Kidney cancer - Treatment

Treatment-Kidney cancer




The treatment for kidney cancer depends on the size of the cancer and whether it has spread to other parts of the body.
The main treatments are:
  • surgery to remove part or all of the affected kidney – this the main treatment for most people
  • ablation therapies – where the cancerous cells are destroyed by freezing or heating them
  • biological therapies – medications that help stop the cancer growing or spreading
  • embolisation – a procedure to cut off the blood supply to the cancer
  • radiotherapy – where high-energy radiation is used to target cancer cells and relieve symptoms
Cancer that hasn't spread out of the kidney can usually be cured by removing some or all of the kidney, although sometimes cryotherapy or radiofrequency ablation may be used instead.
A complete cure may not be possible if the cancer has spread, but it may be possible to slow its progression and treat any symptoms with surgery, medication and/or radiotherapy.

Surgery

There are two main types of surgery for kidney cancer:
  • an operation to just remove part of the kidney containing the cancer – called a partial nephrectomy
  • an operation to remove the entire affected kidney – called a radical nephrectomy
A partial nephrectomy is usually done if the cancer is small and easy for the surgeon to access. A radical nephrectomy may be necessary for larger cancers or if the cancer has spread beyond the kidney.
It's possible to live a normal life with only one kidney. Your other kidney can usually make up for the kidney that was removed.
Surgery for kidney cancer can be carried out in one of two ways:
  • through a single large incision (cut) in the tummy or back – known as "open" surgery
  • using surgical tools inserted through smaller incisions – known as laparoscopic or "keyhole" surgery
Keyhole surgery tends to have a faster recovery time, but can only be done by trained surgeons and it isn't always suitable. Talk to your surgeon about the pros and cons of each method.
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Ablation therapies

Ablation therapies are treatments that involve either:
  • destroying cancer cells by freezing them (cryotherapy)
  • destroying cancer cells by heating them (radiofrequency ablation)
Either technique may be recommended in certain circumstances (for example, to ensure your kidney keeps working), or if your tumour is small. Both treatments are only available in specialist centres, so you may need to travel to another hospital to have it.
Radiofreqency ablation is carried out by inserting a needle-like probe through your skin, so no large incisions are needed.
Cryotherapy is carried out using needles inserted into the tumour. This can be done through your skin (percutaneous cryotherapy) or through a small incision (laparoscopic cryotherapy).
Side effects of ablation therapies can include bleeding around the kidney and damage to the tube that carries urine from the kidney to the bladder (the ureter).
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Biological therapies

If your cancer is advanced, treatment with biological therapies may be offered. These are medications, usually taken once or twice a day, that help stop the cancer growing and spreading.
There are many different biological therapies, including:
  • sunitinib 
  • pazopanib
  • cabozantinib
  • axitinib
  • everolimus
  • bevacizumab and interferon
  • nivolumab
  • tivozanib
At present, sunitinib, pazopanib, cabozantinib, axitinib, everolimus, nivolumab and tivozanib are recommended for routine use on the NHS.
Some people with advanced kidney cancer may be offered a medication called lenvatinib, to take along with everolimus.
Other medicines aren't currently recommended, but some may be available through the Cancer Drugs Fund.

Side effects

Sunitinib, pazopanib, cabozantinib, axitinib and tivozanib are all taken as regular tablets. Possible side effects include:
Nivolumab is given as a drip directly into a vein every 2 weeks. It works by helping the body's immune system destroy the cancer cells. Side effects are uncommon, but can include:
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Embolisation

Embolisation is a procedure to block off the blood supply to the tumour, causing it to shrink.
It's sometimes recommended if you have advanced kidney cancer and you're not in good enough health to have surgery to remove the affected kidney.
During embolisation, the surgeon will insert a small tube called a catheter into a blood vessel in your groin and then guide it to the blood vessel supplying the tumour.
A substance will be injected through the catheter to block the blood vessel.

Radiotherapy

Radiotherapy is a treatment where radiation is used to target or destroy cancerous cells. It can't usually cure kidney cancer, but it can slow down its progress and help control your symptoms.
It may be recommended if you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain.
The treatment involves a large machine directing a carefully aimed beam of radiation at the cancerous cells. It's often carried out for a few minutes every day, over a few weeks.
  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin in the treatment area
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Care and support

If you're diagnosed with cancer, your treatment and medical care will be of utmost importance.
But other aspects of your life are also important. You'll need to think about the kind of support you need, and know what assistance is available and where you can get it.
Support is also available for people who care for ill partners, children, relatives or friends.
See the care and support guide for information about all aspects of care.
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