Once kidney cancer has been detected, graded, and categorized by stage, your team of specialists in oncology, radiation oncology, surgery and pathology will work together to assess your best course of treatment for your specific type of kidney cancer. This will include formulating a coordinated plan of personalized treatment consistent with the highest standards of care. Your treatment will be tailored to the type, grade, and stage of kidney you have, and may include a combination of surgery, radiation, targeted therapy, immunotherapy, and chemotherapy.
Kidney Cancer Surgery
Surgery is the main treatment for most kidney cancers, and the only treatment for the 40% of kidney cancers that are confined to the kidney. Without surgery, chances of survival are very small, and even patients whose cancer has spread may benefit from removal of the tumor. Depending on the type, grade, and stage of the cancer, surgery may remove just the cancer and some surrounding kidney tissue or an entire kidney, and may remove nearby lymph nodes, adrenal gland and protective fat as well.
Laproscopic nephrectomy is the preferred method for removing an entire kidney (radical nephrectomy). The operation is done through several small incisions, into one of which a camera is inserted, and from one of which the kidney withdrawn. Most people do fine with just one kidney.
With earlier-stage tumors (generally, smaller than 4-7 cm), often only the tumor and some surrounding tissue is removed (partial nephrectomy). Studies indicate that long-term results are about the same as with radical nephrectomy. This is considered difficult surgery; WellStar surgeons are very experienced with this procedure.
Sometimes, the lymph nodes and/or adrenal gland near the kidney will be removed to see if they're cancerous as well. Patients whose imaging tests indicate well-localized cancer that does not involve the lymph nodes and adrenal gland may be spared this surgery; this should be discussed with your WellStar physician before surgery.
Nephrouterectomy is the the standard treatment for transtional cell carcinoma (TCC), the ureter (which conducts urine from the kidney to the bladder) and the bladder cuff (which connects the ureter to the bladder) will also be removed.
In about 25% of patients with kidney cancer, the cancer will have spread before diagnosis. The lungs, bones, brain and liver are the most common sites of spread. In some patients, surgery may still be helpful. In rare cases where there is only one of a few points of spread, they may be removed along with the kidney or at a later time. Otherwise, removing the tumors may relieve some symptoms, but this doesn't usually extend life.
For patients unable to undergo surgery, there are a few treatments that are used to destroy kidney tumors. However, there is much less clinical evidence of their effectiveness than there is for surgery.
- Cryoablation uses extreme cold to freeze the tumor. A needle is inserted into the tumor, through which cold gas is pumped. The physician watches the tumor during the test to ensure that the tumor is destroyed without too much damage to surrounding tissue.
- Radiofrequency ablation (RFA) uses high-energy radio waves from a probe to heat and destroy the tumor.
Radiation therapy uses high-powered beams of energy to kill cancer cells. Kidney cancers are relatively insensitive to radiation, so it is generally used only in people who cannot undergo surgery, or to ease the pain caused by cancers that have spread.
Chemotherapy is the use of drugs given by mouth or injection to destroy cancer cells. It can be used to assist in the cure of cancer patients or to prolong life or the quality of life.
Kidney cancers are usually resistant to chemotherapy, but it may be useful to combat cancers that have spread to other organs.
Target therapy differs from standard chemotherapy in that it focuses on the genetic and molecular mechanisms underlying the cancer. It is particularly useful for advanced kidney cancers because they resist radiation and chemotherapy; while they may shrink or slow the cancer, they have not yet been shown to be curative.
- Sorafenib (Nexavar®) and Sunitinib (Sutent®) block growth of blood vessels and growth-stimulating molecules in cancer cells.
- Temsirolimus (Torisel®) and Everolimus (Afinitor®) block a protein that promoted cell growth and division.
- Bevacizumab (Avastin®) inhibits the growth of blood vessels, and is particularly useful in conjunction with interferon-alpha.
Immunotherapy works by stimulating the immune system to fight the cancer. The two most frequently used types of immunotherapy are Proleukin® (interleukin-2) and alfa interferon.
Since immunotherapy's side-effects may be severe, and even fatal, is used to treat only advanced, metastatic cancers.
Proleukin® (interleukin-2): Prior to the FDA-approval of new targeted therapies, Proleukin was the standard of care for patients with renal cell cancer. It is typically administered in high doses as an inpatient treatment and has historically been associated with severe side effects. However, the safety of high-dose Proleukinhas significantly improved over the past decade.
Unfortunately, long-term results of clinical trials indicate that only approximately 15% of patients with advanced renal cell carcinoma have an anticancer response when treated with high-dose Proleukin.For this reason the combination of targeted therapy plus Proleukin is being evaluated in clinical trials.
Interferon: Interferon is naturally produced in the body and stimulates the immune system. Interferon-alpha is produced in a laboratory, and mimics the action of natural interferon. It has been shown to stimulate the immune system to recognize and destroy some types of cancer cells.
Treatment of renal cell carcinoma with interferon appears to produce anticancer responses in fewer than 15% of patients with advanced renal cell cancer. Because side effects can be severe and it has not been shown to improve survival, the use of interferon alone in the treatment of renal cell carcinoma remains controversial.