NEW DELHI: For nearly two years, a 48-year-old Delhi man noticed blood in his urine. It appeared suddenly, then settled with medication. There was no pain, no fever, or weight loss. Each time, he was treated locally and reassured.But when the bleeding returned late last year, things were different. He developed urinary retention and needed to be catheterised. Further tests revealed the cause: a large tumour in his right kidney.By the time he was referred to AIIMS, scans showed the cancer did not remain confined to the kidney. It grew into the renal vein and further into the inferior vena cava (IVC), the major vein that carries blood from the lower body to the heart.Kidney cancer constitutes about 2–3% of all cancers, with global incidence rates around 4–6 per 100,000. However, in about 4–10% of cases, the tumour extends into major veins, making the surgery more complex.“When the tumour enters the IVC, you are operating within a major blood vessel,” said Prof B Nayak from the department of urology at AIIMS. “In some cases, it can even extend towards the heart. These are technically demanding procedures.”The tumour measured nearly 8–9 cm. The patient, who has a history of poliomyelitis and lives with physical disability, experienced painless haematuria — a symptom doctors stress should never be ignored.Traditionally, such cases are managed through open surgery with a large incision, often at specialised centres with cardiovascular backup.In this case, the surgical team opted for a robotic approach to remove both the kidney tumour and the tumour thrombus from the vein.Prof Rajeev Kumar, part of the surgical team, said robotic technology allows certain complex procedures to be performed in a minimally invasive manner. “This case shows how robotic assistance can be helpful in technically demanding situations,” he said.Doctors cautioned that such procedures should be undertaken at experienced centres. “Most tumour thrombus cases are treated with open surgery. But in selected patients, a minimally invasive approach may offer faster recovery,” head of the Department Prof Amlesh Seth said.The surgery was performed three weeks ago. Histopathology confirmed clear cell renal carcinoma. The tumour and its venous extension were removed. The patient is recovering well.Even at this advanced stage, five-year survival can range between 50–70% if the cancer has not spread elsewhere and is fully removed.For doctors, the case carries a clear public message: blood in urine is not trivial. It can be the only visible sign of a serious disease.
