How Kidney Cancer Is Treated

Treatment options for kidney cancer will depend on the disease stage and other factors. Most people, even those with advanced kidney cancer, will have some form of surgical treatment. Additional treatments may include targeted therapies and immunotherapy. Chemotherapy and radiation are not commonly used to treat kidney cancer.

Types of Treatment

The therapy for treating kidney cancer has changed significantly in the past few years with the addition of targeted therapies and immunotherapies.

Treatment options for kidney cancer include two categories:

• Local treatments treat cancer where it originates and include surgery, cryosurgery, radiofrequency ablation, arterial embolization, and radiation therapy.
• Systemic treatments reach kidney cancer cells wherever they are in the body and include targeted therapy, immunotherapy, chemotherapy, and other treatments in clinical trials.

Many people diagnosed with kidney cancer will have a combination of these treatments.

Surgery

Most people who have kidney cancer will be treated with surgery. People with early-stage kidney cancer are the best candidates for surgery, but kidney cancer is one of the few solid tumors in which surgery may be beneficial even with advanced metastatic disease (stage 4).

Surgery Types

If a person has two functioning kidneys, removal of the entire kidney is considered safe, as only one kidney is needed for proper function. Some people, however, may have only one functioning kidney, or have a variant such as a horseshoe kidney, and this may influence the choice of procedure.

The best option for surgery can vary depending on the stage of kidney cancer.

Options include:

• Partial nephrectomy: During this procedure, the cancer is removed, along with some surrounding tissue. With early-stage cancers (stage I) this can sometimes be curative.
• Simple nephrectomy: A simple nephrectomy involves the removal of the whole kidney. A simple nephrectomy is often done for stage I kidney cancer, but a radical procedure may be done as well.
• Radical nephrectomy: In addition to removal of the whole kidney, a radical nephrectomy includes removal of the adrenal glands, nearby lymph nodes, and some surrounding tissues (perirenal fat and Gerota's fascia). A radical nephrectomy is often the recommended treatment for stage II and stage III kidney cancer, and it can be curative. In very advanced cancers, the renal vein and part of the inferior vena cava may be removed as well.

Surgery is often done even for people who have stage IV kidney cancer. If there are no distant metastases (spread), a radical nephrectomy may be considered. For those who have distant metastases, a nephrectomy may be done as a palliative treatment to improve symptoms or extend life, but not as a curative treatment.

Surgical Approaches

Surgical approaches used to treat kidney cancer include:

• Open nephrectomy: This is a traditional surgery in which a long incision is made to gain access and remove the kidney.
• Laparoscopic nephrectomy: During a laparoscopic procedure, several small incisions are made in the abdominal wall. Special instruments are inserted through these incisions to remove the kidney and surrounding tissues.
• Robotic surgery: Robotic surgery is similar to a laparoscopic procedure, but the surgery is performed with a system of robotic devices.

When choosing a surgeon, it's very important to ask about experience, especially with the newer less invasive procedures. It's entirely appropriate to ask your surgeon how many of the procedures they have performed.

Side Effects

The common side effects of surgery include bleeding, infection, anesthesia risks, and the risk of blood clots following surgery.

If you have one normal kidney, your kidney function is expected to remain normal because you only need one kidney. If your other kidney has any disease, or if your only kidney is being removed, you will need dialysis or a kidney transplant after your kidney is removed.

Alternative Local Therapies

While surgery is the treatment of choice for most kidney cancers, a procedure might not be possible for people who have serious underlying health issues. For those who would not tolerate surgery, treatments such as cryosurgery (freezing the tumors) or radiofrequency ablation (burning the tumors) may be options.

Tumor Embolization

Arterial embolization is a local therapy that may be done to shrink a kidney tumor. During this procedure, a substance is injected into the artery that sends blood to the kidney for the purpose of blocking blood flow to the kidney. The kidney tissue that is supplied by the artery is deprived of blood flow and dies.

Adjuvant Therapy

Even if kidney cancer is completely removed with surgery, there is a chance that it will recur. Adjuvant treatments may be used to treat kidney cancer that has spread and may also be used after successful surgery to treat any remaining cancer cells that are too small to be seen on imaging tests.

Targeted Therapy

Targeted therapies are drugs that "target" specific biological pathways to stop the growth and spread of cancer cells. Unlike chemotherapy (a treatment that attacks any rapidly dividing cells), targeted therapies interfere primarily with cancer cells and not with healthy cells, and as such, they often have fewer side effects.

Different targeted therapy drugs work in different ways.

• Angiogenesis inhibitors: These drugs work to prevent the angiogenesis (growth of blood vessels) that allows tumors to grow. An example is Avastin (bevacizumab).
• Kinase inhibitors: These drugs work to block the growth of cancer cells. Examples include the mTOR inhibitors Afinitor (everolimus) and Torisel (temsirolimus), as well as Nexavar (sorafenib), Sutent (sunitinib), Votrient (pazopanib), Inlyta (axitinib), and Cabometyx (cabozantinib).

Side Effects

The types of inhibitors vary in their side effects, and the side effects are generally mild. Less common, but serious side effects include liver damage, high blood pressure, bleeding, and bowel perforation.

Immunotherapy

Immunotherapy, also known as biologic therapy, is a group of treatments that work by stimulating your own immune system to fight cancer. Immunotherapy includes a wide variety of treatment types.

The most common immunotherapy drugs used to treat kidney cancer include:

• Checkpoint inhibitors: Checkpoint inhibitors such as Opdivo (nivolumab), Yervoy (ipilimumab), Keytruda (pembrolizumab), and Tecentriq (atezolizumab) work by essentially taking the brakes off the immune system so that it can fight cancer.
• Cytokines: Cytokines such as interferon and interleukin-2 are non-specific immunotherapy drugs that stimulate the immune system to fight off foreign invaders, including cancer cells.

Side Effects

Side effects of immunotherapy drugs may vary, and they often include a fever, skin rash, cough, high potassium, and low sodium levels, pneumonitis (inflammation of the lungs), and hepatitis (inflammation of the liver).

Chemotherapy

Chemotherapy drugs are not commonly used for the treatment of kidney cancer because they often don't help.

Radiation Therapy

Radiation therapy uses high energy x-rays to damage tissues. It may be given externally (external beam radiation) or internally via the placement of radioactive seeds (brachytherapy).

A specialized form of radiation therapy called stereotactic body radiotherapy (SBRT) has been increasingly used in recent years to treat isolated (only a few) metastases from kidney cancer to the brain or spinal cord. During this procedure, a high dose of radiation is given to a localized area of tissue (such as a spot of kidney cancer that has spread to the brain) in an attempt to cure the metastasis. It's too soon to really know how this may affect outcomes.

This approach of treating only a single or a few areas of spread (called "oligometastases" in medical lingo) is relatively new and it has been found to improve outcomes for people with some types of cancer.

Clinical Trials

There are currently many clinical trials in progress looking at better ways to treat cancer. These research studies are examining combinations of existing treatments, as well as newer treatments that have not yet been approved.

Many people are frightened about the idea of clinical trials, but it's helpful to keep in mind that all treatments currently used for kidney cancer were once studied in clinical trials. In the case of the most commonly used medications for metastatic kidney cancer, many of these were only available in clinical trials even a year or so ago.

As an example, a 2018 review and meta-analysis concluded that, for first-line treatment of metastatic kidney cancer, Cabometyx and Opdivo plus Yervoy are likely to be the best choices. Cabometyx was only approved in the United States for first-line treatment of kidney cancer in December of 2017 (it was approved for kidney cancer that failed other treatments in 2016), and Opdivo and Yervoy were only approved in 2016.

Most of the medical research studies in progress for kidney cancer are examining drugs that specifically target kidney cancer cells, and therefore have a much higher probability of being effective than treatments studied in the past.

It's very helpful if you can be your own advocate in your cancer care as you consider your options.

Complementary Medicine (CAM)

There are no alternative therapies that have been found to effectively treat kidney cancer, but some of these therapies may help ease the symptoms of cancer and the side effects of cancer treatments. Integrative cancer therapies such as meditation, massage, and acupuncture are now available at many cancer centers.

It's important to talk to your healthcare provider about any dietary supplements or vitamin or mineral supplements that you are considering—some could potentially interfere with your cancer treatments.

Kidney Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

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Home Remedies and Lifestyle

While lifestyle practices are seldom discussed when it comes to "treatment options," they are important.

It can feel more isolating to be diagnosed with kidney cancer than some other more common types of cancer. You may not know anyone who has the disease, and there may not be a support group in your community.

The organization Inspire, in conjunction with the Kidney Cancer Association, has an active kidney cancer community. There are many other kidney cancer communities online as well. Facebook groups exclusively for those living with kidney cancer are available, and those who are active on Twitter can find others using the hashtag #KidneyCancer.