Therapy is based on the stage of cancer, patient's age, and overall health. It's critical to know the stage and grade of kidney tumors. Sometimes other factors are also considered to determine treatment, such as levels of blood calcium or blood lactate hydrogenase. Staging ranges from early-stage disease to stage IV kidney cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts survival rates.
Some patients' cases are discussed at Wilmot's multidisciplinary tumor board — a conference that is attended by all different specialties required for your care.
Seven types of treatment are commonly used for kidney cancer: surgery, active surveillance, ablation and other local therapies, radiation, chemotherapy, targeted therapy, and biologic or immune therapy.
This is the main treatment for most kidney cancers; the chances of surviving without surgery are small and even patients with cancer that has begun to spread outside the kidney often have surgery. Types of surgery include:
Partial nephrectomy. The surgeon removes just the cancer inside the kidney and some of the tissue surrounding the tumor. This surgery can be used for smaller tumors, to preserve as much healthy tissue as possible. Wilmot Cancer Institute and the Department of Urology at URMC helped to pioneer the use of new technology to perform minimally invasive, robotic surgery in these cases.
Simple nephrectomy. The surgeon removes one entire kidney.
Radical nephrectomy. The surgeon removes the entire kidney, the attached adrenal gland, surrounding tissue, and lymph nodes. Wilmot uses the latest, robotic technology to perform minimally invasive surgery when possible. Urologists at Wilmot also conducted research and found that radical nephrectomy is a reasonable option for patients who might qualify for a partial nephrectomy but wish to have the entire kidney removed, as long as the patient is otherwise healthy and the second kidney is working well.
Kidney transplant. A person can live with one kidney. But if both kidneys must be removed or are not working properly due to cancer or other conditions such as diabetes or high blood pressure, a transplant to replace one of the kidneys might be considered. The URMC is the only institution in upstate New York with a nationally renowned kidney transplant program.
When surgery isn't possible or necessary, doctors can use ablation to destroy kidney tumors. Cryoablation involves using a probe to pass very cold gases to the tumor site. Radiofrequency ablation uses high-energy radio waves to heat the tumor and destroy it.
This approach is an option for patients with very small kidney tumors (less than 1.5 inches), or very old or frail patients. Doctors monitor the cancer carefully to see if the tumor grows; at that point more treatment would be offered.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. Kidney cancers are not very sensitive to radiation, but it can be used to ease symptoms.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. Kidney cancer is often resistant to chemotherapy, so it's used only if other treatments have already been tried.
These are newer drugs designed to target specific gene changes that result in kidney cancer. They single out cancer cells and usually have less severe side effects compared to chemotherapy. Targeted therapy is often the first treatment used to treat advanced kidney cancer. Some drugs block the growth of blood vessels that feed tumors, and others target certain proteins involved in kidney cancer. Examples of targeted therapies used to treat kidney cancer are: Nexavar, Sutent, Afinitor, and Avastin.
Biologic or immunotherapy
This type of therapy uses a person’s own immune system to fight cancer. Interleukin 2 (IL-2) can be helpful for some people with advanced kidney cancer, but it comes with serious and sometimes life-threatening side effects. Doctors tend to recommend it for patients who are otherwise very healthy and can withstand the side effects. Not every patient responds well to IL-2, but those who do respond to the drug sometimes get long-lasting benefits. A second type of biologic therapy is interferon alfa, which has less-serious side effects compared to IL-2. It's sometimes used in combination with other therapies. Recently, a third type of biologic treatment that unblocks the immune system — called checkpoint inhibitors — have been used to treat kidney cancer with favorable results.
Many standard cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences side effects the same way.
Wilmot's Cancer Control & Survivorship program is one of the oldest and most highly regarded research programs in the country to investigate the management of side effects, including cancer-related fatigue.
The American Cancer Society also offers a free online classto help patients manage the side effects of their illness.