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Research is showing that kidney cancer patients do not need a radical nephrectomy (or complete removal of the organ) to get rid of their tumour, yet studies are showing that up to 80 per cent of kidney cancer patients are still having this procedure done.

When Jill Custeau-Maida was diagnosed with kidney cancer in 2008, her doctor booked her for surgery to have her left kidney removed. But Ms. Custeau-Maida, a recovery-room nurse in Ancaster, Ont., says she had doubts about the procedure.

Ms. Custeau-Maida's family history of Type 2 diabetes put her at risk for renal failure down the road - a dire prospect for a patient missing a kidney. So she consulted a surgeon, who cut out the five-centimetre tumour, leaving two-thirds of her kidney intact. "I've been fine ever since," she says.

Organ-sparing procedures should be the norm, according to Kidney Cancer Canada. But despite 2009 consensus guidelines indicating that many patients do not need a full nephrectomy (kidney removal), up to 80 per cent of kidney-cancer patients in Canada are still losing a kidney, the organization reports.

Evidence suggests that the practice puts kidney-cancer patients at increased risk for renal failure in the surviving kidney.

A Canadian study published this month in the journal European Urology shows that in less than three years after surgery, one in 10 kidney-cancer patients develops kidney disease. But the risk is nearly double for patients who have a full nephrectomy, compared with those who have only part of the original kidney removed.

The study confirms earlier research conducted at the Memorial Sloan-Kettering Cancer Center in New York and the Kaiser Permanente based in Oakland, Calif., says Ron Moore, an Edmonton urologist who specializes in kidney cancer and transplantation.

Cancer recurrence is no more likely in patients with a partial versus full nephrectomy, Dr. Moore notes. "I think it's taken a while for the information to get out that total nephrectomy potentially has adverse effects."

The findings do not apply to kidney donors, he adds. Donors are healthy individuals who are intensively screened for risk factors for kidney disease, Dr. Moore explains, "so they aren't as likely to run into problems long-term."

The best candidates for partial nephrectomy are patients with tumours measuring less than seven centimetres and not located near the main blood vessel in the kidney. The procedure involves minor risks, including post-operative bleeding and urine leakage, which are usually managed without repeat surgery, Dr. Moore says. And depending on how much normal kidney is left, "there's barely a change in the overall renal function with a partial nephrectomy."

Kidneys act as filters for the blood, removing waste such as urea and ammonium, which are excreted by the bladder. During urine production, the kidneys reabsorb water, glucose and amino acids. They also produce vital hormones, including erythropoietin, which controls the production of red blood cells.

Kidney cancer is the 10th-most-common form of the disease in Canada, with a higher mortality rate than many cancers. Each year, about 4,800 new cases are diagnosed and 1,600 patients die from the disease. Symptoms, which include a pain in the back or abdomen, are easily mistaken for other conditions, Kidney Cancer Canada says.

Since kidney tumours are resistant to conventional chemotherapy or radiation, surgery (including laparoscopy, or "keyhole" surgery) is the most common treatment. Organ-sparing alternatives include freezing the tumour (cryotherapy), heating (radiofrequency ablation) or monitoring the tumour (active surveillance).

"Those are very good options for patients," says Joan Basiuk, a nurse and media-relations director for Kidney Cancer Canada.

Ms. Basiuk likens partial nephrotomy and ablative techniques to the medical advances that have enabled breast-cancer patients to avoid full mastectomies. But since these alternatives have not been widely adopted, she says, patients should make sure to discuss treatment options with their doctors before surgery. Ms. Basiuk suggests considering questions listed on the Internet at kidneycancercanada.org.

Ms. Custeau-Maida recommends doing research and getting a second opinion. It's natural to feel panicky after a diagnosis, she says, but kidney tumours tend to grow slowly. "You've got some time to make a decision."

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