kidney cancer presents no symptoms, although small traces of blood may appear in urine tests. There is no specific blood test to detect it, and most cases are diagnosed incidentally during imaging done for other reasons. Abdominal ultrasound or CT scans conducted during health screenings or for unrelated issues often reveal the presence of kidney tumours.
As kidney cancer progresses, symptoms such as visible blood in urine, persistent back pain, or abdominal swelling may manifest. Dr Murali stated that treatment depends on the size and location of the tumour, with options ranging from partial nephrectomy to remove just the tumour, to total nephrectomy for advanced cases.
He noted that surgery can be performed via open surgery or through minimally invasive methods like laparoscopy or robotic surgery. A particularly complex scenario arises when the tumour extends into major blood vessels, known as a tumour thrombus, occurring in 4 to 10 per cent of kidney cancer cases, making surgery extremely challenging.
Dr Murali recounted a recent case at SMC involving a woman in her 50s with a large tumour thrombus extending from her kidney into her heart. This required a highly customised surgical plan involving a multidisciplinary team, including anaesthetists, cardiothoracic and vascular surgeons, urologists, oncologists, nephrologists, perfusionists, radiologists, and intensive care specialists.
SMC's cardiothoracic surgeon Prof Dr Anand Sachithanandan and vascular surgeon Dr Naresh Govindarajanthran were among those who participated in the surgery. Dr Anand explained that locally advanced kidney tumours (levels 3 or 4) reaching the heart's right atrium necessitate deep hypothermic circulatory arrest (DHCA) to create a bloodless surgical field.
Dr Murali emphasized that standard laparoscopic surgeries typically require a hospital stay of two to three days with a full recovery in four weeks. However, surgeries involving the heart necessitate longer hospitalisation, usually 10 to 14 days, and up to three months for full recovery. He also addressed misconceptions about kidney cancer, underscoring that routine blood tests cannot detect the disease.
He encouraged high-risk individuals, including smokers, dialysis patients, and those with a family history of kidney cancer, to undergo regular screening. The most effective and cost-efficient screening tool remains the abdominal ultrasound, while CT scans are the gold standard for confirming solid organ cancers.