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In the United States, about 35,000 people are diagnosed with kidney cancer every year. Men are twice as likely as women to develop a kidney tumor. Other risk factors include smoking, obesity and high blood pressure.
Although blood in the urine can be a sign of kidney cancer, early kidney cancers usually do not have any symptoms at all. In fact, most cases today are diagnosed incidentally through computerized tomography (CT) scans or other imaging procedures performed for unrelated reasons. Tests to confirm a kidney cancer diagnosis can include X-ray procedures, urine and blood tests and needle biopsy.
When kidney tumors are detected at an early stage, a large majority of patients achieve long-term survival.
Kidney Cancer TreatmentIn the past, the most common approach to treating kidney cancer was to remove the entire organ. As diagnostic imaging technologies like CT have become more sophisticated and more widely used, more kidney tumors are being identified at an early stage. Physicians are increasingly able to treat just the tumor rather than removing a kidney.
Treatment options vary, depending on each patient’s individual disease and health issues. An organ-sparing approach to treating kidney cancer can help a patient avoid some long-term potential side effects, especially for patients who already suffer from diabetes, hypertension or cardiovascular disease.
The Prostate and Urologic Cancer Program offers a full range of surgical and interventional techniques for treating kidney tumors while preserving as much healthy organ tissue as possible.
Ablation Techniques for Early CancersMany patients with early kidney cancer are eligible for minimally invasive procedures to destroy tumors. These treatments minimize side effects, pain and recovery time and can provide an excellent chance to achieve a cure while preserving kidney function. Froedtert & The Medical College of Wisconsin form one of the busiest centers in the Midwest for kidney cancer ablation.
- Percutaneous cryoablation: During this outpatient procedure, special instruments are used to destroy kidney tumors using cold energy. After an area of the patient’s skin has been numbed, physicians use CT and ultrasound imaging to position a thin needle probe within the kidney tumor. The tip of the probe is then super-cooled, engulfing the tumor (along with a margin of healthy tissue) in a ball of ice. The dimensions of the ice ball are easily monitored using CT imaging, and freeze-thaw cycles effectively kill the tumor cells. Percutaneous cryoablation is for patients with kidney tumors smaller than 3 centimeters and other patients who are not good candidates for surgery because of age or health problems. Most patients who undergo percutaneous cryoablation go home the same day and are able to perform regular activities within a couple of days. At Froedtert & The Medical College of Wisconsin, percutaneous cryoablation is performed jointly by a urologic surgeon and an interventional radiologist. The urologic surgeon provides in-depth understanding of kidney malignancies, and the IR specialist supplies imaging expertise and minimally invasive therapy options.
- Laparoscopic cryoablation: For many patients, kidney tumor cryoablation is performed using laparoscopic techniques. A cryoablation probe mounted on a catheter is introduced into the body through a small incision. The probe is then guided to the tumor using imaging technology.
- Open cryoablation: Because of the characteristics of their tumor, some patients undergo cryotherapy as part of a traditional “open” surgical procedure. A surgeon accesses the kidney through a traditional surgical incision and applies the cryoablation probes directly to the cancer site.
Partial NephrectomyPartial nephrectomy is a surgical procedure in which only a portion of a kidney is removed. This treatment removes the tumor while leaving much of the kidney intact and preserving normal kidney function.
- Robotic/laparoscopic partial nephrectomy: For some patients, surgeons can remove part of the kidney using minimally invasive, small-incision techniques. In some instances, laparoscopic partial nephrectomy can be performed with the assistance of robotic tools such as the da Vinci® Surgical System.
- Open partial nephrectomy: For larger tumors and more complex cases, surgeons perform a traditional open surgery to remove a portion of the kidney.
Radical NephrectomyIn rare cases, total removal of the affected kidney may be necessary. Patients with adequate kidney function can generally tolerate the loss of one kidney. Over the long term, these patients are at a slightly increased risk of needing dialysis. For patients who suffer from diabetes, high blood pressure or cardiovascular disease, radical nephrectomy can increase the risk of kidney failure.
Patients who require a radical nephrectomy usually suffer from advanced kidney cancer or very large kidney tumors. Radical nephrectomy can be performed either as a laparoscopic procedure or a traditional open surgery, depending on the patient’s individual situation.
- Pre-surgery embolization: Patients with very large kidney tumors can benefit from a pre-surgical procedure to cut off the blood supply to the tumor. Using minimally invasive techniques, an interventional radiologist injects a vessel-blocking substance into the main kidney artery. This procedure can make the nephrectomy surgery safer and faster by reducing surgical blood loss.
- Treatment for tumor thrombus: In a small number of patients, a kidney tumor may invade major veins nearby. This condition is called tumor thrombus. Depending on how extensive they are, tumor thrombi can require complex treatment. An embolization procedure will often be performed to shrink the tumor before surgery. In some cases, a vascular surgeon must remove the tumor from within the blood vessel, and surgical reconstruction of a vein may be required. Tumor thrombi can sometimes grow all the way up to the heart, in which case a cardiac surgeon may need to perform a bypass. Occasionally, treatment of a thrombus will require the liver to be temporarily moved out of the way. In these instances, transplant specialists are part of the surgical team.
Care for Metastatic DiseaseKidney cancer can spread to other parts of the body, often to the bones, brain, lungs or liver. For patients with metastatic kidney cancer, several therapies can successfully extend survival and relieve pain.
- Targeted chemotherapy: New “targeted” chemotherapy drugs are able to extend overall survival for patients with metastatic kidney cancer. These new drugs affect key molecular processes that make cancer cells thrive and multiply. By inhibiting these processes, the drugs can help block the proliferation and spread of cancer cells and the growth of new blood vessels within tumors. Kidney cancer is a very different disease in different people, and patients without high-risk disease characteristics can respond to these drugs for a very long time. There are currently five FDA-approved targeted chemotherapeutic agents for treating metastatic kidney cancer. Some of these drugs are oral medications. There is data to suggest that the efficacy of chemotherapy can be increased by surgically removing any intact primary tumors.
- Radiation therapy: Kidney cancers that have spread to other parts of the body can also be treated with radiation therapy. For these patients, radiation treatments can relieve pain, principally bone pain caused by spread of the tumor to the bone. There are two options: External beam radiation is often used when there are limited number of bone tumors that require treatment. Patients who are experiencing bone pain in several different sites can be treated with radiopharmaceuticals — radioactive drugs that collect in bone tissue and shrink bone metastases.
- Palliative embolization: Patients with advanced kidney cancer for whom surgery is not an option and who are experiencing significant kidney pain can receive embolization therapy to lessen symptoms. An interventional radiologist uses minimally invasive techniques to block the blood supply to the tumor. Although embolization cannot cure the cancer at this stage, it can reduce kidney inflammation and pain.
- Osteoplasty: Many patients with bone metastases suffer bone fractures. Osteoplasty is a minimally invasive procedure in which an interventional radiologist injects a special type of cement at a fracture site to reinforce the bone. Patients can experience significant pain relief.
Clinical Trials for Kidney CancerDrug therapy for kidney cancer is a rapidly evolving field, and there are many promising targeted drug therapies in development. Urologic cancer specialists at Froedtert & The Medical College of Wisconsin are actively involved in national trials to evaluate new medications. Certain drug therapies are only available through these investigational studies. To find out more, view our full listing of current clinical trials.
Genetic ScreeningWhile most cases of kidney cancer are “spontaneous,” some are associated with specific genetic syndromes. Individuals with a strong family history of kidney tumors may benefit from genetic counseling through our Cancer Genetics Screening Program.
Last Review Date: Apr. 30, 2010 Online Editor(s): Richard Petre |
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