KUALA LUMPUR, Aug 18 (Bernama) — 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 said Malaysia records about two kidney cancer cases per 100,000 people annually, or roughly 700 cases in a population of 35 million.
“The disease typically affects older adults, particularly those over 50, and is more common in men — especially those who are overweight or smokers,” he told Bernama in an exclusive interview.
Other high-risk groups include patients with kidney failure on dialysis and individuals with a family history of kidney cancer or certain genetic disorders.
“In the early stages, kidney cancer presents no symptoms. There may be small traces of blood in the urine tests, but there is no specific blood test that can detect it. Most cases are diagnosed incidentally during imaging done for other reasons,” said Dr Murali.
He said abdominal ultrasound or CT scans done during health screenings or for unrelated issues often reveal the presence of kidney tumours.
As the disease progresses, symptoms such as visible blood in urine, persistent back pain, or abdominal swelling may appear.
Dr Murali said treatment depends on the size and location of the tumour.
“If the tumour is small, a partial nephrectomy can often be performed to remove just the tumour, preserving the rest of the kidney,” he said. In advanced cases, a total nephrectomy — removal of the entire kidney — is necessary.
He said surgery can be done via open surgery or through minimally invasive methods like laparoscopy or robotic surgery.
One of the most complex scenarios is when the tumour extends into major blood vessels, known as a tumour thrombus.
“This occurs in 4 to 10 per cent of kidney cancer cases and makes surgery extremely challenging because the tumour can extend all the way into the heart,” he said.
He shared a recent case at SMC involving a woman in her 50s with a large tumour thrombus that reached from her kidney into her heart.
A highly customised surgical plan was required, involving a multidisciplinary team — including anaesthetists, cardiothoracic and vascular surgeons, urologists, oncologists, nephrologists, perfusionists, radiologists and intensive care specialists, he said.
Dr Murali, who served as the patient’s primary care consultant, said several pre-operative meetings were held to evaluate all treatment options and plan for potential complications.
SMC’s cardiothoracic surgeon Prof Dr Anand Sachithanandan and vascular surgeon Dr Naresh Govindarajanthran were among those involved in the surgery.
Dr Anand said locally advanced kidney tumours (levels 3 or 4) that reach the heart’s right atrium require deep hypothermic circulatory arrest (DHCA) to create a bloodless surgical field.
“To do this, we connect the patient’s circulation to a heart-lung machine — a routine procedure for most heart surgeries — before we carefully and deliberately lower the patient’s core body temperature to about 18 degrees Celsius to safely stop the heart and the entire circulation.
“Then all the blood in the body is drained away into the heart-lung machine,” he said. He added that DHCA must be performed swiftly and precisely.
“The patient will only tolerate a brief period of DHCA. We typically have a 45-minute window to avoid the risk of irreversible brain or organ damage.”
Dr Murali said standard laparoscopic surgeries usually require a hospital stay of two to three days and a full recovery in four weeks. However, surgeries involving the heart require longer hospitalisation — typically 10 to 14 days — and up to three months for full recovery. He also addressed misconceptions surrounding kidney cancer, stressing that routine blood tests cannot detect the disease.
“The most effective and cost-efficient screening tool remains the abdominal ultrasound, while CT scans are the gold standard for confirming solid organ cancers,” he said.
He urged high-risk individuals — including smokers, dialysis patients and those with a family history of kidney cancer — to undergo regular screening.
— BERNAMA
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