Kidney Cancer :-
It is important to realize that with timely diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent. More than 100,000 survivors of kidney cancer are alive in the United States today. The following information addresses the most common questions about kidney tumors and serves as a supplement to the discussion that you have with your physician.
What are some facts about kidney cancer?
In the United States, 2 percent of all cancers arise from the kidney. Each year, kidney cancer is diagnosed in approximately 38,000 Americans and is the cause of death in nearly 12,000 Americans. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma.
What risk factors are associated with kidney cancer?
The following associations may increase the risk of developing kidney cancer.
1-smoking
2-family history of kidney cancer
3-polycystic kidney disease
4-chronic kidney failure and/or dialysis
5-diet with high caloric intake or fried/sautéed meat
low vitamin E intake
6-diuretic use or hypertension, although this is still somewhat controversial
7-von Hippel Lindau disease
8-tuberous sclerosis
9-exposure to asbestos, blast furnaces and ovens used in iron/steel manufacturing
What are the symptoms for kidney cancer?
Many kidney tumors do not produce symptoms, but may be detected incidentally during the evaluation of an unrelated problem or during routine screening for people who are in high-risk categories (e.g. Von Hippel Lindau disease, tuberous sclerosis). Compression, stretching and invasion of structures near the kidney may cause pain (in the flank, abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung, bone pain or fracture may occur when cancer is in the bone and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 20 percent of patients with kidney cancer and can occur in any stage (including cancers confined to the kidney). Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated red blood cell sedimentation rate, low blood count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high blood count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.
How is kidney cancer diagnosed?
Unfortunately, there are no blood or urine tests that directly detect the presence of kidney tumors.
When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if the cancer has spread beyond the kidney (metastasis). An evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray and blood tests. A bone scan is also recommended if the patient has bone pain, recent bone fractures, or certain abnormalities on their blood tests. Additional tests may be obtained when indicated. Kidney cancer has the tendency to grow into the renal vein and vena cava. The portion of the cancer that extends into these veins is called "tumor thrombus." Imaging studies, particularly MRI, can help determine if tumor thrombus is present.
What are the different stages of kidney cancer?
The most commonly used staging system for kidney cancer was developed by the American Joint Committee on Cancer (AJCC). The most current version is the 2002 AJCC Staging System. This staging system includes the extent of the primary kidney tumor (T stage), the status of lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage). In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging the cancer helps predict prognosis and survival. In general, cancers with higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates, and these patients need to consider more aggressive treatments.
Grade: Tumor grade is a subjective measure of how aggressive the tumor looks under the microscope; therefore, it is determined from a surgical specimen. Grade cannot be determined from radiographic imaging, blood tests or urine tests. Grade usually ranges from one to three or one to four, with higher numbers indicating a more aggressive tumor. Thus, higher grade implies a worse prognosis.
Stage I: The tumor is confined to the kidney. There is no spread to lymph nodes or distant organs.
Stage II: The tumor is locally invasive into the fat around the kidney or the adrenal gland above the kidney. There is no spread to lymph nodes or distant organs.
Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumores that invade into other adjacent organs or those with distant metastasis.
Stage IV: There are several combinations of T, N, and M categories that included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall, and those with distant metastases.
Primary tumor (T): TX: Primary tumor cannot be assessed T0: No evidence of primary tumor
T1: Tumor 7.0 cm or less, confined to the kidney T1a: Tumor 4.0 cm or less, confined to the kidney T1b: Tumor 4.0-7.0 cm, confined to the kidney T2: Tumor greater than 7.0 cm, limited to kidney T3: Tumor extends into major veins/adrenal/ perinephric tissue; not beyond Gerota's fascia T3a: Tumor invades adrenal/perinephric fat T3b: Tumor extends into renal vein(s) or vena cava below diaphragm T3c: Tumor extends into vena cava above diaphragm T4: Tumor invades beyond Gerota's fascia, into adjacent organ systems
N - Regional lymph nodes NX: Regional nodes cannot be assessed N0: No regional lymph node metastasis N1: Metastasis in a single regional lymph node N2: Metastasis in more than one regional lymph node
M - Distant metastasis MX: Distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis
What are the treatment options for tumors that appear confined to the kidney?
When the tumor appears confined to the kidney (a "localized" tumor), there are three main treatment options: tumor removal, tumor ablation and surveillance. Chemotherapy, hormone therapy and radiation therapy are not effective treatments for kidney cancer.
Tumor removal:
Tumor removal is considered the standard mode of therapy for most patients and is accomplished by performing a surgery called nephrectomy. Radical nephrectomy is surgical removal of everything within Gerota's fascia, including the whole kidney. Partial nephrectomy is surgical removal of part of the kidney (in this case, the part that contains the tumor). The goal of partial nephrectomy is to remove the entire tumor while preserving as much normal kidney tissue as possible. The kidney tissue that is conserved may prevent the need for dialysis if subsequent kidney damage occurs. Nephrectomy can be performed through a traditional incision (open surgery) or through several small incisions (laparoscopic or retroperitoneoscopic surgery).
Open nephrectomy (radical and partial):
Traditional open nephrectomy (partial or radical) is performed through a flank or abdominal incision. This incision is typically 10 to 20 inches in length and may include removal of a rib. In the past, open radical nephrectomy was considered the treatment of choice for tumors that appeared to be confined to the kidney. However, five- to 10-year follow up reveals that partial and radical open nephrectomies provide equally effective cancer treatment for many patients with a single, small, localized tumor. Therefore, partial and radical nephrectomies are now considered standard treatments. If you are interested in partial nephrectomy, it is important that you seek a urologist who has experience with this technique.
As stated before, partial nephrectomy is performed to preserve as much normal kidney tissue as possible; however, its complication rate may be slightly higher than radical nephrectomy. Open partial nephrectomy should be considered in any patient with a small (ideally less than four centimeters) localized kidney tumor and a normal kidney on the opposite side. Open partial nephrectomy is usually the treatment of choice when radical nephrectomy results in either immediate dialysis or a high risk for subsequent dialysis, such as when the patient has a single functioning kidney, poor overall kidney function, medical or genetic diseases that threaten kidney function or bilateral kidney tumors. Partial nephrectomy is usually not recommended in patients with tumors that have any of the following characteristics: extension into the renal vein, close proximity to the main kidney vessels or factors that would make complete tumor resection unlikely. When the tumor cannot be safely removed by partial nephrectomy, radical nephrectomy is performed. If you elect to undergo a partial nephrectomy, there is always a risk that the entire kidney may need to be removed.
Laparoscopic radical nephrectomy
: Laparoscopic nephrectomy is performed using telescopes that are inserted into the abdominal cavity through small "key hole" incisions; however, a somewhat larger incision is often made to permit removal of an intact kidney. Nephrectomy performed by inserting the telescopes into the cavity that surrounds the kidney (rather than into the abdominal cavity) is called retroperitoneoscopic nephrectomy.
Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that appear confined to the kidney. Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, shorter hospital stay and shorter recovery time. If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the "key hole" incisions to a larger incision). Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein. Open nephrectomy is preferred in patients with severe scarring around the kidney or a history of extensive abdominal surgery. Surgeons who are experienced with retroperitoneoscopy may consider this approach in patients with a history of extensive abdominal surgery.
Laparoscopic and retroperitoneoscopic partial nephrectomy:
Information is accumulating on laparoscopic and retroperitoneoscopic partial nephrectomy, but the data on complications and cancer control is still premature. In general, this approach is best suited for relatively small, peripherally located tumors that are relatively easy to remove and for which reconstruction of the kidney is straightforward.
Tumor ablation:
Tumor ablation destroys the tumor without surgically removing it. Examples of ablative technologies include cryotherapy, interstitial radiofrequency ablation, high- intensity focused ultrasound, microwave thermotherapy and laser coagulation. Ablation can be accomplished during open surgery, laparoscopy, retroperitoneoscopy or percutaneously (through the skin). Since renal tumor ablation is a relatively new procedure, long-term results are unknown. However, ablation may be less invasive than nephrectomy and may be useful in patients who cannot tolerate a more extensive surgery. Tumor ablation may also permit a better chance of preserving kidney function in situations when multiple tumors are present. In general, tumor ablation is best reserved for older or somewhat frail patients. The risk to tumor recurrence with these approaches is somewhat higher than with surgical excision.
Embolization: This is not a standard treatment option, but may be considered in patients who cannot tolerate tumor removal or ablation. It may also be considered as an adjunct to standard forms of treatment, especially when the tumor is actively bleeding. Embolization can stop the bleeding and permits physicians to stabilize the patient before surgery. Embolization is usually performed under sedation and is accomplished by advancing a long narrow catheter from a peripheral artery (such as in the groin) into the artery of the kidney. The catheter is used to deposit small embolic material particles in the vessels of the kidney. These particles block the flow of blood to the tumor and, therefore, stop active bleeding. Furthermore, without a blood supply, the tumor eventually dies. Since it is unclear whether or not embolization completely eliminates the tumor, it is not considered a primary form of therapy for kidney cancer.
What are the treatment options for tumors that invade the renal vein or vena cava?
When tumor invades into the renal vein or vena cava, open surgery is recommended to remove the affected kidney and to extract the tumor from the veins. It is important that you seek a urologist who has experience with this type of surgery. This is a major operation that requires isolation and clamping of the inferior vena cava, the largest vein in the body. After the blood flow is blocked the vein is opened and the tumor thrombus is extracted. The vein is then sutured closed. Sometimes embolization is performed before tumor removal. Embolization may also be considered in patients who cannot tolerate surgery.
What are the treatment options for tumors that have spread to other organs?
When the tumor has spread to other organs, there have traditionally been four primary treatment options: nephrectomy followed by immunotherapy, initial treatment with immunotherapy, clinical research trials and surveillance. More recently, a new category of treatment has been added, namely treatment with drugs that block the blood flow into the cancer (anti-angiogenic agents, see below).
Immunotherapy:
Immunotherapy stimulates your immune system to attack cancer. Hopefully, the immune system will eliminate cancer in much the same way it eliminates the flu. The most commonly used immunotherapy agents are interleukin-2 (IL-2) and interferon. Until recently, IL-2 was the only effective therapy approved by the Food and Drug Administration (FDA) for the treatment of metastatic kidney cancer. Approximately 20 percent of patients respond to immunotherapy with some degree of tumor regression. Approximately 5-7 percent of patients have complete cancer regression—most of those patients have been treated with the high dose IL-2 protocol. Many different immunotherapy regimens have been studied. One of the most effective regimens is high dose bolus IL-2, which requires inpatient hospitalization. During the initial hospitalization, intravenous IL-2 is administered over five days. The patient is usually allowed to go home for a rest period of five to10 days. Then, the patient is readmitted to the hospital for another five-day course of intravenous IL-2. The most common side effects of immunotherapy are similar to flu symptoms and include fever, chills, nausea, vomiting, diarrhea and fatigue. Other side effects include low blood pressure, fluid accumulation in the lungs (pulmonary edema), impaired liver function, impaired kidney function, mental status changes (such as confusion, agitation, disrupted sleep pattern), rapid heartbeat and irregular heartbeat. Most side effects are temporary and subside when the immunotherapy is stopped. To be a candidate for immunotherapy, the patient must be in good general condition, have adequate function of vital organs (such as the heart, lungs and kidneys) and have no brain metastasis. Immunotherapy is not effective against cancer in the brain. Before immunotherapy, patients must have tests to assess vital organ function and a scan to determine if brain metastases are present.
It is important to realize that with timely diagnosis and treatment, kidney cancer can be cured. If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent. More than 100,000 survivors of kidney cancer are alive in the United States today. The following information addresses the most common questions about kidney tumors and serves as a supplement to the discussion that you have with your physician.
What are some facts about kidney cancer?
In the United States, 2 percent of all cancers arise from the kidney. Each year, kidney cancer is diagnosed in approximately 38,000 Americans and is the cause of death in nearly 12,000 Americans. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma.
What risk factors are associated with kidney cancer?
The following associations may increase the risk of developing kidney cancer.
1-smoking
2-family history of kidney cancer
3-polycystic kidney disease
4-chronic kidney failure and/or dialysis
5-diet with high caloric intake or fried/sautéed meat
low vitamin E intake
6-diuretic use or hypertension, although this is still somewhat controversial
7-von Hippel Lindau disease
8-tuberous sclerosis
9-exposure to asbestos, blast furnaces and ovens used in iron/steel manufacturing
What are the symptoms for kidney cancer?
Many kidney tumors do not produce symptoms, but may be detected incidentally during the evaluation of an unrelated problem or during routine screening for people who are in high-risk categories (e.g. Von Hippel Lindau disease, tuberous sclerosis). Compression, stretching and invasion of structures near the kidney may cause pain (in the flank, abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung, bone pain or fracture may occur when cancer is in the bone and neurologic symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 20 percent of patients with kidney cancer and can occur in any stage (including cancers confined to the kidney). Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated red blood cell sedimentation rate, low blood count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high blood count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.
How is kidney cancer diagnosed?
Unfortunately, there are no blood or urine tests that directly detect the presence of kidney tumors.
When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if the cancer has spread beyond the kidney (metastasis). An evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray and blood tests. A bone scan is also recommended if the patient has bone pain, recent bone fractures, or certain abnormalities on their blood tests. Additional tests may be obtained when indicated. Kidney cancer has the tendency to grow into the renal vein and vena cava. The portion of the cancer that extends into these veins is called "tumor thrombus." Imaging studies, particularly MRI, can help determine if tumor thrombus is present.
What are the different stages of kidney cancer?
The most commonly used staging system for kidney cancer was developed by the American Joint Committee on Cancer (AJCC). The most current version is the 2002 AJCC Staging System. This staging system includes the extent of the primary kidney tumor (T stage), the status of lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage). In kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging the cancer helps predict prognosis and survival. In general, cancers with higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates, and these patients need to consider more aggressive treatments.
Grade: Tumor grade is a subjective measure of how aggressive the tumor looks under the microscope; therefore, it is determined from a surgical specimen. Grade cannot be determined from radiographic imaging, blood tests or urine tests. Grade usually ranges from one to three or one to four, with higher numbers indicating a more aggressive tumor. Thus, higher grade implies a worse prognosis.
Stage I: The tumor is confined to the kidney. There is no spread to lymph nodes or distant organs.
Stage II: The tumor is locally invasive into the fat around the kidney or the adrenal gland above the kidney. There is no spread to lymph nodes or distant organs.
Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumores that invade into other adjacent organs or those with distant metastasis.
Stage IV: There are several combinations of T, N, and M categories that included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall, and those with distant metastases.
Primary tumor (T): TX: Primary tumor cannot be assessed T0: No evidence of primary tumor
T1: Tumor 7.0 cm or less, confined to the kidney T1a: Tumor 4.0 cm or less, confined to the kidney T1b: Tumor 4.0-7.0 cm, confined to the kidney T2: Tumor greater than 7.0 cm, limited to kidney T3: Tumor extends into major veins/adrenal/ perinephric tissue; not beyond Gerota's fascia T3a: Tumor invades adrenal/perinephric fat T3b: Tumor extends into renal vein(s) or vena cava below diaphragm T3c: Tumor extends into vena cava above diaphragm T4: Tumor invades beyond Gerota's fascia, into adjacent organ systems
N - Regional lymph nodes NX: Regional nodes cannot be assessed N0: No regional lymph node metastasis N1: Metastasis in a single regional lymph node N2: Metastasis in more than one regional lymph node
M - Distant metastasis MX: Distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis
What are the treatment options for tumors that appear confined to the kidney?
When the tumor appears confined to the kidney (a "localized" tumor), there are three main treatment options: tumor removal, tumor ablation and surveillance. Chemotherapy, hormone therapy and radiation therapy are not effective treatments for kidney cancer.
Tumor removal:
Tumor removal is considered the standard mode of therapy for most patients and is accomplished by performing a surgery called nephrectomy. Radical nephrectomy is surgical removal of everything within Gerota's fascia, including the whole kidney. Partial nephrectomy is surgical removal of part of the kidney (in this case, the part that contains the tumor). The goal of partial nephrectomy is to remove the entire tumor while preserving as much normal kidney tissue as possible. The kidney tissue that is conserved may prevent the need for dialysis if subsequent kidney damage occurs. Nephrectomy can be performed through a traditional incision (open surgery) or through several small incisions (laparoscopic or retroperitoneoscopic surgery).
Open nephrectomy (radical and partial):
Traditional open nephrectomy (partial or radical) is performed through a flank or abdominal incision. This incision is typically 10 to 20 inches in length and may include removal of a rib. In the past, open radical nephrectomy was considered the treatment of choice for tumors that appeared to be confined to the kidney. However, five- to 10-year follow up reveals that partial and radical open nephrectomies provide equally effective cancer treatment for many patients with a single, small, localized tumor. Therefore, partial and radical nephrectomies are now considered standard treatments. If you are interested in partial nephrectomy, it is important that you seek a urologist who has experience with this technique.
As stated before, partial nephrectomy is performed to preserve as much normal kidney tissue as possible; however, its complication rate may be slightly higher than radical nephrectomy. Open partial nephrectomy should be considered in any patient with a small (ideally less than four centimeters) localized kidney tumor and a normal kidney on the opposite side. Open partial nephrectomy is usually the treatment of choice when radical nephrectomy results in either immediate dialysis or a high risk for subsequent dialysis, such as when the patient has a single functioning kidney, poor overall kidney function, medical or genetic diseases that threaten kidney function or bilateral kidney tumors. Partial nephrectomy is usually not recommended in patients with tumors that have any of the following characteristics: extension into the renal vein, close proximity to the main kidney vessels or factors that would make complete tumor resection unlikely. When the tumor cannot be safely removed by partial nephrectomy, radical nephrectomy is performed. If you elect to undergo a partial nephrectomy, there is always a risk that the entire kidney may need to be removed.
Laparoscopic radical nephrectomy
: Laparoscopic nephrectomy is performed using telescopes that are inserted into the abdominal cavity through small "key hole" incisions; however, a somewhat larger incision is often made to permit removal of an intact kidney. Nephrectomy performed by inserting the telescopes into the cavity that surrounds the kidney (rather than into the abdominal cavity) is called retroperitoneoscopic nephrectomy.
Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that appear confined to the kidney. Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, shorter hospital stay and shorter recovery time. If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the "key hole" incisions to a larger incision). Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein. Open nephrectomy is preferred in patients with severe scarring around the kidney or a history of extensive abdominal surgery. Surgeons who are experienced with retroperitoneoscopy may consider this approach in patients with a history of extensive abdominal surgery.
Laparoscopic and retroperitoneoscopic partial nephrectomy:
Information is accumulating on laparoscopic and retroperitoneoscopic partial nephrectomy, but the data on complications and cancer control is still premature. In general, this approach is best suited for relatively small, peripherally located tumors that are relatively easy to remove and for which reconstruction of the kidney is straightforward.
Tumor ablation:
Tumor ablation destroys the tumor without surgically removing it. Examples of ablative technologies include cryotherapy, interstitial radiofrequency ablation, high- intensity focused ultrasound, microwave thermotherapy and laser coagulation. Ablation can be accomplished during open surgery, laparoscopy, retroperitoneoscopy or percutaneously (through the skin). Since renal tumor ablation is a relatively new procedure, long-term results are unknown. However, ablation may be less invasive than nephrectomy and may be useful in patients who cannot tolerate a more extensive surgery. Tumor ablation may also permit a better chance of preserving kidney function in situations when multiple tumors are present. In general, tumor ablation is best reserved for older or somewhat frail patients. The risk to tumor recurrence with these approaches is somewhat higher than with surgical excision.
Embolization: This is not a standard treatment option, but may be considered in patients who cannot tolerate tumor removal or ablation. It may also be considered as an adjunct to standard forms of treatment, especially when the tumor is actively bleeding. Embolization can stop the bleeding and permits physicians to stabilize the patient before surgery. Embolization is usually performed under sedation and is accomplished by advancing a long narrow catheter from a peripheral artery (such as in the groin) into the artery of the kidney. The catheter is used to deposit small embolic material particles in the vessels of the kidney. These particles block the flow of blood to the tumor and, therefore, stop active bleeding. Furthermore, without a blood supply, the tumor eventually dies. Since it is unclear whether or not embolization completely eliminates the tumor, it is not considered a primary form of therapy for kidney cancer.
What are the treatment options for tumors that invade the renal vein or vena cava?
When tumor invades into the renal vein or vena cava, open surgery is recommended to remove the affected kidney and to extract the tumor from the veins. It is important that you seek a urologist who has experience with this type of surgery. This is a major operation that requires isolation and clamping of the inferior vena cava, the largest vein in the body. After the blood flow is blocked the vein is opened and the tumor thrombus is extracted. The vein is then sutured closed. Sometimes embolization is performed before tumor removal. Embolization may also be considered in patients who cannot tolerate surgery.
What are the treatment options for tumors that have spread to other organs?
When the tumor has spread to other organs, there have traditionally been four primary treatment options: nephrectomy followed by immunotherapy, initial treatment with immunotherapy, clinical research trials and surveillance. More recently, a new category of treatment has been added, namely treatment with drugs that block the blood flow into the cancer (anti-angiogenic agents, see below).
Immunotherapy:
Immunotherapy stimulates your immune system to attack cancer. Hopefully, the immune system will eliminate cancer in much the same way it eliminates the flu. The most commonly used immunotherapy agents are interleukin-2 (IL-2) and interferon. Until recently, IL-2 was the only effective therapy approved by the Food and Drug Administration (FDA) for the treatment of metastatic kidney cancer. Approximately 20 percent of patients respond to immunotherapy with some degree of tumor regression. Approximately 5-7 percent of patients have complete cancer regression—most of those patients have been treated with the high dose IL-2 protocol. Many different immunotherapy regimens have been studied. One of the most effective regimens is high dose bolus IL-2, which requires inpatient hospitalization. During the initial hospitalization, intravenous IL-2 is administered over five days. The patient is usually allowed to go home for a rest period of five to10 days. Then, the patient is readmitted to the hospital for another five-day course of intravenous IL-2. The most common side effects of immunotherapy are similar to flu symptoms and include fever, chills, nausea, vomiting, diarrhea and fatigue. Other side effects include low blood pressure, fluid accumulation in the lungs (pulmonary edema), impaired liver function, impaired kidney function, mental status changes (such as confusion, agitation, disrupted sleep pattern), rapid heartbeat and irregular heartbeat. Most side effects are temporary and subside when the immunotherapy is stopped. To be a candidate for immunotherapy, the patient must be in good general condition, have adequate function of vital organs (such as the heart, lungs and kidneys) and have no brain metastasis. Immunotherapy is not effective against cancer in the brain. Before immunotherapy, patients must have tests to assess vital organ function and a scan to determine if brain metastases are present.
