The kidney cancer treatment mainly depends on the stage, location of the tumor, whether unilateral/bilateral, performance status of the patient, along with other factors. Following are the preferred treatment approaches for different stages of kidney cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.
|Stage||TNM Score||Preferred Treatment|
|I||T1 N0 M0||Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment approach.
In case of patients who cannot have surgery, arterial embolization or ablation may be employed in selected cases.
|II||T2 N0 M0||Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment.|
|III||T1-2 N1 M0
T3 N0-1 M0
|Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment.|
|IV||T4 Any N M0
Any T Any N M1
|Systemic therapy with targeted drug and/or immunotherapy is the mainstay of treatment in most cases.
Surgical removal of the kidney with/without removal of metastasis may be done in selected cases.
Palliative therapy to relieve symptoms and improve the quality of life may be employed.
Following is the brief description of various treatment types employed for kidney cancer:
1.Surgery: Surgery provides significantly longer survival and is considered as the treatment of choice for resectable kidney cancers in most cases. Sometimes, surgery is employed in palliative setting to relieve symptoms like bleeding and pain. The following types of surgery may be used for the treatment of Kidney cancer:
-Partial nephrectomy: In this surgery, only the kidney tissue containing cancer is removed with adequate margins leaving the rest of the kidney in place. This surgery is sometimes referred to as nephron-sparing surgery. This is generally preferred in case of early-stage disease where tumor size is small.
-Radical nephrectomy: In this surgery, the entire kidney along with associated adrenal gland, nearby lymph nodes, and fatty tissue surrounding the kidney is removed. This is generally used when cancer affects most of the kidney tissue. Sometimes, the adrenal gland may be spared, especially when tumor involves only the lower part of the kidney.
2.Arterial Embolization: in this technique kidney tumor is destroyed by blocking the blood supply to the tumor cells with the help of inert tiny particles that are injected directly in the artery supplying blood to tumor cells. It is used for small tumors localized to kidney, before surgery to downsize the tumor, or in palliative settings in non-operable tumors.
3.Ablation: Ablation is a technique in which tumors are destroyed without actual removal from the body. High-energy radio waves are utilized in radiofrequency ablation (RFA), microwaves are used in microwave ablation (MWA) technique, while very cold gases are used in cryoablation to destroy tumors. It is done for small tumors in patients who cannot tolerate surgery, as it has fewer side effects.
4.Targeted Therapy: Targeted drugs are designed to target a specific gene or protein characteristic of the stomach cancer cells. With the advancement in diagnostic techniques, genetic abnormalities for stomach cancer have been identified that can be targeted with the help of targeted drugs. Molecular testing to confirm the genetic abnormality is the pre-requisite for starting a targeted therapy. For example, sunitinib and axitinib target several tyrosine kinases; Bevacizumab targets vascular endothelial growth factor (VEGF) receptor.
5.Immunotherapy: Cancer cells utilize certain mechanisms to escape from the immune system of the patient from attacking these cells. Immunotherapeutic agents activate the immune system to recognize and kill cancer cells. Nivolumab targets PD-1 protein on T-cells and activate them to kill cancerous cells. This activates the immune system to kill the PD-L1 expressing cancer cells. Interleukin-2 (IL-2) and interferon-alpha also boost body’s immune system to kill cancer cells.
6.Bone Directed Therapy: Spread of kidney cancer to bones may lead to various symptoms like pain in bones, fractures, hypercacemia, etc. To relieve symptoms of bone metastasis, and to prevent further complications, following bone directed therapies are generally employed :
-Bisphosphonates (e.g. Zoledronic acid, Pamidronic acid, etc)
Normally, bones are constantly remodeled by two types of bone cells: osteoblasts (they increase bone density) and osteoclasts (they decrease bone density). Bisphosphonates decrease the activity of osteoclasts by inducing apoptosis (natural cell death) in them, and thus, help in maintaining bone density and to relieve symptoms of bone metastasis. Bisphosphonates may cause side effects such as flu-like symptoms, renal dysfunction, hypocalcemia and rarely, osteonecrosis of the jaw (ONJ).
-Denosumab: Denosumab is a monoclonal antibody that binds to RANKL and blocks osteoclast maturation, thus reducing bone resorption and helps in maintaining bone density and relieve symptoms of bone metastasis. It can cause side effects like hypocalcemia, osteonecrosis of jaw, etc.
7.Palliative Treatment: This helps in improving the overall quality of life by providing relief from the symptoms caused by kidney cancer. However, it does not directly treat kidney cancer. It is generally given as supportive care for advanced stage cancer. It may include but are not limited to surgery, radiotherapy, embolization, ablation, and drugs to reduce pain and other symptoms.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Sometimes patient’s choice and health condition are also important to make a treatment choice. Following are ultimate goals of treating kidney cancer:
-Prolongation of life
-Reduction of symptoms
-Improvement of overall quality of life
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