Treatment and Testing
RMC treatment varies depending on the extent of the cancer. Localized cancer means the tumor is limited to the kidney, while advanced stages of RMC can mean the tumor has spread beyond the kidney and into the tissue surrounding the kidney. In some cases, the cancer can spread to other vital organs.
Treatment and Testing
Surgery to remove the entire affected kidney (total nephrectomy) or part of the kidney (partial nephrectomy) is frequently done in localized RMC. This can often achieve the goal of removing all of the cancer.
Surgery is often the first and most effective way of treating many kidney cancers. Deciding whether to have surgery will happen after completing initial testing for diagnosis and after discussion with a surgeon. You may also consider getting a second opinion from another kidney cancer specialist before opting for surgery. Second opinions may not change your diagnosis but it may give you useful information and treatment alternatives, such as clinical trials. If surgery is done first, additional treatment may be recommended to delay the cancer’s return or to treat metastatic disease.
A variety of surgical procedures can be considered depending on the type and size of the tumor, the extent of disease, and the patient’s overall physical condition. You and your doctor should discuss the surgical options that are appropriate for you.
The treatment of many kidney cancers begins by removing the primary tumor in an operation called a nephrectomy. The purpose of surgery is to remove the primary tumor and involved tissue in the kidney. Even if the cancer has already spread, a nephrectomy may still be beneficial because your body then has less cancer to eliminate through treatments that your doctors might recommend after surgery.
Though nephrectomy is the most common treatment for kidney cancer, it may not be appropriate in some cases. Your urologist can help explain the factors that influence whether to proceed with nephrectomy. There are two basic types of nephrectomies for kidney cancer. A partial nephrectomy involves removing just the part of the kidney that contains the tumor. A radical nephrectomy involves removal of the entire kidney and often the removal of the adrenal gland above the kidney, the surrounding fatty tissue, and the lymph nodes adjacent to the kidney.
Types of Surgery
Minimally invasive surgeries involve the use of a laparoscope, an instrument that is passed through a series of small incisions or “ports” in the abdominal wall to reach the internal organs. Laparoscopy can be used for both radical and partial nephrectomies and can obtain the same results as previous traditional surgical techniques that required larger openings in the abdominal wall. Laparoscopic radical or partial nephrectomy can result in decreased blood loss, shorter hospital stays, less need for narcotic pain medication, and shorter recovery time when compared with open radical nephrectomies.
"Cryosurgery and radiofrequency ablation (RFA) may be used to destroy small kidney tumors in select patients. Cryosurgery, or cryoablation, uses freezing temperatures (achieved by using liquid nitrogen or carbon dioxide) to destroy diseased tissue. RFA destroys tumors with thermal energy (heat). These procedures can be done without an incision by passing tiny probes directly through the skin into the tumor under x-ray guidance." (Source NCBI)
Laparoscopy and Other Minimally Invasive Procedures
Drug treatments are medicines that are given intravenously or taken orally. These types of treatments are also called systemic therapies because they treat cancer cells anywhere in the body.
Drug treatment includes medicines approved by a regulatory body to be used by persons with kidney cancer. In the United States, the regulatory body is the Food and Drug Administration (FDA). In Europe, it is the European Medicines Agency (EMA).
An FDA-approved drug is one that has been tested in humans in clinical trials and found to be safe and effective for the type of cancer being treated. An investigational drug is one that is being evaluated in clinical trials to determine if it is safe and effective for cancer. Investigational drugs might be considered for certain eligible patients if other approved options have already been tried or if there is an investigational combination treatment of two approved drugs for kidney cancer. Not all oncology practices are able to offer clinical trials or investigational drugs.
Afinitor (everolimus) Avastin (bevacizumab)
Bavencio (avelumab) Cabometyx (cabozantinib)
Inlyta (axitinib) Interferon
Keytruda (pembrolizumab). Lenvima (lenvatinib)
Nexavar (sorafenib) Opdivo (nivolumab)
Your doctor may order some or all of a variety of tests that are available to determine the extent of your cancer and to develop your treatment plan.
Your doctor may use different approaches to diagnose RMC, depending on your symptoms, beginning with a physical examination and discussion of past and present medical problems.
Blood & Other Tests
In addition to a physical exam and medical history, your doctor will order some lab tests to complete your evaluation. Blood samples will be collected as a part of a routine physical exam to evaluate kidney function and overall health. Urinalysis will be done to collect and test urine. Microscopic tests can detect small amounts of blood or infection in the urine.
Magnetic Resonance Imaging (MRI)
An MRI is a specialized scan, similar to a CT scan, but may be used if the patient’s kidney function is elevated – a sign the kidneys are not functioning properly. Because MRI machines use a powerful magnet, people with metal within their body, such as prosthetic hip replacements or pacemakers, should discuss the use of an MRI with their physician before the scan is performed. MRI scans require a person to lie still for a long time in an enclosed space, which may be difficult for those who don’t like to be in confined spaces.
A plain x-ray of the chest may be done to see if the cancer has spread to the lungs. If something notable is seen on the x-ray, the doctor may order a CT scan of the chest to help determine what it is.
A bone scan is used to check for the spread of cancer to the bones.It is done by injecting small amounts of a special radioactive material through a vein into your bloodstream. The test can identify both cancerous and non-cancerous diseases.
Computed Tomography (CT scan)
A CT scan is a highly specialized x-ray that can visualize internal organs and provides a very accurate cross section picture of specific areas of the body. It is one of the primary imaging tools for assessing RCC. To enhance the image of the abdominal organs, dye may be given orally (by mouth) or intravenously (IV) before the scan. The IV dye (also called IV contrast) may cause a hot flushing sensation or an allergic reaction, especially in individuals who are allergic to iodine.
If the diagnostic test results are not clear, a biopsy may be performed. During a biopsy procedure a small sample of tissue is removed from the mass and examined to determine whether it is benign (non-cancerous) or malignant (cancerous). Using ultrasound or a CT scanner for guidance, the doctor will insert a long thin needle through the skin, directly into the mass, and remove the sample tissue. A pathologist will evaluate the biopsy tissue under a microscope to determine the histology and make a diagnosis. If there is clear evidence of widespread metastasis when the kidney mass is discovered, a biopsy may be taken from an area of metastasis instead of from the kidney. A pathologist may also receive a tissue sample taken during a surgery to remove a mass/tumor to study the tumor type and make a diagnosis, but this is not considered a biopsy.