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.
Kidney cancer treatment plans
For patients whose cancer hasn’t metastasized, or spread beyond the kidney and nearby lymph nodes, surgery to remove the tumor is the primary treatment. Patients with medullary kidney cancer, a rare subtype of the disease, may be given chemotherapy after surgery.
If the disease has spread beyond the kidney, patients usually get a combination of different immunotherapy drugs or an immunotherapy/targeted therapy combination. Radiation therapy may be used to help control symptoms and even slow the growth of the metastases.
In most cases this approach slows the growth of the cancer but does not result in a cure. However, for a small but growing percentage of patients, these drug combinations do cure the cancer, with some patients showing no evidence of disease even after they’ve stopped taking these medications.
Kidney cancer treatments
Cancer treatment can be a significant physical burden and risk for older patients and/or those in poor health. These patients may be good candidates for active surveillance, especially if the tumor is small. With this approach, doctors monitor the cancer through blood and urine tests as well as imaging exams. Treatment only begins when and if the cancer advances or if the patient’s overall health improves.
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, though in some cases the entire organ will need to be taken out.
At MD Anderson, these surgeries are usually minimally invasive, meaning only a few small incisions are needed. Minimally invasive surgery can be performed with a laparoscope (a thin rod with a camera and surgical tools attached) or with a robot controlled by a surgeon.
Minimally invasive surgery is shown to result in less pain, shorter hospital stays and quicker recovery times than traditional “open” procedures, which require incisions ranging from 4 to 8 inches. Open surgery is usually performed only when a patient is not eligible for minimally invasive surgery because of the specific aspects of his or her cancer.
You can usually live with one kidney, but if both kidneys are removed or not working you will need dialysis (a way to clean the blood with a machine). A kidney transplant may be an option for some patients.
The two main types of surgery for kidney cancer include:
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, 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, but it can be done for larger tumors when possible.
Radical nephrectomy: In this procedure, the entire kidney along with the surrounding fatty tissue is removed. Sometimes the adrenal gland and nearby lymph nodes are also removed. Radical nephrectomy is typically performed on patients with more advanced cancer.
Energy ablative techniques
Other minimally invasive techniques use either heat or cold to treat tumors in place, without having to remove any of the kidney. These are ideal for smaller kidney tumors in patients considered at high risk for surgery.
Cryoablation freezes the tumor 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.
While many medications directly kill cancer cells, targeted therapy works by stopping or slowing the growth or spread of cancer.
This happens on a cellular level. Cancer cells need specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. For kidney cancer, these therapies are mainly used for patients whose disease has spread to other organs in the body.
Most targeted therapies for kidney cancer are angiogenesis inhibitors. Angiogenesis is the process of tumors creating their own network of blood vessels, enabling the cancer to thrive and grow. Angiogenesis inhibitors disrupt this process.
Other targeted therapies for kidney cancer interrupt the cancer cell division and multiplication. These drugs are approved for treatment of advanced kidney cancer but are less commonly used.
Like targeted therapy, immunotherapy does not directly kill cancer cells. Instead, these drugs work by improving the ability of the patient’s immune system to eliminate cancer.
Most immunotherapies for kidney cancer are known as checkpoint inhibitors. These medications help cancer-fighting immune cells, called T cells, mount a longer-lasting response against the disease.
Cytokines, including interleukin-2, spur the growth of immune system cells to fight cancer. They are used only rarely for patients with advanced kidney cancer.
Most traditional chemotherapy is generally ineffective against kidney tumors, so it is currently not used often. Chemotherapy can be used in cases of patients with medullary kidney cancer.
Kidney tumors are not very sensitive to standard forms of radiation but healthy kidney cells are. For this reason, standard radiation therapy has a limited role in the treating the primary kidney tumor.
In rare cases, radiation oncologists may use highly focused beams to treat the tumor. These techniques include stereotactic radiosurgery and occasionally proton therapy.
If a patient’s cancer has spread beyond the kidney, standard radiation may be used to help stop the growth of metastases, relieve pain and minimize other symptoms.
Angiogenesis is the process of creating new blood vessels. Some cancerous tumors are very efficient at creating new blood vessels, which increases blood supply to the tumor and allows it to grow rapidly.
Researchers developed drugs called angiogenesis inhibitors, or anti-angiogenic therapy, to disrupt the growth process. These drugs search out and bind themselves to VEGF molecules, which prohibits them from activating receptors on endothelial cells inside blood vessels. Other angiogenesis inhibitor drugs work on a different part of the process, by stopping VEGF receptors from sending signals to blood vessel cells.
Treatment at MD Anderson
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Often, patients who are diagnosed with renal cell carcinoma when it is in its earliest stages can be successfully treated. But what are the treatment options for early-stage disease as well as renal cell carcinoma that has spread to other parts of the body? How do you know which treatment is right for you?
Here’s what to know about current treatment options and new approaches being explored through clinical trials.
Active surveillance for renal cell carcinoma
If renal cell carcinoma is growing slowly, active surveillance may be an option, says Pavlos Msaouel, M.D., Ph.D. Patients under active surveillance will have checkups every few months and undergo imaging exams to see if the tumor is growing or spreading.
Some patients may be hesitant to choose this option, in fear of cancer spreading unchecked. But Msaouel says regular checkups generally make active surveillance a safe option.
Surgery is an option when renal cell carcinoma hasn’t spread
Surgery to remove the affected kidney offers the highest chance for successful treatment when cancer hasn’t spread.
Your kidneys filter blood and waste in our bodies and help produce urine. Since we have two kidneys, it’s possible to live with one.
But if both kidneys are removed or if they’re not working, you will need dialysis indefinitely. Dialysis cleans the blood through a machine.
Treatment options for metastatic renal cell carcinoma: targeted therapy and immunotherapy
It’s often more challenging to treat kidney cancer if it spreads to other parts of the body. This is known as metastatic disease. Kidney cancer is most likely to spread to the lungs, lymph nodes, liver or bones. Surgery may not be the best option for some patients with metastatic disease, especially if cancer has spread to more than one location.
When the cancer has spread, targeted therapy and immunotherapy may be effective. Targeted therapies work by stopping or slowing the spread of cancer on a cellular level. A type of immunotherapy called immune checkpoint inhibitors train your immune system to recognize and target cancer cells.
Most of the time, kidney cancer doesn’t respond to chemotherapy. “But the cellular characteristics that make kidney tumors resistant to chemotherapy also make them vulnerable to newer treatment options, including targeted therapy and immunotherapy,” Msaouel says.
Depending on your specific diagnosis and goals for treatment, your care team can customize a plan that can target the characteristics of the cancer for the best possible results.
Managing renal cell carcinoma treatment side effects
“Over the last decade, treatment advances have given patients with metastatic kidney cancer more time,” Msaouel says.
Most of these side effects can be managed by adjusting your medication dose, or with other medications or treatment approaches.
For severe side effects, your care team may even suggest stopping your medication temporarily. “Even just one or two days after pausing treatment, patients feel the relief they need to recover before starting treatment again,” Msaouel says.
If you’re experiencing challenging side effects, talk to your care team. “We can help you come up with strategies to cope,” Msaouel says.
Clinical trial explores whether radiation therapy could treat metastatic renal cell carcinoma
Msaouel has teamed up with radiation oncologist Chad Tang, M.D., to investigate whether radiation therapy can be used to manage metastatic kidney cancer as an alternative to systemic therapy.
The side effects of radiation therapy tend to be more manageable than side effects from systemic therapies like chemotherapy, immunotherapy and targeted therapy, Msaouel says. He’s hoping that introducing this treatment approach can improve patients’ quality of life.
“We already know radiation therapy works well for treating lung cancer,” Tang says, “So, we wondered, why wouldn’t it work for kidney cancer that’s spread to the lungs?”
Early results from the clinical trial Msaouel and Tang are co-leading show that some patients with metastatic renal cell carcinoma can delay or avoid immunotherapy or targeted therapy – and their negative side effects – if they undergo radiation therapy first.
Depending on the size and location of the tumors, intensity modulated radiation therapy or stereotactic body radiation therapy may be used.
“It’s not just about improving quality of life,” Msaouel says. “We’re also improving survival for our patients.”
By radiating metastatic cancer cells, they can shrink tumors – and potentially even keep them from coming back for years at a time with fewer treatments and fewer side effects.
“Our goal is to turn a terminal diagnosis into a chronic disease,” Tang says.
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