Kidney Cancer Treatment
Kidney cancer treatment, also known as renal cancer treatment, depends on the stage of the cancer and the person’s overall health. Once a patient is diagnosed with the stage of cancer, he or she will be referred to a specialist, who could be an oncologist or urologist.
Kidney cancer treatment options, which are described further below, include:
- Surgery to remove the tumor with a partial nephrectomy (removes part of the kidney) or radical nephrectomy (removes the entire kidney).
- CyberKnife radiosurgery therapy.
- Radiation therapy.
- Targeted therapy.
- Radiofrequency ablation.
- Arterial embolization.
- Active surveillance.
Kidney cancer treatment options
When possible, surgery is the main kidney cancer treatment. For some people surgery is not an option because they are too sick. In those cases, other approaches can be used to destroy the kidney tumors.
Below are the most popular kidney cancer treatment options.
Surgery is the most common kidney cancer treatment. Even people whose cancer has spread to other organs can benefit from having their kidney tumors removed. There are two types of surgeries to remove the kidney.
- Radical nephrectomy. This surgery is the most common option for treating kidney cancer. Depending on the individual’s case, the surgeon may also remove the lymph nodes, adrenal gland and fatty tissue around the kidney. Modern radical nephrectomies are now performed laparoscopically (a minimally invasive surgical method) through several small incisions. Most people do just fine with only one working kidney.
- Partial nephrectomy. The other surgical option is a partial nephrectomy surgery, also known as nephron-sparing surgery which only removes part of the kidney. A partial nephrectomy is performed in patients with small tumors or when a surgeon determines that a radical nephrectomy may result in the patient not having enough residual kidney function if a whole kidney is removed. This surgical option is also primarily done laparoscopically.
CyberKnife is an excellent alternative to cancer surgery and other treatment options. The CyberKnife Robotic Radiosurgery System is the most advanced system for the delivery of radiosurgery, a form of therapy that precisely focuses radiation on tumors or other conditions in one to five treatments.
The CyberKnife advantage over other therapies is that it can target and treat an abnormal area of the body with minimal damage to surrounding healthy tissue, which is the primary cause of cancer treatment side effects. A tumor in or near the kidneys may move as a person breaths, making it difficult to target a kidney tumor. But with the CyberKnife tracking abilities, the tumor is located in real time to deliver a precise amount of radiation without damaging surrounding healthy tissues.
Kidney cancer cells are highly resistant to traditional radiation therapy. But CyberKnife’s pinpoint accuracy can deliver the highest dose of radiation possible, can kill the tumor cells and over time the tumor dies.
Traditional radiation therapy
Radiation therapy uses high-energy radiation to kill cancer cells. General radiation therapy is not very effective as a primary kidney cancer treatment. When radiation therapy is used, it is best to be given in a higher daily dose, like what is offered in CyberKnife.
Targeted drugs are proving to be especially important to kidney cancer, particularly where chemotherapy has not been shown to be effective. This treatment option is best for treating advanced kidney cancer and after surgery as an adjuvant therapy, meaning in addition to the primary treatment.
These drugs aim to shrink or slow the growth of the cancer for a time. These drugs (other substances also may be used) “target” and attack specific kinds of cancer cells and avoid healthy cells. Targeted therapy sometimes blocks the action of proteins and enzymes that cause cancer’s growth and spread. At this time, none of these drugs have been proven to cure kidney cancer.
Types of targeted drugs used for kidney cancer include:
- Sorafenib (brand name Nexavar).
- Sunitinib (Sutent).
- Temsirolimus (Torisel).
- Everolimus (Afinitor).
- Bevacizumab (Avastin).
- Pazopanib (Votrient).
- Axitinib (Inlyta).
- Cabozantinib (Cabometyx).
- Lenvatinib (Lenvima).
The goal of immunotherapies, also known as biologic therapies, is to boost the body’s immune system to help fight off or destroy cancerous cells.
- Cytokines. This immunotherapy treatment option is a man-made version of natural proteins that activate the immune system and can cause kidney cancer cells to shrink in a small percentage of patients. The two cytokines interleukin-2 (IL-2) and interferon-alpha are commonly used for kidney cancer. There are multiple side effects for cytokines that include fatigue, problems breathing, diarrhea, low blood pressure, abdominal pain, heart attacks, high fever and chills, fluid buildup in the lungs, mental changes and intestinal bleeding.
- Immune checkpoint inhibitors. This treatment option targets the checkpoint cells, the cells that keep the body from attacking normal cells. The drug used to do this is nivolumab (brand name Opdivo). This drug blocks the protein on the immune system cells called T cells that normally keeps these cells from attacking other cells in that body. This will then boost the immune response against cancer cells. This treatment option can shrink or slow the growth of some tumors. Possible side effects caused by immune checkpoint inhibitors include coughing, nausea, skin rash, fatigue, itching, loss of appetite, diarrhea, constipation and joint pain. In more serious cases the body’s immune system could start attacking other parts of the body, which could cause life-threatening problems in the liver, lungs, intestines, hormone-making glands and other organs.
- CTLA-4 inhibitors. The ipilimumab (brand name Yervoy) drug also boosts the immune system. It works by targeting CTLA-4, another protein on T cells. This drug can be taken at the same time as an immune checkpoint inhibitor. Common side effects include diarrhea, skin rash, fatigue and itching. This drug can also have more serious life-threatening side effects if it attacks other parts of the body.
Chemotherapy, also known as chemo, is a drug or combination of drugs that prevents cancer cells from dividing and growing. Unfortunately, kidney cancer cells usually do not respond well to chemo. It is a possible treatment option when the cancer has spread to organs beyond the kidney.
Chemo is also used if targeted drugs and immunotherapy have already been tried and were not successful. Chemo has been found to be successful in a small number of patients.
Side effects of chemotherapy include loss of appetite, hair loss, constipation, diarrhea, fatigue, increased chance of infections, mouth sores and nausea and vomiting.
Cryotherapy, also known as cryoablation or freezing therapy, is a treatment option that uses freezing or near freezing temperatures to destroy the tumor. A needle is inserted into the tumor either laparoscopically or through the skin, and very cold gasses are passed through the needle, creating a cold tip that kills the cancerous cells.
Possible side effects of cryotherapy include bleeding, urine leakage and damage to the kidneys or other nearby organs.
Radiofrequency ablation (RFA)
This approach uses high-energy radio waves or electric currents to heat the tumor. A needle is placed through the skin to the tumor, then an electric current is passed through the needle to heat the tumor and destroy the cancerous cells.
Complications are uncommon but could include bleeding and harm done to the kidneys as well as to organs close by.
An arterial embolization blocks the blood supply going to the kidney with the tumor. This procedure consists of a small catheter being placed in an artery in the inner thigh and moved to the renal artery that supplies the kidney with blood. Then a special material is injected into the artery to block it, in turn cutting off the kidney’s blood supply. This will cause the kidney and tumor to die.
This procedure is not used very frequently but at times is done before a radical nephrectomy to reduce bleeding during the operation.
For people with small kidney tumors an option may be no treatment at all but rather watching the tumor to see if it grows. This option is most often used for the elderly or weak patients to avoid the risks of treatment. Prior to deciding on this approach a biopsy is done to confirm the tumor is cancerous. Some of these small tumors turn out to not be cancerous.