Metastatic kidney cancer

Metastatic kidney cancer

Kidney tumours can spread to other organs or distant lymph nodes. This is called metastatic disease. In metastatic disease, the kidney tumour is referred to as the primary tumour and the tumours in other organs are called metastases. Your doctor may recommend to treat metastatic disease with surgery, usually in combination with antiangiogenic therapy, also known as targeted therapy. In rare cases, immunotherapy is also used. For the treatment of metastases, radiotherapy may be recommended.

The treatment of metastatic disease aims to reduce the size of the primary tumour and the metastases. This will give you the chance to live longer and have fewer symptoms. This section describes the different treatment options, which you should discuss with your doctor.

This is general information which is not specified to your individual needs. Keep in mind that situations can vary in different countries.

What is metastatic kidney cancer?

If kidney cancer metastasises, it generally spreads to the lungs, bones, distant lymph nodes, or the brain
(Fig. 1). Metastases can be seen on a CT scan, either on initial diagnosis or during follow-up visits after treatment. They could also be detected because they cause symptoms.

Metastatic disease may be asymptomatic or can cause different symptoms, according to where the cancer has spread. The most frequent symptoms are a persistent cough in case of lung metastasis, or bone pain if the cancer has spread to the bones.

Fig.1: Metastatic kidney cancer can spread to the lungs, bones, or brain.

Treatment options

If you have metastatic disease, surgical removal of the kidney is recommended to reduce the size of the tumour and relieve symptoms. This surgery is called cytoreductive nephrectomy. The procedure is only possible if you are fit enough to undergo surgery. If successful, you can live longer and with fewer side effects.

If the metastases cause much pain or other symptoms, you may have further surgery to remove those metastatic tumours. Your doctor may recommend this if the tumours can be removed and you are fit for major surgery.

If the primary tumour is not very large or if your other kidney is not working well, your doctor may recommend cytoreductive partial nephrectomy. During this surgery, the doctor leaves as much as possible of the healthy kidney tissue intact.

In metastatic disease, surgery is generally combined with drug therapy. There are several types of drug treatment for kidney cancer:

  • Antiangiogenic therapy, commonly described as targeted therapy
  • Immunotherapy
  • Chemotherapy, in combination with immunotherapy

The most commonly used drug treatment for kidney cancer is antiangiogenic therapy

Your doctor may recommend drug treatment before surgery to shrink the tumour so it can be removed. In some cases, antiangiogenic therapy is used before surgery to see how the cancer responds to it. If it responds well, treatment continues after surgery. It is also possible that your doctor recommends drug treatment only after surgery.

If surgery is not possible, you will start treatment with drug therapies right away. These drugs influence the mechanisms that tumours use to grow. Generally, antiangiogenic therapy is used. In rare cases you may be recommended immunotherapy. Drug therapy can relieve your symptoms and may shrink the primary tumour and the metastases.

If the metastases still cause symptoms after surgery or while you receive drug treatment, radiotherapy may help to relieve them further. These are some topics you should discuss with your doctor when planning your care pathway:

  • Your medical history
  • Your kidney function
  • Whether you have one or more tumours in one or both of your kidneys
  • Where the cancer has spread to
  • The kind of treatment available at your hospital
  • The expertise of your doctor. Ask your doctor about his or her experience with the recommended treatment option.
  • Your personal preferences and values
  • Support during treatment

Drug treatment for metastatic disease

Drug treatment is a common option for metastatic kidney cancer. There are several types of treatment:

  • Antiangiogenic therapy, commonly described as targeted therapy
  • Immunotherapy
  • Chemotherapy, in combination with immunotherapy

These drugs influence the mechanisms that tumours use to grow. All decisions about the right therapy for you are taken after careful consideration of your general condition, your symptoms, and your prognosis. Further tests or scans are also used to see which treatment to select.

Generally, antiangiogenic therapy is recommended for kidney cancer. If you have a rare type of kidney cancer, your doctor may recommend chemotherapy treatment in combination with immunotherapy.

Radiation therapy

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. Treatment can be given in a single dose of radiation. You could also need to go to the hospital several times for a fractionated course of radiation therapy. In this case, you receive one dose of radiation per day.

Radiation therapy for kidney cancer is generally recommended as part of a palliative care approach.

Clinical trials

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.

Participating in a clinical trial has several advantages. It gives you the opportunity to be treated with drugs that are currently not widely available. These drugs have been tested before to ensure there are no further health risks. It could also be that you participate in a clinical trial to test the order in which different drugs can be used, or a new combination of drugs.

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.

Palliative care

Sometimes recovery from kidney cancer is not possible. When treatment is no longer successful you may be offered palliative care to make you more comfortable. Palliative care is a concept of care with the goal to optimise your quality of life if you cannot recover from your illness.