Treatments for Different Types of Kidney Cancerby Rachel Zohn Health Writer
Kidney cancer begins when healthy cells in one or both kidneys begin to change and grow out of control, forming a mass called a tumor. Kidney cancer is unique in that even if the cancer has spread, removing the tumor has been shown to help patients live longer. So surgery is often a first-line treatment. But treatment also depends on what type of kidney cancer you have, as well as your overall health.
Categorizing kidney cancers
Diagnosed in about 85 percent of patients, renal cell carcinoma (RCC) is the most common type of adult kidney cancer; urothelial carcinoma, or transitional cell carcinoma, accounts for 10 to 15 percent of kidney cancers in adults. Treatment for the latter is similar to the treatment for bladder cancer, because both start in the same type of cells. Wilms tumor, meanwhile, is the most common kidney cancer in children and is often treated with a combination of surgery, radiation, and chemotherapy.
Cancer cells respond to treatment in different ways
Knowing the type of cell that makes up a kidney tumor can help a doctor plan treatment. RCC, for example, has several subsets of cancer cells. The most common subset is clear cell RCC, which tends to respond well to immunotherapy and targeted therapy. Papillary RCC develops in 10 to 15 percent of patients and is treated similarly to clear cell RCC, but some doctors recommend clinical trials because targeted therapy isn’t always as successful in these cases.
Surgery is a first-line treatment
Surgery is the most common treatment for most types of kidney cancer. Taking into account the stage of the cancer and a patient’s overall health, a doctor may recommend a partial or radical nephrectomy, which is the removal of part or all of the kidney and surrounding tissue. This may be done through an incision or through a laparoscopic or robotic-assisted laparoscopic procedure. Removal of the kidney often improves survival rates, and you can survive without a kidney.
There are non-surgical alternatives, too
Non-surgical treatment options for kidney cancer can help alleviate pain or sickness and improve quality of life. Such treatments can include radiofrequency ablation (RFA), where a needle is inserted into the tumor to destroy the cancer with an electrical current.
Examining more non-surgical options
Cryoablation involves the insertion of a metal probe into cancerous tissues to freeze cancer cells. Arterial embolization cuts off the blood supply to the kidney that has the tumor, which will cause both the kidney and the tumor to die.
Chemotherapy: useful in some kidney cancer types
Chemotherapy is the use of drugs to destroy cancer cells. This therapy is given to the patient over a period of time. Chemotherapy is most effective in treating urothelial carcinoma and Wilms tumor, a rare form of kidney cancer that affects children.
Radiation: not usually first-line kidney cancer treatment
Radiation is the use of high-energy X-rays to target and destroy cancer cells, but it’s not usually considered effective as a primary treatment for kidney cancer. That’s because renal cell carcinomas are considered “radioresistant” or resistant to the effects of radiation. It is most commonly used when surgery isn’t an option, and usually on areas where the cancer has spread, to help ease symptoms.
New forms of radiation may be effective
Stereotactic ablative radiotherapy is emerging as an effective radiation therapy in treating patients with RCC. A 2017 study at the University of Texas Southwestern Medical Center reviewed data on this technique, which showed this type of therapy is effective in controlling the cancer by delivering high doses of radiation to the tumor while minimizing the dose to adjacent healthy tissue.
Targeted therapy and anti-angiogenesis therapy additional options
Targeted therapy involves drugs that block the growth and spread of cancer cells while limiting damage to healthy cells. Anti-angiogenesis therapy is a targeted therapy that focuses on stopping the process of making new blood vessels. This therapy is effective for clear cell kidney cancer, which has a mutation of the VHL gene that causes the cancer to make too much of a certain protein.
Immunotherapy boosts the body’s defenses
Some researchers are focusing their studies on the growing field of immunotherapy, which works with the body’s natural immune defenses to fight cancer. The Food and Drug Administration approved the use of two immunotherapy drugs, nivolumab and ipilimumab, to be used in combination. These drugs are immune checkpoint inhibitors that work by blocking a certain protein within immune cells, called T cell, and some cancer cells. When these proteins are blocked, T cells can better target cancer cells.
Immunotherapy treatments offer hope
The use of nivolumab and ipilimumab as a frontline treatment is an exciting development for many kidney cancer patients, according to Eric Jonasch, M.D., a professor in medical oncology at the University of Texas MD Anderson Cancer Center. “The ipilimumab plus nivolumab combination demonstrated improved survival and response rate in patients with intermediate and unfavorable risk features, and a complete response rate of 9 percent,” Dr. Jonasch wrote in an email to HealthCentral.
When 'active surveillance' is recommended
Sometimes a doctor may recommend no treatment for the time being, but instead to actively monitor the tumor with regular tests. This can be effective in older patients with a small kidney tumor who aren’t showing many symptoms from kidney cancer or may be in frail health because of other serious medical issues, such as heart or lung disease.
Taking a look at clinical trials
Clinical trials are studies that people volunteer to take part in to test new drugs or procedures. A trial may give you access to treatment not widely available elsewhere. In kidney cancer, many clinical trials are focused on new targeted therapies such as immunotheraphy methods. To find out more, here is a list of clinical trials in treating kidney cancer.