Methods of Treatment and Palliative Care

Treatment options for kidney cancer depend on how advanced the disease is: thirty percent of cases have metastasized by the time of diagnosis. For localized tumors, surgery is the treatment of choice. Renal cell carcinoma (RCC) is highly resistant to chemotherapy, hormone therapy, and radiation therapy. Immunotherapy medications, which stimulate the immune system, are showing promising results in kidney cancer clinical trials.

Surgical removal of renal cell carcinoma offers the best chance of survival. If the cancer is diagnosed at an early stage, surgery can be curative. For over fifty years the surgery of choice has been radical nephrectomy, but developments in cancer research have resulted in other options.

Radical Nephrectomy: A radical nephrectomy is the complete removal of the affected kidney, the adrenal gland, and surrounding fat. Sometimes, nearby lymph nodes are removed in a procedure called a lymphadenectomy. The patient's other kidney, if healthy, is capable of continuing renal function.

Radical nephrectomy may also be used in palliative care, even if the disease has spread to other organs. Removing the diseased kidney reduces symptoms and can increase survival odds.

Nephron-Sparing Surgery: If the malignancy is small, removal of the entire kidney may not be necessary. Instead, nephron-sparing surgery attempts to remove only the cancerous tissue, leaving the rest of the organ intact. Investigative clinical trials reveal that, when the tumor is small enough, the technique is just as effective as radical nephrectomy.

As with any other surgical procedure, kidney cancer surgery has risks. Bleeding and infection may occur. Damage to surrounding organs is a possibility, including damage to the spleen, lungs, vena cava, pancreas and bowel.

Immunotherapy is a promising area of kidney cancer research. Immunotherapy stimulates the immune system, helping it to kill the malignant cells. Interferon has displayed some ability to treat RCC, but its results have been limited.

Interleukin 2 appears to be more effective than interferon for RCC treatment. Interleukin 2 stimulates the immune system's lymphoid cells. Due to severe side effects, people treated with Interleukin 2 must be relatively fit: the medication can cause renal failure, gastrointestinal hemorrhage and heart attacks.

Chemotherapy and hormone therapy have not proven very effective against renal cancer. Kidney tumors appear to have a high resistance to chemotherapy drugs, although tamoxifen (a drug also used in breast cancer treatment) is used in palliative care to reduce symptoms.

If the disease has spread to other organs, especially to the bones, radiation therapy is often employed. The therapy can reduce painful symptoms in the bones and other metastatic organs.

Advanced stages of RCC are difficult to treat: once the disease has metastasized, surgery no longer offers a cure, and other existing therapies are not very effective. Accordingly, people with advanced stages of the disease are often offered experimental treatments available only through kidney cancer clinical trials.

 

 

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