Cancer Type Category: Kidney Cancer

Treatments for Kidney Cancer

There are different types of treatment for patients with kidney cancer, depending on the stage of the cancer and the person’s overall health. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. As part of a research medical center, Siteman Cancer Center, Barnes-Jewish Hospital and Barnes-Jewish West County Hospital have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principal investigators in these trials, which cover medical and surgical therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for kidney cancer include surgery, chemotherapy, and biologic therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery and Other Procedures

Partial nephrectomy: This surgical procedure removes the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed. The Siteman team has developed techniques to perform robotic partial kidney removal – one of highest volumes in the world for this procedure.

Radical nephrectomy: Performed for larger kidney cancer and may include the adrenal gland, surrounding tissue, and, usually nearby lymph nodes. Siteman surgeons can often do these laparoscopically and robotically with smaller incisions and shorter recovery time.

Cytoreductive radical nephrectomy: This is generally preformed for metastatic cancers that have spread outside the kidneys. It can be done as an open or laparoscopic procedure. Siteman surgeons do 25 of these a year and have advanced expertise.

Nephroureterectomy: Used for transitional cell cancer of the renal pelvis and ureter, it involves removal of the kidney, the ureter and bladder cuff. This procedure can also be done robotically.

Segmental resection of the ureter: Also for the same type of renal cancer, this procedure involves removal of the part of the ureter that contains cancer and some of the healthy tissue around it. The ends of the ureter are then reattached. This treatment is used when the cancer is superficial and in the lower third of the ureter only, near the bladder.

Arterial embolization: When surgery to remove the cancer is not possible, arterial embolization may shrink the tumor. A small incision is made and a catheter is inserted into the main blood vessel that flows to the kidney, releasing small pieces of a special gelatin sponge to block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow.

Percutaneous cryoablation: Siteman is the only center in the country currently offering treatment for kidney cancer patients ineligible for any type of surgery due to their failing health or age. Percutaneous cryoablation is a procedure that involves inserting probes through the skin to freeze small tumors in the kidney. This procedure currently is used only for small tumors or for patients who have no other alternative. Because this technique holds the promise for being the least debilitating of all kidney cancer treatments, researchers are focused on expanding its application for the future.

A person can live with part of one working kidney, but if both kidneys are removed or are not working, the person will need dialysis or a kidney transplant.

After surgery, some patients are given chemotherapy to kill any remaining cancer cells and lessen the chances the cancer will come back.

Radiation Therapy

Kidney cancers are more resistant to radiation than other organs, so radiation is usually used to manage symptoms of bony or soft-tissue metastases. Newer techniques that allow safe delivery of high doses of radiation to a kidney cancer are becoming available.

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Over the last five years, several new drugs have increased the options for physicians treating patients with kidney cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery, in conjunction with radiation or by itself.

Biologic or immunotherapy: These drugs harness the body’s own immune system to fight cancer.

Targeted therapy: Use of antiangiogenic agents allows treatment of advanced renal cell cancer. Antiangiogenic agents keep blood vessels from forming in a tumor, causing the tumor to starve and stop growing or shrink. Monoclonal antibodies and kinase inhibitors are two types of antiangiogenic agents used to treat renal cell cancer. Many tumors occur because of dysregulation of mTOR signaling, so in addition to kinase inhibitors, one very effective targeted therapy uses mTOR inhibitors.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.

Effects of Kidney Cancer Treatments

Cancer treatment is geared toward positive outcomes, such as removing the cancer, reducing tumor size and preventing recurrence. However, many of the treatments used to accomplish that have their own challenges for our bodies. Prior knowledge of what to expect helps in treatment decision-making and getting the support you need to deal with these effects.

Effects of Surgery

Many cases of kidney cancer do not receive chemotherapy or radiation. The effects of surgery are generally related to pain and recovery time.

Chemotherapy-related effects

• Fatigue: The most common effect of cancer treatment, this fatigue is different than the kind healthy people experience. It can result from any type of cancer treatment.
• Nausea and vomiting: These can be serious consequences of cancer treatment, but Siteman has considerable experience managing these so cancer therapy can continue and you can live your normal life.
• Peripheral neuropathy: Chemotherapy-induced peripheral neuropathy (CIPN) is a set of symptoms caused by damage to the nerves that control the sensation in our arms and legs.
• Sexual dysfunction and urinary incontinence: Patients with kidney cancer may experience these problems due to nerve damage. Our nerve-sparing approach to surgery allows small tumors to be removed without these effects in most cases.
• Sleep disorders: More common in people with cancer, sleep may be disturbed by the cancer, pain, or certain drugs or treatments.

Your physician’s office should have information sheets on the most likely side effects of your specific therapy.

Side effects related to biologic/immunotherapy

Tyrosine kinase inhibitors, while effective, can cause side effects such as:

• Fatigue
• Mouth sores
• Diarrhea
• Elevated liver function tests
• Decreased thyroid function
• Increased blood pressure
• Skin rash
• Inflammation of the palms of the hands and soles of the feet

Cardio-oncology

Cardio-oncology is a new medical discipline focused on optimally treating any associated heart conditions in patients who have been treated for cancer, or are currently being treated for cancer. Specialized cardiologists can assess patients for the potential risk of developing certain heart conditions, especially if they are receiving particular types of cancer drugs, or following radiation treatment to the chest.

Learn more about the cardio-oncology program at Siteman

Risk Factors

Most patients don’t have an identifiable risk factor. However, kidney cancer has been linked to:

• Smoking
• Having certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma
• Being exposed to certain dyes and chemicals used in making leather goods, textiles, plastics, and rubber

Making a diagnosis of kidney cancer may involve different approaches. The following tests and procedures may be used:

After kidney cancer has been diagnosed, additional tests may be done to determine if the cancer has spread to other parts of the body.

There are two types of kidney cancer seen at Siteman: renal cell cancer (also called renal adenocarcinoma, characterized by cancer cells found in the lining of tubules in the kidney; and transitional cell cancer of the renal pelvis and ureter, malignant cells that form in the renal pelvis where the ureters connect and in the ureters, the long tubes that connect the kidney to the bladder. The main goal at the Siteman Cancer Center is to get a correct diagnosis of your condition and decide on the proper treatment. Specialists here excel in using the technology and experience to make an accurate diagnosis, often down to the genetic level so the best treatment options may be identified.

Estimate your risk for kidney cancer.

Symptoms of Kidney Cancer

The majority of small tumors have no signs or symptoms and are found on radiology tests done for another reason. However, you may experience:

• Blood in the urine
• A lump in the abdomen
• A pain in the back or side that doesn’t go away
• Loss of appetite
• Weight loss for no known reason
• Anemia
• Painful or frequent urination

Staging of Kidney Cancer

Staging is ranked 1 through 4 and recurrent, meaning the cancer comes back after treatment. Stage is an important factor in treatment options.

Prognosis

The prognosis (chance of recovery) depends on the following:

• The stage and grade of the cancer.
• The location of the tumor.
• Whether the patient’s other kidney is healthy.
• The patient’s age and general health.
• Whether the cancer has recurred.

Most transitional cell cancer of the renal pelvis and ureter can be cured if found early.

Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine’s team of urologic surgeons sees on average 350 cases of kidney cancer a year, and performed the world’s first kidney removal using minimally invasive laparoscopic surgery. Compared to traditional surgery, laparoscopic surgery requires only three or four small punctures, instead of a large incision. This approach substantially reduces the pain and discomfort of patients and hastens recovery.

Siteman also offers non-surgical treatment for kidney cancer, especially for patients ineligible for any type of surgery due to their poor health or age. This group of patients may receive percutaneous cryoablation, a procedure that involves inserting probes through the skin to freeze small tumors in the kidney. This procedure currently is appropriate only for small tumors or for patients who have no other alternatives. Because this technique holds the promise for being the least debilitating of all kidney cancer treatments, researchers are focused on expanding its application for the future. 

Our Approach to Kidney Cancer

Patients who come to the Siteman Cancer Center for treatment of kidney cancer are seen by a team of WashU Medicine physicians — surgical, medical and radiation oncologists — often during the same visit. A health psychologist is also available as needed. Experienced nurses then spend time with you, answering your questions and putting you in touch with resources that may help during this stressful time. These nurses offer patient literature on your condition, chemotherapy, radiation therapy, surgery and other related issues.

Our team of urologic surgeons sees on average 350 cases of kidney cancer a year, and performed the world’s first kidney removal using minimally invasive laparoscopic surgery. Compared to traditional surgery, laparoscopic surgery requires only three or four small punctures, instead of a large incision. This approach substantially reduces the pain and discomfort of patients and hastens recovery.

The team also has developed techniques to perform robotic partial kidney removal — a complex procedure being performed at only a few centers around the country. Siteman specialists pioneered the technique and perform it more than many other cancer treatment facilities around the world. They are often able to remove tumors and save kidneys using methods with expertise that most centers don’t have.

Siteman also offers non-surgical treatment for kidney cancer, especially for patients ineligible for any type of surgery due to their poor health or age. This group of patients may receive percutaneous cryoablation, a procedure that involves inserting probes through the skin to freeze small tumors in the kidney. This procedure currently is appropriate only for small tumors or for patients who have no other alternatives. Because this technique holds the promise for being the least debilitating of all kidney cancer treatments, researchers are focused on expanding its application for the future.

There are two major categories of kidney cancer seen at Siteman:

• Renal cell cancer (also called renal adenocarcinoma): This disease is characterized by cancer cells found in the lining of tubules in the kidney. This type of cancer accounts for about 80 percent of kidney cancers. Renal cell cancer is generally what is meant by kidney cancer.
• Transitional cell cancer of the renal pelvis and ureter: In this type of cancer, malignant cells form in the renal pelvis where the ureters connect and in the ureters, the long tubes that connect the kidney to the bladder.

For treatment purposes, types of primary kidney cancer are also divided into clear cell and non-clear cell types of tumors.

Siteman treats all major categories of kidney cancer, and can use laparoscopic and robotic techniques with tiny incisions and shorter recovery time. Types of treatment used for kidney cancer depend on the stage, size and location of the tumor at which it is diagnosed, whether the cancer has spread outside the kidney, the patient’s age and overall health. All surgical and chemotherapy options are available.

Siteman cancer physicians are actively involved in clinical trials that investigate new chemotherapy regimens, and other approaches to cure. Having your cancer treated at Siteman gives you access to new therapies that are as good as – or potentially better than – current standard therapies available elsewhere.