Early diagnosis of kidney cancer is important to successful treatment. As with most types of cancer, the earlier the tumor is discovered, the better a patient's chances for survival, as tumors discovered at an early stage often respond well to treatment. Survival rates in such cases are high. Tumors that have grown large or spread (metastasized) through the bloodstream or lymphatic system to other parts of the body are more difficult to treat and present an increased risk for death.
There are numerous factors that are considered in assessing which treatment option is best suited for a patient, such as medical history, current health condition, clinical and diagnostic test results and patient preference. Other factors that are taken into account are the tumor size, location and stage of the disease.
Based on the final assessment, your doctor will recommend an individualized treatment plan that may include: surgery (where part or all, of the kidney is removed), tumor ablation, embolization, or surveillance. Some patients will benefit from a combined approach that may include surgical removal in addition to targeted therapy, immunotherapy, research protocols (clinical trials) or chemotherapy.
Surgery is the most common treatment for kidney cancer, and very often is the only treatment required. The surgery to treat kidney cancer is called a nephrectomy. Depending upon specific tumor size, location and stage of the disease, your UCLA Kidney Cancer Program surgical oncologist may elect to remove a portion of the kidney (partial nephrectomy) or to remove the entire kidney (radical nephrectomy).
Kidney removal, or resection, whether a partial or radical nephrectomy, is often an extremely difficult and complicated surgery. This is one of the important reasons why it is essential that your cancer treatment be carefully controlled and managed by experienced, skillful and highly specialized surgeons and oncologists.
For some tumors that are small and located at the outer edge of the kidney, it may be possible to kill the tumor without having to surgically remove it. Tumor ablation destroys the tumor without surgically removing it. Examples of ablative technology include:
- Interstitial Radiofrequency Ablation
- High Intensity Focused Ultrasound
- Microwave Thermotherapy
- Laser Coagulation
Embolization is not a standard treatment option for kidney cancer, but may be considered for patients who cannot tolerate surgery or ablation treatments. It may also be considered as an adjunct to standard forms of treatment, especially when the tumor is actively bleeding.
Embolization is used to shrink the tumor, and may be used to stop the tumor from bleeding, and permits physicians to stabilize the patient before surgery. Embolization is usually performed under sedation and is accomplished by advancing a long, narrow catheter from a peripheral artery, such as the groin, into the artery of the kidney. The catheter is used to deliver small amounts of material that block the flow of blood to the tumor and therefore stop active bleeding. Without a blood supply, the tumor dies. Since it is unclear whether or not embolization completely eliminates the tumor, embolization is not considered as a primary form of therapy for kidney cancer.
Immunotherapy is designed to stimulate the body's own immune system to attack cancer.
The idea is that the immune system will attack and rid the body of cancer in much the same way it eliminates the flu. Renal cell carcinoma (RCC) is very responsive to immunotherapy, which has become the standard of care for metastatic disease, either independently or in combination with other treatments.
Not everyone is a candidate for immunotherapy treatment. A patient must be in good general condition, have adequate function of vital organs, including the heart, lungs and kidneys, and have no brain metastasis. Immunotherapy is not effective against cancer in the brain. Prior to immunotherapy treatment, patients must undergo diagnostic tests to assess their vital organ function and scans to determine if any brain metastases are present.
Surveillance is the ongoing monitoring of a patient who does not undergo treatment. Surveillance is generally recommended in the following situations:
- The kidney tumor has a low probability of being cancer.
- The patient cannot tolerate treatments.
- They have a short life expectancy and are likely to pass away from other causes.
- When a patient elects not to undergo any of the traditional or newer treatments.
With lesions that have a low probability of being cancer, regular follow-up with a physician is mandatory. Angiomyolipoma, a benign tumor, is the only kidney tumor that can be diagnosed by a CT scan. Patients with angiomyolipoma may undergo surveillance with periodic imaging studies; however, embolization or surgical removal may be necessary when the angiomyolipoma is symptomatic, bleeding or greater than 4 cm in size.
Clinical trials are carefully controlled research studies in which cancer patients help doctors and scientists find ways to improve health and cancer care, and to make sure the treatments are safe and effective. Each study is designed to address and answer specific scientific questions and to find better ways to prevent, diagnose or treat cancer. A clinical trial is one of the final stages resulting from the research conducted during intensive and lengthy laboratory studies.
If you are interested in finding out more about these studies, visit our Clinical Trials Guide for general information and a listing of currently open clinical trials.