Kidney Cancer: Treatment Options

How is it treated?

Treatment for Kidney Cancer depends on a variety of factors. The doctor will use the tumor's size and the degree to which the cancer has spread throughout the body to determine which treatment to use, along with the patient's age, general health, and personal preferences. The treatments for Kidney Cancer may be local (involving only the regions around the kidneys) or systemic (affecting the entire body).

SURGERY FOR KIDNEY CANCER

The goal of surgery as a treatment for Kidney Cancer is to remove as much of the tumor as possible. This usually means that part or all of the kidney must be removed. There are three types of surgical treatments for Kidney Cancer:

• Radical Nephrectomy - The most common type of surgery for Kidney Cancer, radical nephrectomy is the removal of the entire kidney along with the adrenal gland and most of the surrounding fatty tissue and possibly the lymph nodes. Tumor can grow into the renal vein requiring removal as well.
  
  
• Partial Nephrectomy - Only the cancerous part of the kidney is removed. This treatment is usually done when the cancer is in both kidneys, preventing the doctor from doing a radical nephrectomy, or in those who already have only one kidney. There is a chance that some of the cancer will remain after surgery.
  
  
• Arterial Embolization - A catheter is placed in the groin to deliver a gelatinous material to the artery that feeds blood to the kidney with the tumor. This material will block the artery, depriving the tumor of the nutrients from the blood supply that it needs in order to grow. Often, arterial embolization is used to shrink a tumor and reduce blood loss before surgery.
  

Other Treatments

RADIATION THERAPY

Radiation therapy is the process in which high-energy light waves are directed at the affected area in order to destroy cancer cells. Radiation therapy is local, affecting only the area exposed to the rays. It is typically given five days per week for a period of five or six weeks. Radiation is usually used to alleviate the symptoms of Kidney Cancer and the side effects of other treatments. It can also be helpful to control spreading of the cancer. This is not the primary treatment but may be incorporated with a total treatment program.

CHEMOTHERAPY

Chemotherapy is a systemic, or whole body, treatment, the goal of which is to destroy any remaining Cancer cells in the body and to keep the Cancer from spreading to other organs. The drugs are typically given in cycles of a few days of treatment and then 3-4 weeks to rest, for a period of weeks or months determined by the oncologist. There are two ways chemotherapy can be administered, depending on patient health and the drugs being used:

• Pill form - Chemotherapy pills are available for some drugs and allow the patient to remain at home for the entire treatment.
  
  
• Intravenous - The most common method of chemotherapy, intravenous infusion is usually given on an outpatient basis at the hospital or treatment center. Patients who are in very poor health or have severe side effects may need to remain in the hospital for a few days.
  

BIOLOGICAL THERAPY

Biological Therapy involves using substances to boost the body's own immune system responses to kill the cancer cells. Many new approaches using biologicals are being tested in clinical trials.

Biological Therapy is now standard, state-of-the-art treatment for Kidney Cancer, especially when the cancer has spread beyond the kidneys to the other organs of the body. The most common biological treatment for Kidney Cancer is the use of the cytokines Interleukin-2 (IL-2) and Interferon-alpha. They may be given as a combination or as a high dose of IL-2 alone, and both of these treatments have proven effective. However, the combination of IL-2 and Interferon in lower doses has fewer and less severe side effects than the high dose IL-2 alone.

Biological therapy may also involve gene-therapy. Immune system cells called tumor-infiltrating lymphocytes (TILs), are removed from the body and treated with the cytokines to enhance their defenses against the tumor cells. The TILs are then put back into the body, hopefully to kill the tumor cells.

Possible side effects from treatments

*Unfortunately, the side effects from any treatment of kidney cancer can be severe and are not necessarily temporary.

SIDE EFFECTS FROM SURGERY

The side effects of surgery for Kidney Cancer may include:

• Bleeding during or after surgery requiring a blood transfusion
  
• Infection
  
• Damage to internal organs and blood vessels during surgery
  
• Bulging of internal organs near the incision due to improper healing (incisional hernia)
  
• Failure of kidneys to resume normal function
  
• Temporary pain in the affected area
  
• Fatigue
  
• Abdominal cramping and pain
  
• Trouble with bowel and bladder function
  

The side effects of Kidney Cancer surgery are often temporary and cease after the area has healed. However, some side effects, particularly internal organ damage, hernia, and kidney failure, may be permanent.

SIDE EFFECTS FROM CHEMOTHERAPY

Chemotherapy symptoms vary with the drugs being used and among individuals; however, the following are some common side effects:

• Nausea/vomiting
  
• Hair loss
  
• Fatigue
  
• Increased risk of infection
  
• Fever
  
• Easy bruising/ bleeding
  
• Tingling in the fingers and toes
  
• Ringing in the ears/ difficulty hearing
  

Many of these symptoms are temporary and should cease shortly after treatment is stopped.

SIDE EFFECTS FROM RADIATION

As with chemotherapy, radiation side effects are different for everyone and are usually specific to the areas exposed to the rays. Some commonly reported side effects for Kidney Cancer patients are:

• Fatigue
  
• Skin irritation
  
• Nausea/vomiting
  
• Diarrhea
  
• Urinary discomfort
  

The side effects of radiation therapies are usually temporary, and symptoms should disappear once treatment stops.

SIDE EFFECTS FROM BIOLOGICAL THERAPY

The side effects of cytokine biological treatment can be severe. Most cytokine treatments require a hospital stay, often in the Intensive Care Unit (ICU) of the hospital; however, treatment with cytokines has been found to be very effective in treating Kidney Cancer. Some of the side effects of cytokine therapy may include:

• Low blood pressure
  
• Fluid in the lungs
  
• Heart attack
  
• Kidney damage
  
• Intestinal bleeding
  
• Chills
  
• Fever
  

Clinical trials

There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council (www.ricancercouncil.org) to find out what clinical trials are going on near you and if you are eligible.

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