Kidney Cancer with Vena Caval Involvement

In certain cases, kidney cancer can extend beyond the kidney itself and grow into the renal vein and even into the inferior vena cava (IVC), the major vein carrying blood to the heart. This complex presentation requires highly specialised surgical management.

Understanding Caval Involvement
Extension of the tumour into the IVC is termed a “tumour thrombus”. This can occur in a minority of kidney cancer cases and may extend upward to involve the liver or even the heart.

Symptoms
Patients may experience:

  • Leg swelling (due to impaired venous return)

  • Shortness of breath or chest pain (if thrombus extends to the heart)

  • Symptoms related to the kidney tumour itself

Investigation
A high level of imaging detail is needed to accurately map the extent of tumour thrombus. CT scans, MRI, and echocardiography are commonly used.

Surgical Management
Surgery for kidney cancer with vena caval involvement is highly complex and often requires a multidisciplinary team, including urological and cardiothoracic surgeons. Key considerations include:

  • Careful pre-operative planning with cross sectional imaging

  • Dissection and control of major blood vessels

  • Removal of tumour thrombus from the IVC with or without cardiac bypass support

Guy’s and St Thomas’ Hospital is a tertiary referral centre for advanced renal cancer and maintains a high-volume practice in these complex cases. Mr Kamran Haq is part of the team undertaking these cases, operating alongside colleagues from the renal and cardiothoracic service.