This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. These views are based on their interpretation of studies published in medical journals, as well as their own professional experience.

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor.

Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

After the cancer is found and staged, your doctor will talk with you about different treatment plans. It is important to take time and think about your choices. One of the most important factors is the stage of your cancer. Other things to take into account include your overall health, the likely side effects of the treatment, and the chances of curing the disease, helping you live longer or relieving symptoms.

If you have kidney cancer, your treatment options may include surgery, radiation therapy, targeted therapy, immunotherapy, chemotherapy, or some combination of these. You might want to get a second opinion. This may give you more information and help you feel more confident about the treatment plan you have chosen.

Surgery

Surgery is the main treatment for renal cell cancer. The chances of surviving kidney cancer without surgery are small. Depending on the type and stage of your cancer, you might have one of the following:

Radical nephrectomy

In this operation, the whole kidney, the adrenal gland (the gland that "sits" on top of the kidney), and some nearby fatty tissue are removed. Nearby lymph nodes are sometimes removed, too. (This is called regional lymphadenectomy.) Most people do fine with only 1 kidney.

"Keyhole" surgery

The medical term for this surgery is laparoscopic nephrectomy. In keyhole surgery, the kidney tumors, are removed through small incisions (cuts) in the skin instead of through one large incision. The surgeon can use special long, thin instruments in the incisions to do the surgery. The benefits include a shorter hospital stay, faster recovery, and less pain afterwards.

Removing lymph nodes (lymph node dissection or regional lymphadenectomy)

This method involves removing nearby lymph nodes to see if they contain cancer. Many doctors do this along with the radical nephrectomy. The main reason for doing it is to see for sure whether the cancer has reached the lymph nodes, instead of relying only on imaging study results. This information can be important in choosing among treatment options. This is something you should discuss with your doctor.

Removal of an adrenal gland

If imaging tests show the adrenal gland is not affected, it may not have to be removed. This is also something to talk about with your doctor before surgery.

Partial nephrectomy

This is also called nephron-sparing surgery. The surgeon removes only the part of the kidney with the cancer. The rest is left in place. This might be a choice if your cancer is in both kidneys, if you have only 1 kidney, or if there is a very small cancer in only 1 kidney. As a rule, partial nephrectomies are not done for larger tumors, if there is more than one tumor in the same kidney, or if the cancer has spread to the lymph nodes or distant organs.

Removal of metastases

Sometimes surgery is done to remove cancer that has spread. This can help relieve pain or other symptoms even though it does not usually help patients live longer. It is most often done if there are only a few tumors that can be removed easily. The lungs, bones, brain and liver are the most common sites of spread.

Risks of surgery

Surgery always involves some risks. Here are some possible risks of surgery for kidney cancer:

• bleeding during or after surgery that may require blood transfusions
• wound infection
• damage to internal organs and blood vessels during surgery
• unwanted air in the chest cavity
• bulging (hernia) of internal organs near the incision
• failure of the remaining kidney

Other types of treatments

While surgery is the main treatment for kidney cancers that can be removed, some people are too sick to have surgery, and sometimes other methods can be used to destroy kidney tumors. But there is much less information on how well these methods work over the long term and some doctors may still consider them to be experimental.

Cryotherapy (cryoablation)

This treatment uses extreme cold to destroy the tumor. A hollow probe (needle) is put into the tumor either through the skin or during laparoscopic surgery. Very cold gases are passed through the probe, creating an ice ball that destroys the tumor.

Radiofrequency ablation (RFA)

This treatment uses high-energy radio waves to heat the tumor. A thin, needle-like probe is placed through the skin and moved until the end is in the tumor. Once it is in place, an electric current is passed through the probe, which heats the tumor and destroys the cancer cells.

Arterial embolization

This is treatment blocks the artery that feeds the kidney with the cancer. This method is rarely done, but it is sometimes used before surgery to kill some of the cancer cells and to reduce bleeding during the operation.

Radiation therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells and shrink tumors. External radiation aims radiation from outside the body on the cancer. This type of treatment is sometimes used as the main treatment for kidney cancer in patients who cannot have surgery. It can also be used to ease symptoms such as pain, bleeding, or problems caused by the cancer spreading. But kidney cancer does not respond well to radiation. It is not often used before or after surgery because studies have shown that is doesn't help people live longer.

Radiation therapy is more often used to ease (palliate) symptoms of kidney cancer such as pain, bleeding, or problems caused by cancer spread (especially to the bones or brain). A special type of radiation treatment known as stereotactic radiosurgery can sometimes be used for single tumors that have spread to the brain. This treatment does not actually involve surgery.

Side effects of radiation can include mild skin changes that look like sunburn, nausea, diarrhea, or tiredness. Often these go away after a short while. Radiation can also make the side effects of chemotherapy worse. Radiation to the chest area can cause lung damage and lead to trouble breathing and shortness of breath. Side effects of radiation to the brain usually become most serious 1 or 2 years after treatment and can include headaches and trouble thinking.

Targeted therapies

As researchers have learned more about the gene changes in cells that cause cancer, they have been able develop newer drugs that specifically target some of these changes. These targeted drugs work in a different way than standard chemotherapy drugs, and they have different side effects.

In the past few years several targeted drugs have been approved by the FDA for use against advanced kidney cancer. Targeted therapies include drugs that stop the growth of the new blood vessels that feed cancers and drugs that stop other parts of cancer cell growth. They are often used as the first line of treatment against advanced kidney cancers. While they may shrink or slow the growth of the cancer, it's not yet clear if any of these drugs can cure kidney cancer.

Biologic therapy (immunotherapy)

The goal of biologic therapy is to boost the body's own defense system to help fight off or destroy cancer cells. Before targeted therapies, this was the most common first treatment for advanced kidney cancer, and it may still be helpful for some people. Because biologic therapy can be hard to give and can cause serious side effects, some doctors now reserve it for people who have cancers that don't respond to targeted therapies.

The main immunotherapy drugs used in kidney cancer are cytokines (proteins that activate the immune system). For a small number of patients, cytokines can shrink the cancer to less than half its original size.

The side effects of immunotherapy can be severe and, rarely, fatal. For this reason, only doctors experienced in the use of cytokines should give this treatment to people with kidney cancer.

Chemotherapy

Chemotherapy (often called simply "chemo") is the use of anti-cancer drugs injected into a vein or given as a pill. These drugs enter the bloodstream and go throughout the body, making the treatment useful for cancers that have spread to distant organs. Unfortunately, kidney cancer does not usually respond well to chemo.

Chemo can have some side effects. These side effects depend on the type of drug, how much you take, and how long you take it. Most of the side effects go away when treatment is over. Anyone who has problems with side effects should talk with their doctor or nurse. There are often ways to lessen them.

Pain control

Pain is a major concern for some people with advanced kidney cancer. Be sure to tell your doctor or nurse about any pain you are having. Unless they know about your pain, they can't help you.

For most people, treatment with morphine or other opioids (the strongest pain medicines available) will work to control the pain. For the treatment to work best, the pain medicines must be taken on a regular schedule, not just when the pain gets bad. Some long-acting forms of morphine and other drugs need to be taken only once or twice a day.

In some cases, surgery or radiation may help relieve pain caused by cancer spreading to certain areas. This is called palliative therapy. In people whose cancer has spread to the bones, drugs called bisphosphonates may also be helpful. Sometimes experts in pain control can do certain procedures such as a nerve block to lessen pain.

Last Medical Review: 04/02/2009
Last Revised: 05/06/2009