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Treatment of kidney cancer

Treatment of kidney cancer varies depending on whether the disease is localized or has metastasized.

Primary treatment

Surgery

Standard treatment for patients without metastases is renal resection or nephrectomy. If the general condition of the patient is good this is also done in patients with metastases. For reduced general health status and metastases, tumor volume-reducing surgery is performed.

For tumors < 7 cm, a kidney resection is endeavoured. Laparoscopy, usually robotic assisted, is used increasingly. For large tumors >7 cm and/or centrally located tumors, the kidney is being totally removed.

If systemic therapy is planned, usually with tyrosine kinase inhibitors, a nephrectomy should be perfomed given the patient is in good general health. The nephrectomy will reduce expected or existing local symptoms from the primary tumor, and if possible, tumor-reducing surgery has a favorable effect on the systemic therapy.

The final prognosis depends on the extent of tumor in the surgical specimen, whether there is rupture of the capsule, invasion of blood or lymph vessels, or regional lymph node metastases. The size of the tumor also has prognostic significance. About half of patients with tumor sizes > 5 cm develop metastases usually 5 years or more after primary treatment.

Active monitoring

Small tumors < 2 cm often have very low malignancy potential. Many are also benign, and in older patients may be conservatively monitored routine image diagnostics.  

Percutaneous ablation

At multiple centers in Europe and the USA, the option of ultrasound-guided removal of smaller tumors by cryogenic technique, radio-or ultrasound waves is available. In Norway, radiofrequency ablation is offered  for selected patients which are not suitable for surgery.

Treatment of metastases

  • Palliative radiation therapy 
  • Palliative surgery
  • Treatment with tyrosine kinase inhibitors/VEGF inhibitors

Palliative radiation therapy

In about 1/3 of the patients with large soft tissue- or bone metastases, the radiation therapy will lead to palliation. Radiation therapy after non-radical surgery of metastasis may be appropriate to prevent local invasion, especially in patients with expected lifespan of several months.

Palliative surgery

Ulcerating, bleeding, or stenosing metastases should be removed surgically if possible. Large osteolytic metastases in weight-bearing bones should be considered for stabilizing orthopedic surgery to prevent pathologic fractures, but in view of the risk for serious bleeding during the surgery. Extirpation of metastases should be discussed for solitary metastases as a life-prolonging/curative strategy. 

Treatment with tyrosine kinase inhibitors

Discussed under drug therapy.

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