Treatment of kidney cancer, like other cancers, depends on several factors. These determining factors include:-

• Type of cancer
• Stage of cancer and whether it has spread to other organs. Staging also helps to predict how the cancer is likely to progress.
• Grade or aggressiveness of the cancer
• Patient’s general health

Who treats kidney cancer?

Cancer management involves several specialists and the team is called multi-disciplinary team. It includes:

• an oncologist (cancer specialists)
• oncosurgeon (cancer surgeon)
• nephrologist or kidney specialist
• radiologist
• radiotherapist
• pathologist
• cancer nurse
• psychologists
• occupational therapist
• nutritional advisor
• counsellor
• social worker etc.

What does kidney cancer treatment involve?

Treatment involves surgery, chemotherapy, radiotherapy and other treatments. Each of these treatment options may be used alone or in combination with others as determined by the team treating the patient.

Surgery or nephrectomy

Surgery is the commonest approach to early stages of renal cancer - especially if it is confined within the kidney. Surgery involves removal of all or part of the affected kidney. This may be done as a keyhole operation in some cases or as an open operation (making a large incision over the abdomen.

If the cancer is very small, the surgeon may remove just the part of the kidney containing the tumour and leave as much normal tissue untouched. If the tumour is more than 4cm in diameter, the entire kidney will need to be removed.

During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure that the cancer has not spread beyond the kidney. Surgery may still be advised if the cancer has spread to reduce the burden of the cancer.

Radiotherapy

This therapeutic modality is the use of high energy beams to kill the cancer cells. Radiation is usually given after a surgery to remove and kill the residual cells.

Cryotherapy

In this method of treatment, the cancer cells are killed using a freezing probe. This is done under a local anaesthetic.

Arterial embolisation

This is an alternative to surgery. The artery that supplies blood to the kidney tumor is obstructed. The blood supply to the tumour is then cut off, causing the tumour cells to die.

Radiofrequency ablation

This is another alternative to radiation therapy and cryotherapy. Here high frequency radiowaves heat the cancer cells and kills them.

Targeted therapy or biological therapy

These are immunological therapies that target the cancer cells specifically and kill them. These drugs include:

• pazopanib
• sunitinib
• sorafenib
• axitinib
• bevacizumab
• temsirolimus
• everolimus
• aldesleukin (Proleukin)
• interferon-alpha

These drugs are useful in advanced cancers as well and reduce the risk of cancer returning after surgery. At the moment, only sunitinib and pazopanib have been recommended by the National Institute of Health and Clinical Excellence (NICE).

Chemotherapy

Oral anticancer drugs are not very useful in kidney cancers as well as other cancers. Chemotherapy may be used in combination with other modalities of therapy and are used in some types of kidney cancers like Wilm’s tumors specifically.