Kidney Cancer

Treatment >>

Once a diagnosis of renal cell cancer has been confirmed and the disease's stage determined, physician and patient decide on a treatment plan. Factors that are considered include the patient's age and overall health and the extent to which the cancer has spread. For example, a patient with one healthy, functioning kidney and one afflicted with an aggressive Stage 2 RCC is a more likely candidate for radical surgery than a patient with only one kidney and a less aggressive Stage 1 cancer..

A second opinion can provide additional information in the decision-making process and help the patient feel that he or she has made the right choice. Some insurance companies require a second opinion before they approve payment for treatment.

Treatment options include the following:

Two or more forms of treatment may be used in combination, such as surgery to remove a primary tumor followed by radiation treatment or chemotherapy to kill cancer cells that may remain in the body.

Another form of treatment, called gene therapy, is being explored by researchers who think inherited genetic mutations may cause many cases of RCC. Eventually, a process that uses normal genes to overcome or reverse the cancer-causing process may be developed.

Surgery >>

Surgery is the standard treatment for RCC. There are several surgical options, depending on the stage of the disease and the overall health of the patient.

Prior to surgery, most patients undergo an electrocardiogram (ECG), chest x-ray, complete blood count (CBC), and electrolyte profile with BUN and creatinine. Imaging tests (e.g., CT scan, intravenous pyelogram [IVP], MRI scan) are performed to determine the exact location of the kidneys and to detect anatomic variations (e.g., duplicated ureter, horseshoe kidneys), kidney stones, and cancer of the bladder, ureter, or other kidney.

When the tumor is small and confined to the top or bottom portion of the kidney, a partial nephrectomy (removal of part of the kidney) may be performed. This procedure also may be used to treat patients with RCC in both kidneys and patients who have only one functioning kidney.

Radical nephrectomy is the most common treatment for RCC. This procedure, which is performed under general anesthesia, involves removal of the entire kidney and the adrenal gland. It also may include removal of surrounding tissue and nearby lymph nodes (regional lymphadenectomy), depending on how far the cancer has spread.

Radical nephrectomy may be performed through a large abdominal incision (open radical nephrectomy) or 4 or 5 smaller incisions (laparoscopic radical nephrectomy). In laparoscopic radical nephrectomy, an instrument consisting of a light and camera lens that produces magnified images (called a laparoscope) is used to allow the physician to see inside the abdomen.

Tiny instruments are inserted through the incisions and used to separate the kidney from surrounding structures (e.g., ureter, blood vessels). The physician then enlarges one of the incisions and removes the kidney. Laparoscopic radical nephrectomy takes slightly longer to perform than open surgery.

Generally, the risk for complications and blood loss during surgery is similar in both procedures. Patients who undergo laparoscopic nephrectomy may require less pain medication, usually are discharged from the hospital sooner, and often are able to resume normal activities earlier.

Complications of nephrectomy include the following:

Arterial embolization may be used in patients who are unable to undergo surgery (e.g., patients with severe heart disease). In this procedure, a catheter (thin tube) is introduced into the artery in the groin that supplies blood to the cancerous kidney. A small piece of material (e.g., gelatin sponge) is then inserted into the catheter to cut off the blood supply, destroying the tumor and the organ. If the patient is able to undergo surgery at a later date, the kidney is removed.

Postoperative Prognosis

Renal cell cancer is the second most common tumor type to undergo spontaneous regression following removal of the primary lesion; this occurs in about 0.5% of cases. Once metastasis occurs, prognosis depends on the extent of the spread and the interval between kidney removal and the appearance of metastases. Overall, the 5-year survival rate for RCC—all stages combined—is about 40-45%.

Follow_up Care and Recurrent Kidney Cancer

Patients who undergo kidney cancer surgery may experience a recurrence of the disease. For this reason, most patients undergo a regimen of follow-up examinations after surgery, typically at 3-month intervals for the first year. These examinations include a complete physical examination, chest x-ray, complete blood tests, and assessments of liver and kidney function.

If the disease recurs and remains confined to a few small areas, additional surgery may be recommended. Radiation therapy, biological therapy (immunotherapy), or chemotherapy may be used in addition to surgery (called adjuvant treatment) or to relieve symptoms (called palliative treatment).