Treatment

Treatments

There are different types of treatment for patients with kidney cancer, depending on the stage of the cancer and the person’s overall health. At Siteman, each cancer has a wide range of treatments that can be used alone or in combination to give the best outcome for your specific cancer, including standard therapies and novel therapies only available in clinical trials. That’s why careful diagnosis is so important. As part of a research medical center, Siteman Cancer Center, Barnes-Jewish Hospital and BJ West County Hospital have access to a wide range of clinical trials to test new therapies as they emerge. Many of our doctors are principle investigators in these trials, which cover medical and surgical therapies. Discuss with your physician how your cancer might benefit from clinical trials.

The standard treatments for kidney cancer include surgery, chemotherapy, and biologic therapy. Clinical trials are testing many other approaches, some of which are becoming standard of care.

Surgery and Other Procedures

Partial nephrectomy: This surgical procedure removes the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed. The Siteman team has developed techniques to perform robotic partial kidney removal – one of highest volumes in the world for this procedure.

Radical nephrectomy: Performed for larger kidney cancer and may include the adrenal gland, surrounding tissue, and, usually nearby lymph nodes. Siteman surgeons can often do these laparoscopically and robotically with smaller incisions and shorter recovery time.

Cytoreductive radical nephrectomy: This is generally preformed for metastatic cancers that have spread outside the kidneys. It can be done as an open or laparoscopic procedure. Siteman surgeons do 25 of these a year and have advanced expertise.

Nephroureterectomy: Used for transitional cell cancer of the renal pelvis and ureter, it involves removal of the kidney, the ureter and bladder cuff. This procedure can also be done robotically.

Segmental resection of the ureter: Also for the same type of renal cancer, this procedure involves removal of the part of the ureter that contains cancer and some of the healthy tissue around it. The ends of the ureter are then reattached. This treatment is used when the cancer is superficial and in the lower third of the ureter only, near the bladder.

Arterial embolization: When surgery to remove the cancer is not possible, arterial embolization may shrink the tumor. A small incision is made and a catheter is inserted into the main blood vessel that flows to the kidney, releasing small pieces of a special gelatin sponge to block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow.

Percutaneous cryoablation: Siteman is the only center in the country currently offering treatment for kidney cancer patients ineligible for any type of surgery due to their failing health or age. Percutaneous cryoablation is a procedure that involves inserting probes through the skin to freeze small tumors in the kidney. This procedure currently is used only for small tumors or for patients who have no other alternative. Because this technique holds the promise for being the least debilitating of all kidney cancer treatments, researchers are focused on expanding its application for the future.

A person can live with part of one working kidney, but if both kidneys are removed or are not working, the person will need dialysis or a kidney transplant.

After surgery, some patients are given chemotherapy to kill any remaining cancer cells and lessen the chances the cancer will come back.

Radiation Therapy

Kidney cancers are more resistant to radiation than other organs, so radiation is usually used to manage symptoms of bony or soft-tissue metastases. Newer techniques that allow safe delivery of high doses of radiation to a kidney cancer are becoming available.

Chemotherapy

Chemotherapy involves the administration of drugs, either orally or intravenously to kill cancer cells. Over the last five years, several new drugs have increased the options for physicians treating patients with kidney cancer. Therapy that falls under medical treatment has a wide range of approaches, including timing of treatment. It can be given before or after surgery, in conjunction with radiation or by itself.

Biologic or immunotherapy: These drugs harness the body’s own immune system to fight cancer.

Targeted therapy: Use of antiangiogenic agents allows treatment of advanced renal cell cancer. Antiangiogenic agents keep blood vessels from forming in a tumor, causing the tumor to starve and stop growing or shrink. Monoclonal antibodies and kinase inhibitors are two types of antiangiogenic agents used to treat renal cell cancer. Many tumors occur because of dysregulation of mTOR signaling, so in addition to kinase inhibitors, one very effective targeted therapy uses mTOR inhibitors.

Different combinations of therapies may be used depending on the stage of the cancer and the health of the patient. New combinations of therapies are always being tested in clinical trials and are available at Siteman Cancer Center before other places may have access to them.