Kidney CancerLast Updated: December 30, 2008 This section has been reviewed and approved by the Cancer.Net Editorial Board, 12/08 Overview
The kidneys are reddish-brown organs about the size of a small fist located above the waist on either side of the spine. They are closer to the back of the body than to the front. Kidneys filter blood and remove impurities, excess minerals and salts, and surplus water. Every day, the kidneys filter about 200 quarts of blood to generate two quarts of wastewater (urine). The kidneys also produce hormones to help control blood pressure, red blood cell production, and other functions. Although people have two kidneys, each works independently, which means that the body can function with less than one complete kidney. With dialysis, a mechanized filtering process, it is possible to live without kidneys. Kidney cancer is a disease in which normal cells in the kidneys begin to change, grow without control, and no longer die, forming a mass of cells called a tumor. There are several types of kidney cancer: Renal cell carcinoma. Renal cell carcinoma makes up about 85% of kidney cancers. This cancer develops within the kidney's microscopic filtering systems, the lining of tiny tubes that lead to the bladder. Transitional cell carcinoma. Transitional cell carcinoma begins in the area of the kidney where urine collects before moving to the bladder. This type of kidney cancer is similar to bladder cancer and is treated like bladder cancer. It accounts for 10% to 15 % of adult kidney cancers. Sarcoma. sarcoma of the kidney is rare and is treated with surgery. For some patients, it may be beneficial to combine chemotherapy with surgery, as sarcoma can grow quite large before it is discovered. It does not metastasize (spread) as often as other types of kidney cancer. Wilms tumor. Wilms tumor is most common in children and is treated differently than adult kidney cancer. This type of cancer is more likely to be successfully treated with radiation therapy and chemotherapy than the other types of kidney cancer, and this has resulted in a different approach to treatment. For more information, read the Cancer.Net Guide to Wilms Tumor, Childhood Cancer. Knowing which kind of cell a tumor is made up of helps doctors plan treatment. There are several types of kidney cancer cells. The most common are listed below. Pathologists (doctors who specialize in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) have identified as many as 10 different types of these cells.
Statistics In 2009, an estimated 57,760 adults (35,430 men and 22,330 women) in the United States will be diagnosed with kidney cancer. It is estimated that 12,980 deaths (8,160 men and 4,820 women) from this disease will occur this year. Kidney cancer is the seventh most common cancer and the tenth most common cause of cancer death for men. It is the eighth most common cause of cancer for women. The five-year relative survival rate (percentage of people who survive at least five years after the cancer is detected, excluding those who die from other diseases) of people with kidney cancer is about 67%. Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with kidney cancer. Because the survival statistics are measured in five-year intervals, they may not represent advances made in the treatment or diagnosis of this cancer. Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2009. Find out more about basic cancer terms used in this section. Medical Illustrations
Risk Factors and Prevention
A risk factor is anything that increases a person’s chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health care choices. Not enough is known about kidney cancer to determine exactly how to prevent it. There are some steps people can take to lower their risk, such as quitting smoking, lowering blood pressure, controlling body weight, and eating a diet high in fruit and low in fat. The following factors may raise a person’s risk of developing kidney cancer: Smoking. Smoking doubles the risk of developing kidney cancer and is believed to cause about 30% of kidney cancers in men and approximately 25% in women. Gender. Men are two to three times more likely to develop kidney cancer than women. Race. Black people have higher rates of kidney cancer. Age. Kidney cancer is primarily a disease of adults and is usually diagnosed between the ages of 50 and 70. Nutrition and weight. Research has often shown a link between kidney cancer and obesity (generally caused by many years of eating a high-fat diet.) Hypertension (high blood pressure). Men with high blood pressure may be more likely to develop kidney cancer. Overuse of certain medications. Painkillers containing phenacetin, once popular in over-the-counter medications, have been banned in the United States since 1983 because of the link to kidney cancer. Also, diuretics and analgesic pain pills, such as aspirin, acetaminophen, and ibuprofen, have been linked to kidney cancer. Exposure to cadmium. Some studies have shown a connection between kidney cancer and exposure to the metallic element cadmium. Working with batteries, paints, or welding materials may increase the risk as well; this risk is especially higher for smokers exposed to cadmium. Long-term dialysis. Patients using dialysis for a long time may develop cancerous cysts in their kidneys. These growths are usually found early and can often be removed before the cancer spreads. Genetic and hereditary risks. A hereditary risk of developing kidney cancer has been recognized, but only a few specific genes that increase risk have been found. One of those genes is responsible for an inherited genetic disorder called Von Hippel-Lindau syndrome; 40% of people with this disorder develop kidney cancer. Also, two genetic syndromes related to renal cell carcinoma have been identified recently: Birt-Hogg-Dubé and hereditary leiomyomatosis. Both of these genetic syndromes cause diseases of the skin as well as kidney cancer. Learn more about The Genetics of Kidney Cancer . Other diseases. People with tuberous sclerosis, a complex genetic disorder, have an increased risk of kidney cancer, as do people with Von Hippel-Lindau syndrome (see above). Symptoms
Often, kidney cancer is found when a person has an x-ray or ultrasound (see Diagnosis) for another reason. In its earliest stages, kidney cancer causes no pain. Therefore, symptoms of the disease usually appear when the tumor is large and begins to affect nearby organs. People with kidney cancer may experience the following symptoms. Sometimes, people with kidney cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Routine screening tests to detect kidney cancer early are not available. Doctors may recommend that people with a high risk of the disease have imaging tests to look inside the body. For people with a family history of kidney cancer, CT scans are sometimes used to search for early-stage kidney cancer. However, CT scans have not been proven to be a useful screening tool for kidney cancer for most people. Diagnosis
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
In addition to a physical examination, the following tests may be used to diagnose kidney cancer: Blood and urine tests. A blood test to check the number of red blood cells, and a urine test to detect blood, bacteria, or cancer cells, may be performed. These tests may suggest that kidney cancer is present, but cannot make a definite diagnosis. Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed during the biopsy is analyzed by a pathologist. Then the pathologist issues a pathology report (laboratory test results) that becomes a permanent part of the person’s medical record. Doctors must have a pathology report before they use radiation therapy or chemotherapy to treat the cancer. The pathology report identifies the type of cell involved in the kidney cancer, which is important in planning treatment. For instance, people with clear cell tumors have mutations of the Von Hippel-Lindau (VHL) gene (a tumor suppressor gene [a type of gene that prevents a tumor from growing]), making the cancer more likely to be treated with drugs that target the vascular endothelial growth factor (VEGF; see Treatment). The type of biopsy performed depends on the location of the cancer. A separate biopsy may not be needed if the cancer is found on the CT scan and removal of the kidney is recommended. If surgery is recommended based on the results of other medical tests, such as the CT scan, many doctors will examine the tumor after it is removed during surgery, rather than a separate procedure beforehand. The patient should carefully discuss the reasoning for a recommended biopsy option with his or her doctor. Imaging tests Intravenous pyelogram (IVP). A dye is injected into the patient’s bloodstream to highlight the kidney, urethra, and bladder when an x-ray (see below) is taken. The picture produced can show changes in these organs and in the nearby lymph nodes. Bone scan. A bone scan uses a radioactive tracer to look at the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer or a fracture (break), appear dark. CT scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient’s vein to provide better detail. Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. A contrast medium may be injected into a patient’s vein to create a clearer picture. Positron emission tomography (PET). A PET scan is a way to create pictures of organs and tissues inside the body. A small amount of a radioactive substance is injected into a patient’s body and absorbed by the organs or tissues being studied. This substance gives off energy that is detected by a scanner, which produces the images. Recent research studies suggest that PET scanning may be helpful to monitor tumor shrinkage during treatment of kidney cancer that has spread. However, it is still considered experimental, and health insurance does not often cover the scan because most types of kidney cancer do not absorb the radioactive substance. X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs. Cystoscopy/nephro-ureteroscopy. Rarely, a special test called a cystoscopy and nephro-ureteroscopy may be done for renal (kidney) pelvic cancer. During these procedures, the patient is sedated while a tiny, lighted tube is inserted into the bladder through the urethra and up into the kidney. The device can remove samples of cells and, in some cases, small tumors. To learn more about what to expect during common diagnostic tests, read Cancer.Net: Tests and Procedures. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: Newly Diagnosed. Staging With Illustrations
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer. One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four); stage 0 kidney cancer is extremely rare. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments. It is important for doctors to learn as much as possible about the tumor because this information can help them predict if the cancer will grow and spread or how it will respond to treatment. This information includes the cell type, the grade (describes how similar the cancer cells are to normal cells), the presence of certain proteins on the cancer cells, (such as carbonic anhydrase IX or HLA B7), and information from the patient (his or her activity level, weight loss, and the presence or absence of fevers and sweats, and other symptoms). TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
TX: The primary tumor cannot be evaluated. T0: There is no evidence of a primary tumor in the kidney(s). T1: The tumor is found only in the kidney and is 7 centimeters (cm) or smaller in size at its greatest dimension (its largest area). There has been much discussion among doctors whether this classification should only include a tumor 5 cm and under. T1a: The tumor is found only in the kidney and is 4 cm or smaller in size at its largest area. T1b: The tumor is found only in the kidney and is between 4 cm and 7 cm at its largest area. T2: The tumor is found only in the kidney and is larger than 7 cm in size at its largest area. T3: The tumor has grown into major veins or it has spread to the adrenal gland (gland on top of each kidney that produces hormones and adrenaline to help control heart rate, blood pressure, and other body functions) or perinephric tissue (connective, fatty tissue around the kidneys). It has not grown beyond Gerota's fascia (an envelope of tissue that surrounds the kidney). T3a: The tumor has spread to the adrenal gland or perinephric tissue, but the tumor has not grown beyond Gerota's fascia. T3b: The tumor has grown into the renal vein(s) (the large vein leading out of the kidney) or vena cava (the large vein leading out of the heart) below the diaphragm (the muscle under the lungs that helps breathing). T3c: The tumor has grown into the renal vein(s) or vena cava above the diaphragm. T4: The tumor has spread to areas beyond Gerota's fascia. Node. The “N” in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the kidneys are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes. NX: The regional lymph nodes cannot be evaluated. N0: The cancer has not spread to the regional lymph nodes. N1: The cancer has spread to a single regional lymph node area. N2: The cancer has spread to more than one regional lymph node area. Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. Common areas where kidney cancer may spread include the bones, liver, lungs, brain, and distant lymph nodes. MX: Distant metastasis cannot be evaluated. M0: The disease has not metastasized. M1: There is distant metastasis (the cancer has spread to other parts of the body beyond the kidney area). Cancer stage grouping Doctors assign the stage of the cancer by combining the T, N, and M classifications. Stage I: The tumor is 7 cm or smaller and is in the kidney only. It has not spread to the lymph nodes or distant organs of the body (T1, N0, M0). Stage II: The tumor is larger than 7 cm and is in the kidney only. It has not spread to the lymph nodes or distant organs of the body (T2, N0, M0). Stage III: Either of these conditions:
Stage IV: Any of these conditions:
Recurrent: Recurrent cancer is cancer that comes back after treatment. It may be found in the kidney area or in another part of the body. Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com. Treatment
The treatment of kidney cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient’s overall health. In many cases, a team of specialists that may include a urologist (a doctor who specializes in urinary tract problems), an oncologist, a pathologist, a diagnostic radiologist, and a radiation oncologist will work with the patient to determine the best treatment plan. This section outlines treatments that are the standard of care (the best treatments available) for this specific type of cancer. Patients are also encouraged to consider clinical trials when making treatment plan decisions. A clinical trial is a research study to test a new treatment to prove it is safe, effective, and possibly better than standard treatment. Your doctor can help you review all treatment options. For more information, visit the Clinical Trials section. Kidney cancer is most often treated with surgery, targeted therapy, and/or immunotherapy. Radiation therapy and chemotherapy are rarely used. Each of these treatment options is described in more detail below. Surgery If the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes may be the only treatment necessary. The types of surgery used for kidney cancer include the following procedures: Radical nephrectomy. Surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy. If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection (removal of the lymph nodes affected by the cancer) is performed. If the cancer has spread to the adrenal gland or nearby blood vessels, the surgeon may remove the adrenal gland, called an adrenalectomy, and parts of the blood vessels. Partial nephrectomy. A partial nephrectomy is the surgical removal of a tumor while preserving kidney function and lowering the risk of kidney disease after surgery (called hyperfiltration injury). It is used most often for a small tumor, even when the other kidney functions normally. Laparoscopic surgery. In laparoscopic surgery, the surgeon makes several small incisions, instead of one larger incision in the abdomen used in traditional surgery. The surgeon uses telescoping equipment to remove the kidney completely or perform a partial nephrectomy. This surgery may take longer, but it is less painful afterward and patients recover more quickly. Radiofrequency ablation. Radiofrequency ablation is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. The procedure is performed by a radiologist or urologist. The patient is sedated and given local anesthesia to numb the area. Cryoablation. Cryoablation (also called cryotherapy or cryosurgery) is the freezing of cancer cells with a metal probe inserted through a small incision. The metal probe is placed into the cancerous tissue using a CT scan and ultrasound as guidance. The procedure requires general anesthesia for several hours. The U.S. Food and Drug Administration (FDA) approved this treatment for kidney cancer, but more research studies are needed to determine how effective this treatment is in the long term. Targeted therapy Targeted therapy is a treatment that targets faulty genes or proteins that contribute to cancer growth and development. These drugs are becoming more important in the treatment of kidney cancer. Anti-angiogenic drugs are a type of targeted therapy that blocks the formation of the new blood vessels needed for a tumor to grow and spread. Sunitinib (Sutent) and sorafenib (Nexavar), called tyrosine kinase inhibitors (TKIs), are two anti-angiogenic drugs that may be used to treat clear cell kidney cancer. Clear cell kidney cancer has a mutation of the VHL gene that causes the cancer to make too much of a certain protein, known as vascular endothelial growth factor (VEGF). VEGF controls the formation of new blood vessels. Side effects of TKIs may include diarrhea, high blood pressure, and tenderness and sensitivity in the hands and feet. In 2007, temsirolimus (Torisel) was approved by the FDA as a treatment for people with advanced kidney cancer. Temsirolimus targets another protein that controls tumor growth and blood vessel formation. In clinical trials, it slowed or stopped tumor growth, or in some cases, reduced tumor size. Side effects may include skin rash, weakness, nausea, mouth sores, and loss of appetite. Immunotherapy Immunotherapy (also called biologic therapy) is designed to boost the body's natural defenses to fight cancer. It uses materials either made by the body or in a laboratory to bolster, target, or restore immune system function. Kidney cancer may be one of the few cancers that the body’s immune system can fight, which often makes immunotherapy effective in treating kidney cancer. Interleukin-2 (IL-2) is currently the most effective drug used to treat advanced kidney cancer. It is a cellular hormone (cytokine) produced by activated white blood cells and is important in immune system function, including the destruction of tumor cells. It can successfully treat about 10% of patients who receive it. High-dose IL-2 can cause severe side effects, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attack, bleeding, chills, and fever, so patients may need to stay in the hospital for up to 10 days during treatment. Only centers with expertise in high-dose IL-2 or kidney cancer should recommend IL-2. Some centers use low-dose IL-2 because it has fewer side effects, although it is not as effective. Alpha-interferon is another immunotherapy commonly used to treat kidney cancer that has spread. Interferon appears to change the proteins on the surface of cancer cells and slow their growth. Although it has not proven to be as beneficial as IL-2, it has been proven to increase survival when compared with an older treatment called megestrol acetate. Researchers have tested many combinations of IL-2 and alpha-interferon for patients with advanced kidney cancer, and these treatments have also been combined with chemotherapy. It has not been shown in research studies that these combinations are better than IL-2 or interferon alone. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. It is not considered effective as a primary treatment for kidney cancer. It is used alone only rarely to treat kidney cancer because of the high rate of damage that it causes to the normal kidney. It is used only if a patient cannot have surgery and, even then, usually only on areas where the cancer has spread and not the primary kidney tumor. Most often, radiation therapy is used after the cancer has spread to help ease symptoms, such as bone pain or swelling in the brain. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. For kidney cancer, internal radiation therapy is given using a hollow needle to insert radioactive seeds directly into a tumor. Another type of radiation therapy is stereotactic radiosurgery, which is designed to direct the radiation therapy to a specific area without damaging nearby tissue. Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Internal radiation therapy may cause some bleeding, infection, and risk of injury to nearby tissue. Most side effects go away soon after treatment is finished. Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. While useful to treat most types of cancer, kidney cancer is often resistant to chemotherapy. Researchers continue to study new drugs and new combinations of drugs. For some patients, the combination of gemcitabine (Gemzar) and fluorouracil (5-FU, Adrucil) or capecitabine (Xeloda) will temporarily shrink a tumor. It is important to remember that transitional cell kidney cancer and Wilms tumor are much more likely to be successfully treated with chemotherapy (see Bladder Cancer and Wilms Tumor). The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net’s Drug Information Resources, which provides links to searchable drug databases. Advanced kidney cancer In the most advanced stage (stage IV), kidney cancer cells have broken away from the original tumor and have traveled through the lymphatic system or blood to other parts of the body, where they begin growing tumors. The most common site of distant metastasis is in the lungs, but cancer can spread to the lymph nodes, bones, liver, brain, skin, and other areas in the body. If the cancer has spread to many areas beyond the kidney, it is more difficult to treat. Since 1% of all kidney cancers spontaneously shrink or disappear, researchers have focused on using the body's immune system as a way to treat advanced kidney cancer. If the kidney cancer spreads, radiation therapy, immunotherapy, and chemotherapy may be used alone or in combination. Currently, the most effective treatment for metastatic kidney cancer is targeted therapy that slows or prevents tumor growth and blood vessel formation. These drugs have been shown to prolong life when compared with standard treatment. To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: During Treatment. Clinical Trials Resources
Doctors and scientists are always looking for better ways to treat patients with kidney cancer. A clinical trial is a way to test a new treatment to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment. Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating kidney cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with kidney cancer. To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about Clinical Trials , including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials. Side Effects
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur. Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person’s overall health. Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net’ s section on Managing Side Effects. In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net’s section on Caring for the Whole Patient. For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor. After Treatment
After treatment for kidney cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. As part of this follow-up care, patients should receive regular blood tests to check kidney function, and chest x-rays, CT scans of the abdomen and chest, and other imaging tests to watch for recurrence or metastasis. Patients should have a checkup every three months for the first year, every four months for the second to fifth year, and yearly thereafter. Because people treated for kidney cancer often have a single kidney, they will need to be monitored for possible declining kidney function for the rest of their lives. There are few long-term side effects, although some patients may have chronic pain from the surgical scar. Also, people with kidney cancer have a slightly higher risk of developing colon and prostate cancer. People recovering from kidney cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based on your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer . To learn about the terms used in this section, read the Cancer.Net Feature: Cancer Terms to Know: After Treatment. Current Research
Research for kidney cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor. Because most kidney cancers do not respond well to traditional chemotherapy, research for kidney cancer focuses on using new and different treatments, immunotherapy, and targeted therapy. Targeted therapy. Several recently discovered drugs that affect the process of blood vessel development and/or cancer cell growth are being tested as treatments for kidney cancer. The early results from these clinical trials show that these types of drugs may be effective treatments for kidney cancer, and this is an area of rapid scientific change. Axitunib (AG 013736) is still in clinical trials, but is showing that it may be an effective treatment for kidney cancer. Another anti-angiogenic drug approved by the FDA to treat colon, lung, and breast cancer, bevacizumab (Avastin), has been shown to slow tumor growth for people with metastatic renal carcinoma. Bevacizumab blocks VEGF, preventing a tumor from growing and spreading. A large study in the United States comparing interferon with interferon combined with bevacizumab was completed in July 2005, and a second study has also been completed in Europe. Both these studies show that bevacizumab combined with interferon slows tumor growth and spreading. However, neither clinical trial has shown that patients live longer when treated with bevacizumab. A recent study has shown that adding the drug erlotinib (Tarceva) to bevacizumab caused kidney tumors to shrink for about 40% of patients. However, another clinical trial comparing bevacizumab alone with bevacizumab combined with erlotinib showed no benefit for adding erlotinib to bevacizumab. Cancer vaccines. Cancer vaccines are treatments that help a person’s immune system fight cancer. Doctors are testing the use of several cancer vaccines to treat kidney cancer and prevent recurrence for people with advanced renal cell carcinoma. One vaccine is made from a person's tumor and given after surgery, while others are made from proteins found on the surface of kidney cancer cells or blood vessel cells found in the tumor. Allogeneic (ALLO) stem cell transplantation or mini-transplant. A stem cell transplant is a medical procedure in which diseased bone marrow is replaced by highly specialized cells, called hematopoietic stem cells. Hematopoietic stem cells are found both in the bloodstream and in the bone marrow. In an ALLO transplant, stem cells are obtained from a donor whose tissue matches the patient’s on a genetic level; this testing is called HLA-typing. Most often, a patient’s brother or sister serves as the donor, although unrelated donors can serve as the donor too. The goal of transplantation is to destroy cancer cells in the marrow, blood, and other parts of the body and have replacement blood stem cells create healthy bone marrow. In most stem cell transplants, the patient is treated with high doses of chemotherapy and/or radiation therapy to destroy as many cancer cells as possible. This also destroys the patient’s bone marrow tissue and suppresses the patient’s immune system so that the donor cells are not rejected by the body. After the high-dose treatment is given, blood stem cells are infused into the patient’s vein to replace the bone marrow and restore normal blood counts from donor cells. Sometimes, ALLO transplants can also be performed after giving lower doses of chemotherapy and/or radiation therapy that are still sufficient to suppress the immune system and allow growth of the donor cells. (These transplants, sometimes termed “mini-transplants” or “reduced intensity transplants” have less immediate side effects. A major risk is that the donor’s cells will recognize the patient’s body as foreign, causing graft-versus-host disease (GVHD). GVHD may be a serious complication of allogeneic transplants and can be fatal. Other side effects may include liver problems, diarrhea, infections, and rashes. However, GVHD can also be a benefit, in that the donor cells can recognize the cancer cells as foreign and destroy these cells, a mechanism that is one of the major reasons why ALLO transplantation generally works so well over the long term. The risk of GVHD can be reduced with exact HLA-type matching and the use of preventative drugs. Learn more by reading the Cancer.Net Feature series Understanding Bone Marrow and Stem Cell Transplantation. Questions to Ask the Doctor
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
Patient Information Resources
Action to Cure Kidney Cancer American Urological Association Kidney Cancer Association VHL Family Alliance View all of Cancer.Net's Patient Information Resources. |
