Questions about Treatment
How is kidney cancer treated?
All decisions about the right treatment pathway for you are taken after careful consideration of tumour classification, your prognosis, and the availability of treatment options in your hospital. The most important factor for selecting treatment is the stage of the disease.
Kidney cancer can be treated by:
- Partial nephrectomy
- Radical nephrectomy
- Cytoreductive nephrectomy
- Active surveillance
- Radiofrequency ablation
- Antiangiogenic therapy
- Radiation therapy
What is partial nephrectomy and when is it recommended?
Partial nephrectomy is a type of surgery for kidney cancer in which only the tumour is removed, leaving the healthy kidney tissue untouched. It is recommended whenever possible. Generally it is performed if the tumour is limited to the kidney.
After partial nephrectomy for kidney cancer, your doctor will plan regular follow-up visits with you. Follow-up lasts at least 5 years. Common tests during follow-up visits are abdominal CT scans, ultrasound, chest x-ray, and urine and blood analyses.
What is radical nephrectomy and when is it recommended?
Radical nephrectomy is a type of surgery for kidney cancer in which the whole kidney that contains the tumour is removed. It is generally recommended if the tumour has grown outside of the kidney. It could also be recommended in cases where it is not possible to remove the tumour and leave part of the kidney intact. Most people can live with only one functioning kidney without major complications.
After radical nephrectomy for kidney cancer, your doctor will plan regular follow-up visits with you. Routine follow-up lasts at least 5 years, and often longer. Common tests during follow-up visits are abdominal CT scans, ultrasound, chest x-ray, and urine and blood analyses.
What is cytoreductive nephrectomy and when is it recommended?
Cytoreductive nephrectomy is a surgery recommended for metastatic kidney cancer. The aim is to remove as much of the tumour as possible. In order to do this, it may be necessary to remove the kidney as well as surrounding organs such as the spleen or the pancreas, or parts of the intestines or the liver.
What is active surveillance and when is it recommended?
Active surveillance is a form of treatment in which the doctor actively monitors the tumour. It is recommended if surgery is not the best option for you and you have a tumour in your kidney which is smaller than 4 cm.
If the tumour is aggressive, you need further treatment and surveillance is not an option for you. If you are a good candidate for active surveillance, your doctor will set up a strict visiting schedule.
On each visit, the urologist asks questions about any noticeable changes in your health, performs a physicalexamination, and discusses the results of your blood tests. Before each visit you get a CT or an ultrasound scan of your abdomen to monitor the growth of the tumour. An x-ray of your chest is also done to check your lungs.
In most cases, a follow-up visit is needed every 3 months in the first year after diagnosis. In the following 2 years the visits are scheduled every 6 months, and then once a year.
What is radiofrequency ablation and when is it recommended?
Radiofrequency ablation (RFA) uses the heat produced by high-frequency radio waves to kill the cancer cells.
Your doctor may suggest RFA treatment if you have a small kidney tumour (less than 4 cm) and surgery is not the best option for you. This is an effective and safe treatment for small kidney tumours but there is a risk that tumour cells are left in the kidney after RFA. This increases the risk of recurrence. RFA can be performed more than once in case of recurrence or if the first treatment was unsuccessful.
After RFA, follow-up visits are scheduled every 3 months. During these, CT scan or MRI are used to monitor your kidney and detect possible tumour recurrence on time.
What is cryotherapy and when is it recommended?
Cryotherapy, also known as cryoablation, uses a liquefied gas, most commonly liquid nitrogen or argon, to kill tumour cells by freezing them.
Your doctor may suggest cryotherapy if you have a small kidney tumour (less than 4 cm) and surgery is not the best option for you. Cryotherapy is an effective and safe treatment for small kidney tumours but there is a risk that tumour cells are left in the kidney after the procedure. This increases the risk of recurrence. Cryotherapy can be performed more than once in case of recurrence or if the first treatment was unsuccessful.
After cryotherapy, follow-up visits are scheduled every 3 months. During these, CT scan or MRI are used to monitor your kidney and detect possible tumour recurrence on time.
What is antiangiogenic therapy and when is it recommended?
These are a group of drugs which slow down tumour growth or possibly even shrink the tumour. They prevent the formation of new blood vessels which feed the cancer and allow it to grow. Antiangiogenic therapy is often referred to as targeted therapy because it mainly affects the cancer cells.
It is recommended if the tumour in metastatic disease. It may be the best treatment option for you if you cannot undergo surgery or if the tumour cannot be removed. In other cases, antiangiogenic therapy is recommended before surgery to shrink the tumour so that it can be removed with surgery afterwards.
What are the side effects of antiangiogenic therapy?
Because these drugs influence the formation of new blood vessels throughout the body they cause many side effects. The thyroid, the heart and the skin are affected most commonly.
These drugs slow down wound healing, so you cannot start this treatment until your wounds from surgery have healed completely.
Another common side effect is fatigue. This means you feel more tired than usual, you are out of energy, and it does not get better after you sleep. You may also experience pain in your joints, muscles and chest. Most people experience fatigue for six months up to a year after treatment. Fatigue can be a side effect of the drugs but it may also be caused by the tumour or the metastases.
It is common that you feel nauseous or sick during treatment. You may also have diarrhoea or constipation. If you have any of these symptoms let your medical team know. Your doctor may give you medicine to control these symptoms.
What is immunotherapy and when is it recommended?
Immunotherapy is a type of drug treatment which boosts the immune system to fight tumour cells.
Immunotherapy is rarely used to treat kidney cancer. In metastatic kidney cancer it can be used in combination with the antiangiogenic drug bevacizumab.
What are the side effects for immunotherapy?
Immunotherapy can cause several side effects. The most common include fatigue and flu-like symptoms, such as fever and chills, headaches, and pain in the muscles and joints. Nearly everyone undergoing immunotherapy has these side effects at first. It usually gets better as your course of treatment continues. These symptoms appear 2 to 4 hours after your injection and last for about 12 hours. Paracetamol can help to relieve these symptoms.
Other side effects of the treatment can be more severe. They include changes in your blood counts, nausea, vomiting, diarrhoea, and depression or anxiety. The doctor will closely monitor your health.
What is chemotherapy and when is it recommended?
Chemotherapy is a type of drug treatment which consists of one or more chemicals that are toxic to cells. It attacks any cell in the body that divides rapidly, which includes tumour cells but also hair-growth cells and bone marrow, among others. It is generally administered through an IV.
Chemotherapy is generally not effective for kidney cancer. For metastatic kidney cancer, chemotherapy with 5-fluorouracil can have an effect in combination with immunotherapy after complete resection of the primary tumour.
What is radiation therapy and when is it recommended?
Radiation therapy damages and kills the cancerous tissue. Kidney tumours are generally not very responsive to radiation therapy. Because of this, the therapy is only recommended to relieve symptoms caused by the primary tumour or metastases that cannot be removed by surgery. Radiation therapy for kidney cancer is generally recommended as part of a palliative care approach.
What is a clinical trial?
If you have metastatic kidney cancer, your doctor may suggest you participate in a clinical trial. This is a type of study where new drugs are evaluated. It could also be a study on the sequence or dose of existing drug treatments.
Your doctor will provide all information you might need before participating in a trial. Your symptoms and general condition will be monitored more often and more closely than during regular treatment.
It is important to know that you can stop your participation in a clinical trial at any time. You will not need to explain your reasons.