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.