Kidney cancer: Treatments

Kidney Cancer - Treatments

How is kidney cancer treated?

Treatment for kidney cancer depends on several factors including the patient’s age, medical conditions, significant illnesses, test results, aggressiveness of the cancer and spread of disease.

Kidney cancer treatment usually begins with surgery to remove the cancer if it is diagnosed in its early stages. If the cancer has spread beyond the kidney (advanced stage), additional treatments may be recommended.

An individual with kidney cancer should be assessed by a multi-disciplinary team of specialists to determine which modality of treatment is best for them. Such multi-disciplinary care is available at SingHealth healthcare institutions. It is important to discuss all the possible treatment choices, including what to expect and possible side effects, to help you make an informed decision.

Treatment options for early-stage kidney cancer

Surgery

Surgery is the standard treatment option for those with kidney tumours who are fit for surgery. Depending on the kidney tumour characteristics and patient suitability, kidney surgery may be performed using conventional open surgery, laparoscopic (keyhole surgery) or robot-assisted techniques.

There are two main types of surgery for kidney cancer:

Partial nephrectomy - the tumour is removed with a margin of normal tissue, preserving the rest of the unaffected kidney. Partial nephrectomy is performed when the tumour is small or if the patient has impaired kidney function or a single kidney left.
Radical nephrectomy - the whole kidney including the tumour is removed. Depending on the spread of the cancer, sometimes the adrenal gland, tissue around the kidney and lymph nodes in the area are removed. This procedure is performed when the tumour is large and very close to the blood vessels or ureter. The remaining kidney is usually able to perform the work of both kidneys.

It is possible for an individual to lead a normal, active life with only one good kidney. Most people with one kidney removed do not end up with kidney failure that requires dialysis. Your treating doctor will advise you on the risks of impaired kidney function after surgery, which depends on the presence of other factors such as diabetes, high blood pressure and advanced age.

Targeted ablation therapy

Targeted ablation therapy is a minimally invasive ablative procedure that uses thermal energy or ice (cryotherapy) to destroy tumour cells. This is usually performed with image guidance such as CT to identify the tumour cells.

Active surveillance

Patients with a very small kidney tumour may be monitored closely with regular kidney scans to assess the growth rate or changes in the tumour appearance.

Targeted ablation and active surveillance for early-stage kidney cancer are more suited for elderly patients with multiple medical problems, who are not fit for surgery.

Treatment options for advanced kidney cancer

Radiation therapy

Radiation therapy or radiotherapy uses high-energy beams to kill cancer cells. It is also sometimes used to relieve pain when kidney cancer has spread to the bone.

Systemic therapy

For some patients who present late with kidney cancer that has spread to other parts of the body, surgery to remove the kidney in combination with systemic therapy has shown to be effective.

Systemic treatment for this group of patients includes:

Targeted therapy – the use of drugs that target specific parts of the cancer cells. This is often the first line of treatment for patients with advanced kidney cancer.
Immunotherapy – Immunotherapy uses the body’s own disease-fighting immune system to fight cancer. This is done by extracting immune cells from the body, ‘training’ them in the laboratory to identify and fight kidney cancer cells, then injecting the immune cells back into the body to fight the cancer.

If a patient is not fit for surgery, immunotherapy or targeted therapy may be given to control the disease (with or without surgery), depending on the patient’s response to treatment.

Arterial embolisation

Arterial embolisation is a procedure where a special material is injected through a catheter to clog the main renal blood vessel. This deprives the cancer tumour of oxygen-carrying blood and other substances it needs to grow, and therefore causes the tumour to shrink. Arterial embolisation may be used before surgery or in some cases may be used to provide pain relief when it is not possible to surgically remove the tumour.

Palliative treatment

Palliative treatment is a specialised type of medical care that can help patients with advanced stage disease by providing pain relief and helping with other symptoms they may experience. This is done when the cancer is advanced, and it is not possible to completely remove the cancer. The goal of palliative treatment is to improve the quality of life of the patient and their family. Palliative treatment for kidney cancer may include surgery or other treatments that can help relieve symptoms from the cancer such as pain or bleeding.