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What are the treatment options?
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Treatments for kidney cancer are based on the stage of the cancer at time of diagnosis, as well as the particular cell type. Your physician will recommend an individualized treatment plan that may include surgery, radiation therapy, chemotherapy, immunotherapy, or several of these options used in tandem, which is known as combined modality therapy.
Surgical Procedures
For many patients with early-stage kidney cancer, surgery alone may offer a complete cure. John Muir Health offers the full range of advanced surgical options for the treatment of kidney cancer, including kidney-sparing surgery (partial nephrectomy) and the latest minimally invasive laparoscopic approaches, such as robot-assisted nephrectomy.
For more advanced cancers that are still resectable (conducive to surgical removal), radiation therapy or occasionally chemotherapy may be administered after surgery as well. The postoperative administration of radiation and/or chemotherapy is known as adjuvant therapy.
We are here for education, support and to help you navigate your way through your diagnosis, treatment and recovery.
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The type of surgery that is best for your particular situation depends on many different factors, including the stage and location of your cancer, your age and general health, and your attitude toward the available options. Your physician will help you to evaluate the advantages and disadvantages of each option to determine the best approach.
The full range of advanced surgical options available at John Muir Health includes:
Partial Nephrectomy (Kidney-Sparing Surgery) - Patients with early-stage cancer confined to the kidney may be candidates for a kidney-sparing procedure known as partial nephrectomy. A major advance in the treatment of kidney cancer, partial nephrectomy entails removal of only the tumor and surrounding tissue, rather than the entire kidney. Patients retain full kidney function, and there appears to be no eventual need for dialysis. This approach is also particularly beneficial to patients with only one kidney or limited function in the second kidney.
Simple Nephrectomy - Simple nephrectomy is surgical removal of the affected kidney. Because the two kidneys perform independently, patients are able to retain kidney function and generally do not go on to require dialysis. Radical Nephrectomy - Radical nephrectomy is a more complex surgery, which entails the surgical removal not only of the affected kidney, but also the adrenal gland, adjacent lymph nodes, and fatty tissue.
Laparoscopic Nephrectomy - Certain patients with kidney cancer may be appropriate candidates for minimally invasive laparoscopic nephrectomy, which offers many advantages over conventional "open" surgery. Laparoscopy entails the use of multiple tiny incisions rather than the large incision necessary in conventional surgeries, which results in minimized trauma, shorter hospital stays, and decreased risk of complications. Laparoscopy is performed under the guidance of a miniature camera (the laparoscope), which is inserted through a thin tube placed in the patient's skin. The surgeon inserts surgical tools through adjacent tubes to perform the procedure. A drawback to the laparoscopic approach is that the entire kidney must be removed; partial nephrectomy is not possible.
Robot-assisted surgery is an exciting new minimally invasive option now available at John Muir Health. Robotic surgery - using the da Vinci*#8482; Robotic Surgical System - represents the most advanced approach to laparoscopic surgery available anywhere in the world. Surgeons operating the robotic equipment undergo extensive specialized training.
Nephroureterectomy - Patients with the less common transitional-cell form of kidney cancer may undergo a procedure called nephroureterectomy, in which the affected kidney, ureter, and the top part of the bladder are removed.
Chemotherapy
The most common type of kidney cancer, renal-cortical cancer, does not respond well to currently available chemotherapy (anticancer drugs). Chemotherapy is primarily used to treat recurrent kidney cancer, or cancer that has metastasized to other organs.The less common form of kidney cancer, transitional-cell carcinoma, is far more responsive to chemotherapy.
Radiation Therapy
Radiation therapy is sometimes used after surgical removal of the affected kidney to eradicate any remaining cancer cells. Postoperative radiation therapy is known as adjuvant therapy. In some advanced kidney cancers that are not conducive to surgical removal, radiation therapy may be used alone to help alleviate painful symptoms. The type of radiation therapy used in kidney cancer is external beam radiation, in which the affected area is radiated from outside the body via a precisely targeted beam of radiation from special equipment called a linear accelerator. Before radiation therapy, patients may be given radiosensitizing chemotherapy drugs, which help to enhance the cancer-killing efficiency of radiation. John Muir Health is one of northern California's premier centers for radiation therapy; our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners to ensure the most precise and effective radiation therapy available.
The advanced radiation therapy capabilities at John Muir Health include:
Three-Dimensional Conformal Treatment - This sophisticated form of external beam therapy uses a computerized treatment planning system that optimizes radiation therapy by pinpointing the location of the tumor with the highest level of precision possible. This capability is important in planning the most effective therapies for kidney cancer. Special features on the linear accelerator called multi-leaf collimators enable the radiation beam to be "shaped" to closely conform to the contours of the tumor. This permits a higher dose of radiation to be administered directly to the kidney, while diminishing the radiation dose to surrounding tissue, thereby increasing cancer-killing effectiveness while minimizing toxicity.
Intensity-Modulated Radiation Therapy (IMRT) is a newly introduced enhancement of the technology used in three-dimensional conformal therapy. Specialized treatment planning software is used to development a precise plan that "modulates" or varies the radiation used in each treatment session. The highest possible doses of radiation can be applied directly to the kidney, while lower doses are applied to areas adjacent to organs and critical structures that need to be protected.Immunotherapy
Patients with advanced kidney cancer that has metastasized may be candidates for immunotherapy, the use of biological agents that stimulate the body's own immune system. The approved immunotherapy drugs commonly used in the treatment of kidney cancer are interleukin 2 and interferon.
Arterial Embolization
Some patients who cannot undergo surgery to remove the affected kidney may be candidates for a treatment called arterial embolization. During this procedure, a special gelatin sponge is injected into the main artery that flows to the kidney. This action blocks the blood flow into the kidney, theoretically "starving" the tumor.
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