The kidneys are organs in your body that help get rid of waste while also regulating fluid balance. When a patient is thought to have kidney cancer, a urologist may take out a part of the tumor (biopsy) for testing.
When it comes to choosing a treatment plan, the most important things of the cancer to keep in mind are the size and the grade (how different it looks under the microscope compared to healthy kidneys). Kidney cancer treatment usually starts with surgery to remove the cancer. For cancers confined to the kidney, this may be the only treatment needed. If the cancer has spread beyond the kidney, more treatments may be suggested.
There are two main types of cancer in the kidneys. They are Upper Tract Urothelial Carcinoma (UTUC) and Renal Cell Carcinoma (RCC).
Upper Tract Urothelial Carcinoma (UTUC) is a type of cancer that comes from the transitional cells that line the inside of the kidney where the urine collects (the renal pelvis) and the ureter (the tube that drains the urine from the kidney to the bladder). UTUC treatment options depend in part on if the patient has low- or high-grade cancer.
Low-grade UTUC is treated with different forms of surgery or chemotherapy medicine that is put into the kidney and ureter. The surgery can be minor, which involves laser treatment of the tumor, or can be more involved and need removal of the kidney, ureter and small portion of the bladder where the urine connects. Patients with many or large low grade UTUC tumors may need the latter surgery type.
High-grade UTUC is treated with a combination of surgery and medicine (immunotherapy or chemotherapy), or just medicine alone if the tumor has already spread outside of the kidney. Usual removal of the kidney, ureter and a small part of the bladder is needed for high-grade UTUC, but more minor surgery may sometimes be suggested if the tumor is small.
Renal Cell Carcinoma (RCC) is a type of cancer that comes from the microscopic “tubules” in the meat of the kidney that filters the blood, aid in getting rid of waste and help make urine. RCC occurs when cancer cells start growing uncontrollably in the lining of the tubules of the kidney. RCC is a pretty slow-growing cancer, but if it gets too big it often spreads to the lungs and surrounding organs. When tumors are small, they rarely spread.
There are five kinds of standard options to manage Renal Cell Carcinoma (RCC). One or more may be used to treat the cancer.
- Surgery: This can include different types of procedures and is the best way to fully get rid of a tumor. During a partial nephrectomy, part of the kidney is removed. During a full nephrectomy, the entire kidney may be removed. Depending on how far the disease has spread, more extensive surgery may be needed to remove surrounding tissue, lymph nodes and your adrenal gland.
- Ablation: This is when a needle-like probe is passed through the skin and used to directly burn or “freeze-burn” the kidney tumor. Ablation is as a good option for patients with smaller tumors who need immediate treatment but are not healthy enough to undergo major surgery.
- Immunotherapy. This works to boost your immune system to attack the cancer. Natural enzymes or substances made by the body are used to defend your body against the cancer.
- Targeted therapy: This is a newer kind of cancer therapy. Drugs are used to attack certain cancer cells without damaging healthy cells. Some drugs work on blood vessels to prevent blood flow to the tumor, “starving” and shrinking it.
- Active Surveillance: Some small kidney cancers stop growing or grow so slowly that they will never become big enough to be harmful in the patient’s lifetime. Therefore, a good option for some small kidney cancers is active surveillance, in which the tumor is monitored over time without immediate treatment. Delayed treatment can still be performed later if needed (if the tumor has significant growth) and while cure is still easy to achieve. With active surveillance, some kidney cancer patients are able to avoid treatment long term, which can be helpful since treatment may have undesired side effects.
The best approach may depend on a number of factors, including general health, the kind of kidney cancer, whether the cancer has spread and preferences for treatment.