This information has been reviewed by:
Associate Professor Ian Davis, MB BS (Hons) PhD FRACP FAChPM
Medical Oncologist, Austin Health, Assoc. Member, Ludwig Institute for Cancer Research
New treatments for kidney cancer
Many years of treating cancer patients and testing different treatments in clinical trials has helped doctors know what is likely to work for a particular type and stage of cancer. Your doctor will advise you on the best treatment for your cancer. This will depend on the type of cancer you have, where it is and how far it has spread, your general health, and what you want.
Treatments for kidney cancer include surgery, chemotherapy and radiotherapy. You may be advised to have one or more of these treatments.
Surgery is the main treatment for people with kidney cancer. Surgery is not possible for all people with kidney cancer. If surgery is possible, your doctor will advise which type of surgery is suited to your general health and the stage of your cancer.
Radical nephrectomy is the most common type of surgery for renal cell carcinoma. The operation removes the affected kidney. If the cancer has affected the adrenal gland and nearby, fatty tissue and lymph nodes, they will all be removed. However, sometimes it is not possible to remove all the tissue affected by cancer.
Partial nephrectomy removes the part of the kidney that is affected by cancer. This operation can be the best choice for people who have renal cell carcinoma in both kidneys or have only one working kidney. It is also done for some people with small tumours (less than 4 cm). Your doctor will discuss this if the operation is suitable for you.
You will usually have a general anaesthetic. A cut (incision) is made at the side of your abdomen where the diseased kidney is located. Sometimes this can be done using laparoscopy, also called ‘keyhole' surgery', leaving only a small cut. With very large cancers, the cut may be larger and extend from the chest into the abdomen, through the ribcage.
When you wake up from the operation you will have several tubes in place. You will have an intravenous drip to give you fluid and medicines. You may have tubes in place for a while to drain away fluid from the operation site.
You may need a urinary catheter for a few days after surgery. This is put in your urethra with the tip in the bladder and the other end attached to a bag that collects urine. It is not usually painful.
You will have pain or discomfort in the areas where organs were removed and you will have stitches. You may have an anaesthetic injected into the area around the spine: this method of pain relief is known as an ‘epidural' and can be very effective. If you have pain or discomfort, ask for medicine to help control the symptoms.
You will be in hospital for about a week. You may see a physiotherapist, who will explain how you may begin exercising again.
Arterial embolisation is sometimes recommended for people who have medical problems that mean they cannot have surgery to remove the kidney. It blocks the artery that feeds the tumour in the kidney, causing the tumour to die, because tumours need a blood supply to survive. A very small tube called a catheter is inserted through a blood vessel in the groin and guided up into the kidney. This is done using x-ray. Material is injected through the catheter to block the artery. People who recover from their medical problems sometimes have the kidney removed later. Embolisation is also used to relieve symptoms (such as bleeding) if a person has an inoperable cancer.
Radiotherapy treats cancer by using radiation to destroy cancer cells. The radiation can be targeted to cancer sites in your body. Treatment is carefully planned to do as little harm as possible to your normal body tissue.
Radiotherapy may be used instead of surgery or together with surgery to treat kidney cancer. This is often the case for people who have secondary cancers (cancers that have spread), which cannot be treated with surgery. In these people, radiotherapy can usually relieve symptoms of pain and discomfort caused by the growing secondary cancer. In most cases, radiotherapy is not used to treat the original (‘primary') cancer in the kidney itself.
The treatment is given in the radiotherapy department. The course is usually daily from Monday to Friday. The total number of treatments and duration of your treatment will depend on the type and size of the cancer. Sometimes only a couple of treatments are needed, or you may have many treatments over a number of weeks.
Radiotherapy can cause temporary side effects including feelings of sickness or nausea (which can be helped by medicines), loss of appetite and tiredness.
Skin in the treatment area may become irritated after two or three weeks of treatment. From the start of your treatment, you will need to take care washing and avoid shaving the area or wearing clothing that rubs. Check with your doctor or nurse before using any talcum powders and lotions. Ask a member of your radiotherapy team about how to deal with the side effects.
In late 2006, two new drugs were approved in Australia for use in people with advanced kidney cancer. These drugs are called sunitinib (also called Sutent or SU011248) and sorafenib (also called Nexavar or BAY 43-9006 ). Both of these drugs are taken by mouth. Clinical trials have shown that about two out of every three patients obtain some benefit from these treatments, meaning that the cancer shrinks or stops growing.
These drugs have side effects and they are not safe or suitable for all patients with kidney cancer. Even if they are suitable for you, you may not need to begin treatment with them straight away. At the time of writing (August 2007), neither sunitinib nor sorafenib were available on the PBS scheme and access to the drugs could sometimes be difficult. You should discuss all of these issues with your doctor.
Chemotherapy is the use of anti-cancer drugs. The aim is to destroy all cancer cells while doing the least possible damage to normal cells. The drugs work by stopping cancer cells from growing and reproducing.
Chemotherapy is usually given by injection into a vein.
Chemotherapy is not as effective in treating kidney cancer as it is for some other cancers, so it is not a routine treatment. However, researchers are looking for more effective types of chemotherapy and there may be a new or experimental treatment available for you to try, for example, if you join a clinical trial. Ask your doctor if you would like to know more.
Immunotherapy (or biological therapy) is the use of substances that are naturally produced within the body to encourage the immune system to fight disease. Interferon and interleukin have been used to treat some kidney cancers. While they are ‘natural' substances, they can sometimes cause severe side effects. Immunotherapy is not a standard treatment in Australia for kidney cancer, but is available in some centres. You may be eligible to join a clinical trial of immunotherapy for kidney cancer. Discuss this with your doctor if you wish.
Most cases of kidney cancer can be effectively cured if they are found early, before they have spread.
You will need to talk with your doctor about your own prognosis. Your medical history is unique, so you will need to discuss with your doctor what you can expect and the treatment options that are best for you.
