Treatment options

Treatment and care of people with cancer is usually provided by a team of health professionals, both medical and allied health, called a multidisciplinary team. 

Treatment for kidney cancer depends on: 

• the stage of the disease
• the location of the cancer
• the severity of symptoms
• your general health and wishes. 

Treatment may involve the following: 

Surgery 

Treatment for kidney cancer often involves surgery. 

As well as removing the cancer, surgery may remove: 

• some of the surrounding kidney tissue – this is a partial nephrectomy
• the whole kidney – this is a simple nephrectomy
• the kidney, the adrenal gland that is located on top of the kidney and fatty tissue around the kidney, and sometimes some of the nearby lymph nodes – this is a radical nephrectomy. 

The surgery may involve a single large incision in the abdomen or the back, or a number of small ones (laparoscopic surgery). 

If there is only one small tumour in a suitable location on the kidney, a partial nephrectomy might be the preferred surgery. This option allows some of the function in the kidney to be retained, compared to a nephrectomy which removes the whole kidney.. However, even if a whole kidney is removed, the remaining kidney usually provides enough function to enable a person to lead a normal, healthy life. If too much kidney tissue is removed, dialysis or a kidney transplant will be needed. 

Nearby lymph nodes may also be removed during surgery, especially if they are enlarged. 

If the cancer has spread to other parts of the body, surgery may be used to remove these spots (metastases), to attempt to cure the cancer (if there are only a few metastases that can be easily removed) or to relieve pain and other symptoms. 

Side effects of surgery for kidney cancer might include pain after the operation, leakage of urine into the abdomen (after partial nephrectomy) or kidney failure (if the remaining kidney does not function well). 

Ablation 

Removal of tissue (ablation) by means other than surgery is sometimes used to attempt to destroy kidney tumours. Types of ablation include: 

• cryotherapy – use of extreme cold (delivered at the end of a needle probe)
• radiofrequency ablation – use of high-energy radio waves to heat the tumour (delivered via a needle probe)
• arterial embolisation – injection of a substance to block blood flow to the affected kidney, to starve the tumour of oxygen and nutrients, causing it to shrink. 

Active surveillance 

If the kidney tumour is small, doctors may decide to keep a watch on the tumour to see whether it grows. This approach is most likely to be used in elderly or frail people, to avoid the risks associated with surgery. 

Chemotherapy 

Chemotherapy is not generally used for kidney cancer because kidney cancer cells do not usually respond to traditional chemotherapy medicines. 

Radiation therapy 

Along with surgery, some people may receive radiation therapy. This is usually done if there is a suspicion that some cancer cells are left behind. 

Some kidney cancers do not respond well to radiation, so radiation therapy by itself is more likely to be used in people who need to avoid the risks of surgery. It can also be used to ease the symptoms of kidney cancer. Newer types of radiation therapy might lead to better outcomes in the future. 

Targeted therapy 

Targeted therapy refers to treatment with medicines that are designed to specifically attack cancer cells without harming normal cells. 

Targeted medicines are often used to treat advanced kidney cancers. Although they can shrink or slow the growth of the cancer, none of them have been shown to cure it. 

One type of medicine targets a protein that helps tumours form new blood vessels. This type includes the medicines axitinib, bevacizumab, cabozantinib ^[45], lenvatinib ^[6] (used in combination with everolimus) ^[78] pazopanib, sorafenib and sunitinib ^[9] 

Another type of medicine targets proteins that help cancer cells grow, and inhibits these proteins. This type includes the medicines everolimus, pazopanib, sunitinib and temsirolimus. ^[10][11]

Immunotherapy 

Immunotherapy increases the patient’s immune system to help it fight the cancer. Immunotherapy treatment for kidney cancer may involve taking pills by mouth or placing a solution directly into the bladder through a tube inserted into the urethra ^[12] (see intravesical therapy above) 

Immunotherapy can also be given through an injection into the veins. Cancer cells use different proteins, called “checkpoints” to stop the immune system from attacking them. Newer immunotherapies, called immune checkpoint inhibitors can help the immune system to kill the cancer cells. Some commonly used immunotherapy drugs used in bladder cancer are avelumab and nivolumab. 

For further information regarding immunotherapy, see Immunotherapy. 

Follow-up 

After treatment, you will need regular follow-up sessions to check whether the cancer has come back (recurred) or check for side effects of the treatment. These might include physical examinations, blood tests and CT scans. 

Advanced and recurrent cancer 

If you are diagnosed with stage IV kidney cancer (where the cancer has spread to other parts of the body), the treatment depends on how much the cancer has spread and on your general health. Surgery can be used if the cancer hasn’t spread, or has only spread to one other part of the body, and it appears possible to remove the main tumour and the metastases where it has spread. Even if the cancer has spread to more areas and the metastases cannot be removed, surgery to remove the affected kidney might still be helpful. 

If surgery is not possible, targeted therapy or immunotherapy is likely to be used. 

For advanced kidney cancer, palliative treatments may be used to relieve symptoms such as pain. These treatments include radiation therapy and embolisation. 

Kidney cancer can recur (come back) after treatment. The cancer can recur in the kidney or somewhere else in the body, and is classified as local or distant (often called metastatic cancer). 

Treatment options for recurrent kidney cancer depends on where it occurs, the treatments that have been used previously and your general health. Options are more surgery, targeted therapy, immunotherapy, chemotherapy and palliative treatments.