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This article is the result of the collective efforts of urologists and oncologists at the Dilyanian Clinic.We have attempted to convey to our patients, who are faced with kidney cancer, information about modern methods of diagnosis and treatment of this disease in a clear and accessible language.

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"Nothing hurt"

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Kidney tumor

An eternal story. Please remember: kidney tumors in the early stages do not cause pain at all, and it's not pain that leads a person to see a doctor. Suddenly, I repeat, without any pain, the urine turns red. A visit to the doctor, an ultrasound – and a thunderbolt out of the blue: the diagnosis is "kidney tumor".

More often there are no complaints at all: no blood in the urine, no pain, no discomfort – just a kidney ultrasound in a clinic or a computer tomography for some other disease reveals this condition.

Kidney cancer is a malignant tumor of kidney tissues. It is very important to understand what makes it malignant and why it is dangerous for life. Firstly, tumor cells divide and multiply uncontrollably. Secondly, they can spread through the bloodstream or lymphatic system to other organs – metastasize. Ultimately, cancer cells poison and kill the body.

What to do?

"Informed means armed".

A dire situation: You or your relative have been diagnosed with "Malignant kidney tumor." Question: what to do? Answer: competent diagnosis and timely treatment. Urgently.

Tumors don't like to wait. Time works against the patient.

Diagnosis of kidney cancer


What do we consider competent diagnosis? According to any modern recommendations, it is determining the stage of the tumor, assessing its spread, and understanding the risks of various types of treatment accurately.

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CT scan with contrast for kidneys
This is the most important test that allows us to evaluate the size of the formation, its relationship to the kidney vessels, and its invasion into adjacent organs. Based on this examination, we plan further treatment.
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CT scan of the lungs
Before planning treatment, we must be certain that there are no kidney cancer metastases in the lungs, as their presence drastically changes the treatment plan.
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Kidney biopsy
In modern practice, we rarely resort to kidney tumor biopsies, as contrast-enhanced computed tomography is usually sufficient to determine the malignancy of the kidney tumor.
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Blood tests
Yes, we can prescribe a whole range of blood tests. Complete blood count, biochemical analysis, coagulation tests, and screening for hidden infections... Where would we be without blood type and Rh factor? All of this has one goal: ensuring the safety of the patient.
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Heart and lungs
ECG, echocardiogram, CT scan of the lungs, mandatory consultation with a therapist, and sometimes a cardiologist... Why? Because our surgeons are responsible for the quality of the operation performed, but it's better to reduce the risk of heart attacks and strokes during surgery.
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Leg vessels
Know this: a thrombus quietly sitting in the leg veins can detach during surgery and fly into the pulmonary arteries. This complication is called thromboembolism and, attention, it's deadly. Even in the best hospitals in the world. It's better to make sure there are no clots in the veins.
Important to know!

Since the treatment of kidney cancer is mainly surgical, we always examine the patient for contraindications to anesthesia and surgery.

Finally - treatment of kidney cancer

Requirement, law, dogma - call it what you want, but the decision about any oncological treatment must be made by a multidisciplinary team. We are obligated to consider all possible options, even though surgery is the first-line treatment for kidney cancer. But, for understanding: the surgeon, the best, the most wonderful, after removing the tumor or the kidney with the tumor, gets the patient back on their feet and... that's where their role ends. Can they monitor the patient for 5 years to exclude recurrences or metastases? Certainly, they can, but it's not their role.

That's why a multidisciplinary team exists. For the treatment of kidney cancer, a typical team includes a surgical oncologist, a medical oncologist, a radiation oncologist, and a general oncologist.

NB!!! The multidisciplinary team determines: the stage of treatment, based on the greatest benefit to the patient, the order and frequency of follow-up to monitor for cure, the necessity of chemotherapy (targeted or immune therapy) or radiation therapy (for metastases).

Kidney cancer surgery

Essentially, the surgeon has only two interventions in their arsenal: removal of only the tumor - resection, or removal of the kidney - radical nephrectomy.

Yes, our unequivocal advantage is performing these operations laparoscopically or using the DaVinci robot. Yes, it's minimal trauma, painlessness, absence of a large incision, and rapid rehabilitation. But... What exactly will be proposed? Is it possible not to lose the kidney?

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Doctor Dilyanian. Operating room.

Kidney resection

Removal of only the tumor while preserving the organ is possible only in stage 1 kidney cancer when the tumor size does not exceed 7 cm (ideally 4 cm), if the tumor does not penetrate the kidney capsule, and if there are no metastases. In all other cases, unfortunately, it is better to sacrifice the organ.

Radical nephrectomy

Radical removal of the kidney. Essentially, the surgeon removes the kidney along with all its coverings and the fatty layer. Often, lymph nodes are also removed. We use this method when it's impossible to preserve the organ, or when organ preservation is associated with the risk of disease progression and death.

Life with one kidney doesn't turn into hell, as it's sometimes portrayed online. If you're faced with the need for kidney removal, please know this.

Our Results

Countries
Countries
27
Patients from 27 countries seek surgical treatment from us.
Patients
Patients
900+
By the end of 2019, we had operated on 917 patients.
SERIOUS COMPLICATIONS
SERIOUS COMPLICATIONS
0%
There were no cases of death or major blood loss.
FAST-TRACK PATIENTS
FAST-TRACK PATIENTS
89.7%
827 patients were discharged within 3-4 days after surgery. The rest were discharged within 6-8 days.
PATIENTS UNDER OBSERVATION
PATIENTS UNDER OBSERVATION
300+
More than 300 patients are under our observation annually.
INCISION-FREE
INCISION-FREE
93.7%
859 patients underwent laparoscopic or robotic-assisted surgery.

Treatment in our clinic

DAY 1
CONSULTATION, ONCOLOGICAL TEAM DISCUSSION
DAY 2
PREPARATION FOR SURGERY, HOSPITALIZATION
DAY 3
LAPAROSCOPIC SURGERY FOR KIDNEY CANCER
DAYS 3-10
HOSPITAL OBSERVATION, TREATMENT
1-5 YEARS
FOLLOW-UP, CURE MONITORING

During the consultation, we evaluate available test results and examinations, such as contrast-enhanced computer tomography findings, and gather data on hidden and concomitant diseases. All this information is discussed on the same day during the oncological team discussion.

In the shortest possible timeframe, we conduct preoperative tests and examinations to ensure the safety of the surgical procedure. This includes consultations with a cardiologist and an anesthesiologist. On the same day, the patient can be admitted to the hospital.

Day of the surgery. On this day, we recommend not eating or drinking in the morning. The night before the surgery, we provide the patient with a sedative to alleviate anxiety and promote good sleep. Additionally, preoperative antibacterial therapy is administered.

Inpatient observation and treatment involve careful monitoring of the patient's health to prevent complications. Early patient mobilization is crucial at this stage.

It is important to understand that oncological diseases require 5-year follow-up and monitoring. In the first year after surgery, we invite the patient for follow-up visits every three months, then every six months. This allows for immediate and effective treatment in case of recurrence.

Dr. Oganes E. Dilanyan
Urology-oncology surgeon, Ph.D. of Medical Sciences
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