The treatment of renal cell carcinoma will depend on
the stage and the patient's overall physical health. If there is uncertainty
as to management, a second opinion is always reasonable and can provide
information to the patient to help make a decision.
Surgery is the main treatment for renal cell carcinoma because
it has the highest chance of cure. On the other hand, surgery is typically
performed in lower stage disease with the expectation that all tumor can
be removed. The most commonly performed surgery is called a radical
nephrectomy. Radical nephrectomy removes not only the kidney but
also often the adrenal gland and fatty tissue around the kidney. Sometimes
a regional lymphadenectomy or removal of adjacent lymph nodes is also
performed. A newer procedure called a partial
nephrectomy is becoming much more common, particularly with small
tumors, so that only a portion of the kidney is removed. The patient is
then left with additional kidney tissue so that if another tumor were
to arise, more renal tissue would still be available to the patient. Occasionally,
doctors consider arterial embolization, as these tumors can sometimes
be very vascular. The blood supply can then be occluded to these tumors
and this maneuver may facilitate nephrectomy in select circumstances.
The risks associated with surgery include bleeding, later incisional hernia,
or damage to other organs such as the spleen, pancreas, vena cava, bowel,
pneumothorax (collapsed lung requiring a chest tube).
Chemotherapy uses anti-cancer drugs typically given into a vein
or by mouth which enter the bloodstream and reach all areas of the body.
This type of treatment is typically given when there has been spread of
cancer. Unfortunately, kidney cancer tends to be very resistant to chemotherapy.
Wilms' tumor in children, however, is generally sensitive to chemotherapy
but the adult renal cell carcinoma typically is not. Chemotherapeutic
drugs can 0 cancer cells but they also damage normal cells. The damage
to the normal cells may produce side effects which include upset stomach,
vomiting, loss of appetite, loss of hair, sores in the mouth or vagina
and an increase in infection, bleeding and infertility.
Radiation therapy is also used to kill cancer cells but typically
this form of treatment is used more commonly when there is spread of tumor
to bone. Sometimes if is also used if there is spread of cancer to the
brain. It is not typically used for primary treatment of the original
cancer in the kidney.
RESULTS OF TREATMENT
In stage I to II the overall survival rate is between 70 and 100%. In
stage III, when there is more widespread disease, the survival rate can
vary between 40 and 80%. In stage IV where there is spread of tumor clearly
away from the kidney, the overall five year survival rate is in the 15
to 18% range. After treatment, the patient
will need to be followed carefully with x-rays and blood tests. If there
are new symptoms, then the patient should report them to the doctor immediately.
OF TREATMENT IN KIDNEY CANCER AND KIDNEY CANCER RESEARCH
There are many new forms of diagnostic tests
and treatment for kidney cancer. One of the genes causing clear cell
renal cell carcinoma has been identified on chromosome 3. Ultimately
this may improve diagnosis although it is not available on a widespread
basis at this time. There are constant improvements in imaging techniques
which help doctors diagnose not only the main tumor but also potential
spread of cancer. Undoubtedly in the future there will be improved
blood tests to help monitor patients.
Many advances have occurred in the surgical management of renal cell carcinoma.
Smaller tumors are being managed by preserving a portion of the kidney.
Laparoscopic crysurgery is a new, less invasive form of treatment
that freezes and destroys small kidney tumors without more extensive
open surgery. Patients can be rapidly discharged from the hospital
and recover rapidly. Larger tumors, including tumors that extend
into the vena cava and into the heart, are now potentially surgically
removable, whereas before they were thought to be inoperable.
Multidisciplinary team surgical resection. Using a combination of cardiac surgeons, vascular surgeons and urologists, we are now often able to remove tumors extending all the way into the heart, with quite good results.
- New forms of immunotherapy/vaccines are also
being developed along with investigation of new chemotherapeutic
agents. The goal of immunotherapy is to boost the body's immune
system to fight cancer cells. Compounds such as Interleukin 2 and
gamma Interferon have been used to stimulate the body's immune system
to fight these cancer cells. More recently, a new approach includes
tumor vaccines. This approach involves adding activated genes or
cytokines which can stimulate the body's immune system. Adding a
cytokine to these vaccines is a form of gene therapy which hopefully
Will stimulate the body's immune system in a very specific way to
fight the patient's tumor. Because of the specificity of this %
treatment approach, there is less toxicity than occurs with many
forms of chemotherapy. In the, future bad genes that are discovered
in cells changing to cancer may be effectively combated by adding
normal genes into tumor cells to reverse their cancerous behavior.
These are examples of multiple new processes that are being investigated
for the treatment of renal cell carcinoma.
Cryoimmunotherapy is a new development for advanced kidney cancer, pioneered by Johns Hopkins (Drs. Rodriguez and Fuchs), and represents a very exciting new modality in development for patients with advanced disease not amenable to traditional treatment.