Kidney Cancer

Treatment

Treatment is tailored to the circumstances of the patient's condition after thorough evaluation and discussion. Surgical removal of the entire kidney (radical nephrectomy) or a portion of the kidney (partial nephrectomy), or freeze-killing (cryoablation) or heat-killing (radiofrequency ablation) procedures are the more frequently recommended treatments.

Surgery

Partial Nephrectomy (Kidney-Sparing Surgery)
Most kidney tumors today are detected by chance when a physician studies an MRI, CT scan, or abdominal ultrasound to investigate some other condition. These incidentally discovered kidney masses account for 70 percent of the kidney procedures now performed at Mayo Clinic. Only 5 percent of patients have one or more of the classic symptoms of pain, blood in the urine, or a mass.

New ways of diagnosing kidney cancer spurred Mayo Clinic urologists to investigate the potential of a kidney-sparing procedure to treat small, solid, organ-confined masses. Urologic surgeons now have more than 30 years of experience with kidney-sparing procedures for renal cell cancer.

A kidney-sparing procedure offers excellent protection against cancer recurrence for patients who have small solid masses 3 to 5 centimeters (1 to 2 inches) in size with no other suspicious features. The procedure also improves the odds of good long-term kidney function. Post-surgery analysis of the small masses showed that more than 20 percent were a benign growth (oncocytoma). This suggests that as many as one out of five patients treated by radical nephrectomy had an entire kidney removed unnecessarily.

Urologists at Mayo Clinic routinely use a hand-assisted laparoscopic procedure to remove small to medium-sized tumors, 3 to 10 centimeters (1 to 4 inches) in size. That approach permits the surgeon to make two small abdominal incisions to insert the laparoscopic tools and another incision, about 3.5 inches long, for the surgeon's hand to help dissect and remove the kidney. Traditional surgery involves an 8- to 10-inch incision from the middle of the abdomen to the back. Careful evaluation and discussions with the surgeon are used to identify the best option for each patient.

Radical Nephrectomy
The traditional renal cell cancer treatment is the surgical removal of the diseased kidney and its neighboring adrenal gland (radical nephrectomy). The procedure became the standard when kidney cancer was rarely detected until it was relatively advanced. Diagnosis then usually came only after the development of symptoms such as flank pain, blood in the urine, or a mass or lump in the abdomen or flank. Currently, Mayo Clinic surgeons perform radical nephrectomy only when absolutely necessary to treat advanced kidney cancer. Research has developed successful alternative procedures that produce fewer long-term problems for patients.

Other Minimally Invasive Procedures

For patients that cannot undergo surgery, urologists may recommend new, minimally invasive treatments. Cryoablation and radiofrequency ablation destroy kidney cancer cells with extreme cold or extreme heat.

Percutaneous Cryoablation
In cryoablation, a small freezing probe is inserted through the skin, and its tip is placed into the cancerous tissue using CT and ultrasound guidance. In Mayo Clinic's experience, deep freezing for approximately 20 to 30 minutes destroys the cancer in about 95 percent of cases, based on short-term follow-up. At the end of the procedure, a small adhesive bandage is placed on the skin. The patient is usually discharged after an overnight hospital stay. The U.S. Food and Drug Administration approved this treatment for kidney cancer, but research studies still need to measure long-term outcomes to compare cryoablation to other treatments.

Percutaneous Radiofrequency Ablation
In radiofrequency ablation, ultrasound or CT imaging is used to guide a needle-like electrode through the skin into the tumor. Radiofrequency energy is then passed into the tip of the electrode, resulting in very high temperatures in the surrounding tumor. The tumor is destroyed over the course of 5 to 15 minutes, depending on the tumor's size and location. After the ablation, a small adhesive bandage is placed over the puncture site. In most cases, the patient is observed overnight in the hospital and discharged the next morning.

Radiation Therapy

Radiation therapy is reserved for patients in whom the goal of therapy is only to relieve or diminish the symptoms of the disease, as it is not an effective alternative to surgery. Occassionally, it may be given after surgery if all of the tumor could not be removed or if the tumor regrows in the original surgical site. It may also be directed to sites (such as bone or brain) where the cancer has spread in order to reduce the symptoms the cancer produces in these sites.

Experimental Drug Therapies

Patients can participate in clinical trials to gain access to experimental treatments. Several new drugs are being studied, and new studies may be available in the next year or two. Experts still consider bone marrow transplant for kidney cancer to be experimental.

Immunotherapy uses the body's immune system to fight cancer. Some studies show that patients do better when treated with both surgery and interferon or interleukin-2. The body normally produces those biological response modifiers, which can now be manufactured to help treat disease. Because of potential side effects, immunotherapy is used only for very healthy patients.

Treatment of Metastatic Disease

Patients with metastatic kidney cancer benefit from the extensive experience Mayo Clinic specialists have in treating cancer that has spread. Treatment options may include immotherapy agents such as interferon or interleukin-2 and other experimental treatments available through clinical trials. Physicians develop individualized treatment plan that treats the cancer, manages pain and promotes quality of life.