Cancer Types

If you have been diagnosed with kidney cancer, your doctor will discuss the best options for treating it. This depends on several factors, including the stage of the cancer and your general health.

Active monitoring

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 monitoring, especially if the tumor is small. With this method, doctors can monitor cancer through blood and urine tests, as well as imaging tests. Treatment starts only when the cancer has progressed, or when the patient's overall health has improved.

Surgical operation

Surgical removal of tumors confined to or around the kidneys. It is important for surgeons to preserve as much of the kidney as possible, although in some cases the entire organ will need to be removed. These procedures are usually minimally invasive, meaning that only a few small incisions are required. Minimally invasive surgery can be performed by laparoscopy (a thin rod with a camera and surgical tools) or by a robot controlled by the surgeon.

Minimally invasive surgery is less painful, has a shorter hospital stay and a faster recovery time than traditional "open" surgery, which requires a 4 - to 8-inch incision. Open surgery is usually performed only in cases where a patient is not a candidate for minimally invasive surgery due to specific aspects of their cancer.

You can usually live with one kidney, but if both kidneys are removed or do not work, you will need dialysis (a method of cleaning the blood with a machine). Kidney transplantation may be an option for some patients.

The two main types of kidney cancer surgery include:

Partial nephrectomy (or nephrectomy) : Only the cancerous part of the kidney is removed, and the surrounding healthy tissue is also removed. High-quality pre-treatment imaging is used to determine which tumors need to be removed, and ultrasound can be used to look for other tumors during surgery.

Selection for partial nephrectomy is based on favorable tumor location, health issues that may affect treatment outcome, kidney condition and the patient's desire to preserve the kidney. Partial nephrectomy is best for kidney cancer tumors 4 cm or smaller, but may be used for larger tumors when possible.

Radical nephrectomy: In this procedure, the entire kidney is removed along with the surrounding fatty tissue. Sometimes the adrenal glands and nearby lymph nodes are removed. For patients with advanced cancer, radical nephrectomy is typical.

Energy ablation technology

Other minimally invasive techniques use heat or cold to treat the tumor in place without having to remove any kidneys. These are ideal for patients with small kidney tumors to consider during high-risk surgery.

Cryoablation freezes the tumor with a long, thin probe inserted into the tumor. To ensure that the tumor has been destroyed, X-rays or other imaging tests are needed.

Radiofrequency ablation (rfa) is similar to cryoablation, but heat is used to destroy the tumor rather than freezing.

Targeted therapy

While many drugs kill cancer cells directly, targeted therapies work by stopping or slowing the growth or spread of cancer cells.

This happens at the cellular level. Cancer cells need specific molecules (usually in the form of proteins) to survive, reproduce, and spread. The goal of targeted therapy is to interfere with or target these molecules or the oncogenes that produce them. For kidney cancer, these therapies are mainly used in patients whose disease has spread to other organs in the body.

Most targeted therapies for kidney cancer are inhibitors of angiogenesis. Angiogenesis is the process by which tumors create their own network of blood vessels, allowing cancers to flourish and grow. Angiogenesis inhibitors disrupt this process.

Other targeted treatments for kidney cancer block the division and proliferation of cancer cells. These drugs are approved to treat advanced kidney cancer, but are less commonly used.

immunotherapy

Like targeted therapy, immunotherapy does not kill cancer cells directly. Instead, these drugs eliminate tumors by boosting the patient's immune system.

Most kidney cancer immunotherapies are called checkpoint inhibitors. These drugs help cancer-fighting immune cells, known as T cells, mount a more durable response to the disease.

Cytokines, including interleukin-2, stimulate the growth of immune system cells to fight cancer. They are only rarely used in patients with advanced kidney cancer.

chemotherapy

Most conventional chemotherapy is ineffective against kidney tumors, so it is not used much at present. Chemotherapy may be used in patients with medullary kidney cancer.

radiotherapy

Kidney tumors are less sensitive to standard forms of radiation, but healthy kidney cells are. Therefore, standard radiation therapy has a limited effect on primary kidney tumors.

In rare cases, radiation oncologists may use highly focused beams of light to treat tumors. These techniques include stereotactic radiosurgery and occasionally proton therapy.

If a patient's cancer has spread beyond the kidneys, standard radiation therapy can be used to help stop the growth of metastatic tumors, relieve pain, and minimize other symptoms.

Angiogenesis inhibitor

Angiogenesis is the process of producing new blood vessels. Some cancerous tumors are very efficient at producing new blood vessels, which increases the blood supply to the tumor, making it grow rapidly.

Researchers have developed what are known as angiogenesis inhibitors, or anti-angiogenesis treatments, to disrupt the growth process. These drugs seek out and bind to VEGF molecules, thereby preventing them from activating receptors on blood vessel endothelial cells. Other angiogenesis inhibitor drugs act on different parts of the process by preventing vegf receptors from sending signals to blood vessel cells.