Treatment - Kidney Cancer - Cancer Council Victoria

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Thursday 30 September, 2010

Reviewed by: Associate Professor Ian Davis, MB BS (Hons) PhD FRACP FAChPM
Medical Oncologist, Austin Health, Assoc. Member, Ludwig Institute for Cancer Research

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 about 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, drug treatment and radiotherapy. You may be advised to have one or more of these treatments.

Surgery

Surgery is the main treatment for people with kidney cancer. In almost all cases of kidney cancer, surgery gives the best chance of removing all the cancer. Without surgery, survival rates are low. Even if the cancer has spread to other parts of the body, surgery may still help. However, there may be some people with kidney cancer unable to have surgery. 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 (usually less than 4cm). Your doctor will discuss this if the operation is suitable for you.

The surgery is usually done using a general anaesthetic. A cut (incision) will be 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.

After the operation

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. If so, this will be 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

Arterial embolisation is rarely used; however, it may be recommended:

for people who have medical problems (e.g. in their heart or lung) that mean they cannot have surgery to remove the kidney
to relieve symptoms (such as bleeding and pain) if a person has an inoperable cancer
before nephrectomy, to reduce bleeding during the operation.

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.

This treatment cuts off the blood supply to the kidney cancer. The lack of blood means the cancer cells can't get the food and oxygen they need to survive. They will shrink and die off. It is not a cure though. It does not remove the cancer and there is a high chance of cancer cells breaking off and spreading to other parts of the body.

Radiotherapy

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 cancer that has spread (secondary cancer), and 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.

Side effects of radiotherapy

Radiotherapy can cause temporary side effects including feeling sick (which can be helped by medicine), 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 when 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 of radiotherapy.

Our booklet Coping with Radiotherapy discusses ways of managing side effects. Phone 13 11 20 for a copy.

Chemotherapy

Chemotherapy is the use of anti-cancer drugs. The aim is to destroy 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 for you to try, for example, if you join a clinical trial. There is more about clinical trials later in this booklet. Ask your doctor if you would like to know more.

Our booklet Coping with Chemotherapy discusses ways of managing side effects. Phone 13 11 20 for a copy.

Immunotherapy

Immunotherapy (or biological therapy) is the use of substances that are naturally produced in 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 able to join a clinical trial of immunotherapy for kidney cancer. Discuss this with your doctor if you wish.

Treatment for very small kidney tumours

If you have a very small kidney tumour, your doctor may not recommend ‘active' treatment with surgery. Many small tumours are found in the elderly and don't cause symptoms. Your doctor may suggest they monitor your tumour with regular CT scans or ultrasound. If the tumour grows or begins to cause you problems, you may need active treatment.

New treatments for kidney cancer

The treatments discussed below may not be available in all hospitals or cancer units. Ask your doctor about them if you think they may be suitable for you.

Radiofrequency ablation (RFA)

This is also known as radiowave treatment. RFA is a type of heat treatment. It uses radiowaves to heat and destroy cancer cells. It is a local treatment. This means the heat destroys cancer cells in the specific area it is aimed at. It won't kill cancer cells outside this area. So it is no good for treating cancer that has spread to several other parts of the body.

The most common way of giving this treatment is to insert fine needles through the skin and into the area of cancer needing treatment. You may have some pain in the area after treatment. But pain relievers usually help.

RFA is being tested in clinical trials for use in several types of cancer, including kidney cancer. Some trials have shown it works well but the treatment may need to be repeated. Others are looking at using RFA instead of surgery as a first-line treatment. However, it is too early to know whether or not RFA will be able to control cancers as well as or better than surgery. Larger trials will give us these answers.

Cryotherapy or cryosurgery

This means killing cancer cells by freezing them. Like RFA, it is a ‘local treatment'. There is hope this type of treatment may mean curing a kidney cancer without having to remove part or all of the kidney. Early-stage research suggests cryotherapy is most effective for smaller kidney cancers. But we need results from more clinical trials before we know just how effective cryosurgery is in helping treat any type of kidney cancer.

Prognosis

Most cases of kidney cancer can be 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.

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