Treatment
Treatment of kidney cancer depends on the stage of kidney cancer.
Surgical operations for kidney cancer
- Radiofrequency ablation and cryotherapy – these are minimally invasive operations where a needle is inserted into the tumour and the tumour destroyed rather than removed. Radiofrequency destroys the tumour tissue using heat and cryotherapy destroys the tumour tissue by freezing. These treatments are used for frail elderly people or people with multiple tumours than cannot safely be removed by surgery. Both treatments can be repeated if tumour re-grows. Recovery takes 1-2 weeks.
- Laparoscopic kidney surgery – this is becoming more common – recovery time is 2 weeks.
Open surgery for kidney cancer
- Partial nephrectomy – removal of part of the kidney, leaving functioning kidney behind
- Radical nephrectomy – removal of the whole kidney and tissue around it
- Radical ureteronephrectomy – removal of the whole kidney and the ureter.
This is likely to be used for transitional cell carcinoma of the renal pelvis.
Recovery time from any type of open kidney surgery is 6-8 weeks. The long term side effects of this type of surgery may include the following:
- The need for kidney dialysis if both kidneys are affected by cancer and need to be removed, or when cancer affects a person with only one working kidney. For most people the other unaffected kidney can compensate for the one that has been removed and kidney failure does not develop
- Pain around the scar, likely to be severe if referral to pain clinic has been made.
Adjuvant Chemotherapy – a minority of people with cancer of the kidney will have transitional cell carcinoma type tumours. These people can benefit from adjuvant chemotherapy given after surgery. This is likely to prolong their recovery from surgical treatment. Chemotherapy is likely to be given over 4-6 cycles after surgery. Cisplatin is the most likely drug to be used although other drugs or combinations of drugs may be used. If side effects are severe the total period of treatment related disability may be as long as 8-9 months.
Operations for metastatic disease – a small number of people with metastatic disease will have only limited metastasis, this means metastasis in one area of the body only. For this group further surgery to remove the metastasis may be carried out with the chance of cure. Common sites include bone, liver, lung or the adrenal gland on the opposite side of the body to the original cancer. The ‘solitary’ metastasis may be present when they are diagnosed with kidney cancer or occur some time later. If renal cell cancer has spread into main veins of the body and up to the heart this tumour can be cleared surgically, this will involve an operation on heart bypass. Recovery time will be up to 3 months. Other similar major operations on the liver, spine etc can be carried out with good results in terms of cancer outcome.
For stage 1, 2 and 3 kidney cancer surgery is usually the only treatment necessary. Chemotherapy is often used after treatment of transitional cell type kidney cancers.
Other treatments that can be used when surgery is not possible
Surgery is the best treatment for kidney cancer but the operations involved are major and not everyone with kidney cancer will be fit enough to have them. There are other treatments available including
Arterial embolisation: this is done under x-ray control and involves injecting beads or coils into the blood vessels supplying the kidney tumour, this kills off a lot of the tumour cells but does not stop them from growing back with a new blood supply in the kidney or spreading around the body. This treatment involves an overnight stay in hospital and recovery takes up to a week. This type of treatment may be used prior to open surgery to shrink the tumour first or palliatively to reduce symptoms of untreatable disease.
Chemotherapy: useful palliation of symptoms is more likely in the rare transitional cell carcinoma; it is much less effective in renal cell carcinoma.
Radiotherapy: this treatment is given to the tumour area in 10 sessions over 2 weeks; it is not as effective as surgery and does not prevent the tumour from growing back or spreading around the body. It is generally only used in palliative treatment.
Treatment of advanced kidney cancer
By advanced disease we mean anyone with stage 4 cancer at diagnosis, more than one metastasis or recurrent disease after previous successful treatment of any stage of disease.
If surgery is planned to remove a single area of metastasis then refer above to operations for metastatic disease.
There are multiple treatments for advanced kidney cancer including surgery which are used to improve quality and length of life but do not offer a cure. Any or almost all of these methods may be used for an individual over time.
Treatments to reduce pain and bleeding from kidney cancer may include:
- Surgery including nephrectomy see above for recovery time and long term effects
- Radiotherapy to the kidney tumour or to metastatic disease
- Arterial embolisation see above for recovery time and long term effects
Other treatments for advanced disease include:
Biological therapy using interferon alpha and aldesleukin, the main side effects of these drugs are flu like symptoms on the day of treatment including chills, fever, headache, back ache and muscle pains. They also cause tiredness. Improved median survival of about 2 months can be achieved with this treatment.
Chemotherapy may be used especially for people who have transitional cell type cancer. It may be used in the context of a clinical trial with biological therapy. The side effects of the two types of therapy combined are worse than either type of treatment alone.
Hormone therapy with progestogen may improve symptoms.
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Amended February 2009
