Immunotherapy patient story: Richard Frantz
If you are diagnosed with kidney cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage of the cancer and your general health. Your treatment for kidney cancer at MD Anderson will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Tumors that are confined to the kidney or to the area around the kidney usually are surgically removed. It’s important for the surgeon to leave as much of the kidney as possible. When your surgeon has a high level of experience in this type of surgery, your outcomes are likely to be better.
At MD Anderson, these surgeries sometimes can be minimally invasive (done with a laparoscope and robotic technology).
You can usually live with one kidney, but if both kidneys are removed or not working you will need kidney dialysis (a way to clean the blood with a machine). A kidney transplant may be an option for some patients.
The main types of surgery for kidney cancer include:
Radical nephrectomy is removal of the entire kidney along with the surrounding fatty tissue. Sometimes the adrenal gland and nearby lymph nodes are removed too. One of the following methods will be used, depending on the size of the tumor and other factors that your surgeon will consider.
Standard or "open" surgery: A four- to eight-inch incision (cut) is made in the front of the abdomen. The surgeon removes the entire kidney through the incision.
Laparoscopic radical nephrectomy (LRN): A small incision is made to insert a laparoscope. Other tiny incisions are made for miniature surgical instruments to remove the kidney. Benefits of this procedure include a shorter hospital stay (one to two days vs. five to seven days), shorter recovery time and less blood loss than with open surgery. Surgeon experience is important for this procedure.
Partial nephrectomy (or kidney-sparing surgery): Only the cancerous portion of the kidney is removed, along with a margin of healthy tissue around it. High quality pre-treatment imaging is used to determine what will be removed, and ultrasound can be used to look for additional tumors during surgery.
Candidates for partial nephrectomy are chosen based on favorable tumor location, co-existing health problems that may affect the treatment outcome, the condition of the kidneys and the patient's desire to save the kidney. Partial nephrectomy is best for kidney cancer tumors that are 4 centimeters or less in size. They can be done for larger tumors when necessary. Recurrence rates for stage 1 cancers removed by either radical or partial nephrectomy are about 5%.
Partial nephrectomy can be done by traditional or laparoscopic robotic methods. Robotic partial nephrectomy (RPN) offers a shorter hospital stay (one to two days instead of four to five days) and quicker recovery.
Energy Ablative Techniques
Other minimally invasive surgery techniques use either heat or cold to treat tumors in place, without having to remove the kidney. RFA and cryoablation are ideal for smaller kidney tumors in patients considered at high risk for surgery.
Cryoablation freezes the tumor to -140 degrees Centigrade with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.
Radiofrequency ablation (RFA) is similar to cryoablation, but heat is used to destroy the tumor instead of cold.
Radiation therapy has a limited role in the treatment of kidney cancer. Kidney tumors are not very sensitive to radiation, but healthy kidneys are, so radiation as a frontline treatment is not advisable. In some cases, radiation may be used to help relieve pain and other symptoms when kidney cancer has spread to the bone, brain, or other parts of the body.
Kidney tumors are very vascular, meaning they have a large number of blood vessels. The tumors use a process called angiogenesis to create their own network of blood vessels, enabling the cancer to thrive and grow.
These blood vessels are vulnerable to anti-angiogenic drugs, which are developed to take advantage of this process. This new generation of drugs targets the blood vessels leading to the tumor without harming normal blood vessels.
A number of agents have been developed, including Sutent® (sunitinib), Nexavar® (sorafenib), Votrient® (pazopanib) and Avastin® (bevacizumab). Another drug, Torisel® (temsirolimus), has shown promise in patients with more aggressive kidney disease.
Most traditional chemotherapy is generally ineffective against kidney tumors, with a few exceptions. A combination of gemcitabine and capecitabine is sometimes used to treat metastatic renal cell cancer.
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Renal cell carcinoma is occasionally responsive to immunotherapy, and is one option for kidney cancer that has metastasized (spread). These therapies have only a general, non-targeted effect on the immune system, and their side effects are not well tolerated by many patients.
Two types of immunotherapy are used to treat renal cell cancer:
Interferon-alpha (IFN) is a protein produced by white blood cells in response to a viral infection. It increases antigens on the surface of cancer cells, making them more susceptible to attack by the immune system. IFN is rarely used today.
Interleukin-2 (IL-2) is a protein that stimulates the growth of immune cells and activates them to destroy tumor cells. High-dose IL-2 therapy is given by IV, and treatment requires a five-day hospital stay. Side effects include hypotension (low blood pressure), flu-like symptoms (fever, muscle aches, headache and nasal congestion), decreased urine production, nausea and diarrhea. IL-2 can cause a complete shrinkage of disease in 5% to 10% of patients with clear cell tumors. For that reason, it is still offered as an option to patients with appropriate tumor characteristics who are in excellent overall physical condition.