Kidney cancer treatments

Kidney tumors maybe be treated with a variety treatments and technologies, including surgery, chemotherapy, targeted therapy, immunotherapy and interventional radiology.

Urologists (doctors who manage urinary tract conditions) and/or genitourinary medical oncologists (doctors who specialize in cancer) typically treat kidney tumors. These experts may use a variety of treatments and technologies, including those below.

Local treatment of kidney cancer

Surgery

Surgery is the first-line treatment for most renal cell carcinoma patients. Depending on the type and stage of the disease, a variety of procedures maybe be performed. Nearby fatty tissue may also be removed and tested for the presence of cancer. If kidney cancer has metastasized, your treatment team may combine surgery with targeted therapy or immunotherapy. Examples of surgical procedures used to treat kidney cancer include:

• Radical nephrectomy removes the entire affected kidney. Often, the adrenal gland is also removed if it is involved with, or very close to, the tumor.
• Laparoscopic radical nephrectomy (LRN) requires less recovery time and causes less bleeding than open surgery. An LRN is performed by making a few small incisions, instead of one large incision. Once the incisions are made, a surgical oncologist uses a laparoscope (long tube with small camera attached to the end) to help guide removal of the kidney.
• Partial nephrectomy is performed when it is important to preserve kidney function. This includes people who have cancer in both kidneys, low kidney function, or people with one kidney. Your surgical oncologist may recommend this surgery even if these issues don’t pertain to you, to maintain as much kidney function as possible.
• Robotic surgery with the da Vinci® Surgical System may be an option for patients who are candidates for kidney cancer surgery, since it offers a minimally invasive alternative to a radical nephrectomy. Surgery using the da Vinci System may result in fewer side effects.

Although surgery is usually the treatment of choice for kidney cancer, some people may not be candidates, including those who are too sick and those who are opposed to the idea of surgery. Also, if the tumor is small enough, surgery may not be necessary to treat the cancer.

Interventional radiology

Interventional radiology allows doctors to visualize tumors in the kidneys and perform real-time image-guided interventional procedures, including cryoablation and radiofrequency ablation, which are designed to destroy tissue using extreme temperatures.

Cryotherapy (Cryoablation)

Cryoablation essentially freezes the kidney cancer cells to death. Your doctor inserts a needle into the tumor and passes cold gasses through it, creating an “ice ball” that destroys the tumor.

Radiofrequency ablation (RFA)

Radiofrequency ablation employs high-energy radio waves to heat the kidney tumor via a needle that’s guided by ultrasound or computed tomography (CT) scan.

Radiation therapy

This type of cancer treatment uses high-dose X-ray energy to kill cancer cells. With kidney cancer, radiation is often used to relieve pain and other symptoms.

Systemic treatment of kidney cancer

Sometimes, medications are also part of a kidney cancer treatment plan. They may be used alone or in combination with each other or other modalities.

Chemotherapy

Chemotherapy may be recommended for patients diagnosed with renal sarcoma, which is an extremely rare form of kidney cancer. Chemotherapy may be administered via:

• Mouth
• Injection
• Infusion 

These drugs work by killing all fast-growing cells in the body, including cancer cells. Other fast-growing cells such as hair cells are often collateral damage. Chemotherapy is not often the first choice of systemic therapy for kidney cancer, though, because this cancer typically doesn’t respond well to it. Chemotherapy may be tried if targeted therapy or immunotherapy doesn’t work.

Targeted therapy

Targeted therapy is designed to identify receptors and proteins unique to specific cancer cells. Once attached to the targeted cancer cells, these drugs kill the cells or help other therapies, such as chemotherapy, work better. Among the drugs used in targeted therapy for kidney cancer are angiogenesis inhibitors, which starve cancers by cutting off their blood supply, and/or tyrosine kinase inhibitors, which target specific enzymes that help regulate cell growth. Targeted drugs may be used to treat advanced kidney cancers. While they may shrink or slow the growth of certain tumors, these drugs are not considered cures for kidney cancer. One targeted medication, Sutent (sunitinib), is sometimes used after surgery to help reduce the risk of kidney cancer returning.

Immunotherapy

Immunotherapy is an innovative treatment option for advanced cancers, including kidney cancer that has metastasized. Two types of immunotherapy are used to treat kidney cancer:

• Checkpoint inhibitors work by disrupting the chemical signals that cancer cells send to allow them to hide from the immune system. Most immunotherapy drugs used to treat renal cell carcinoma, the most common form of kidney cancer, target the protein PD-1, a key receptor that helps regulate the body's immune response. More checkpoints are actively being studied in combination with other targeted therapies.
• Cytokines are molecules that help regulate immune activity. The cytokine drugs alpha-interferon (IFN-alpha) and interleukin-2 (IL-2) are used to treat some types of kidney cancer. IFN-alpha may help slow or stop cancer cells from dividing and make them more vulnerable to an immune attack. IL-2 is a natural protein that stimulates the growth of immune cells and activates them to destroy tumor cells.

Preparing for your treatment visit

When it comes to creating a treatment plan, it’s important to stay informed. Before beginning treatment, the American Cancer Society recommends asking your care team the following questions:

• What stage is my kidney cancer?
• Where is it?
• Has it spread outside my kidney?
• Will I need more tests or surgery to find out the stage?
• What are my treatment options?
• What treatments do you recommend and why?
• What’s the goal of treatment?
• When will treatment start?
• What can I do to prepare for treatment?

Learn more about kidney cancer types