Kidney cancer is a disease in which normal cells in the kidneys begin to change, grow without control, and no longer die, forming a mass of cells called a tumor. The kidneys are reddish-brown organs about the size of a small fist located above the waist on either side of the spine. They are closer to the back of the body than to the front.
Kidneys filter blood and remove impurities, excess minerals and salts, and surplus water. Every day, the kidneys process about 200 quarts of blood to generate two quarts of wastewater (urine). These organs also produce hormones to help control blood pressure, red blood cell production, and other functions. Although people have two kidneys, each works independently. The human body can function with less than one complete kidney. With dialysis, a mechanized filtering process, it is possible to live without kidneys.
There are several types of kidney cancer:
Renal cell carcinoma. Renal cell carcinoma makes up about 85% of kidney cancer cases. This cancer develops within the kidney's microscopic filtering systems, the lining of tiny tubes that ultimately lead to the bladder.
Transitional cell carcinoma. Transitional cell carcinoma begins in the area of the kidney where urine collects before being funneled to the bladder. This type of kidney cancer is similar to bladder cancer and is treated like bladder cancer. It accounts for 10% to 15 % of adult kidney cancer cases.
Sarcoma.Sarcoma of the kidney is rare and is treated with surgery. In some cases, it may be beneficial to combine chemotherapy with surgery, as sarcoma can grow quite large before it is discovered. It does not metastasize (spread) as often as other types of kidney cancer.
Wilms tumor. Wilms tumor, found most often in children, is treated differently than adult kidney cancer. This cancer type is much more responsive to radiation therapy and chemotherapy than the other types of kidney cancer, and this has resulted in a different approach to treatment. For more information, read the Guide to Wilms Tumor, Childhood Cancer.
Knowing which kind of cell a tumor is made up of helps doctors plan treatment. There are several types of kidney cancer cells. The most common are listed below. Pathologists (doctors who specialize in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease) have identified as many as 10 different types of these cells.
Clear cell is the type of cell that is found in about 70% of kidney cancer cases. Clear cells range from slow growing (grade 1) up to fast growing (grade 4). This type of kidney cancer is particularly responsive to immunotherapy and some of the newer biologic agents (see Treatment).
Papillary kidney cancer, which develops in 10% to 15% of patients, is classified into two different types that are pathologically and genetically different from the clear cell type and treated differently from other cell types.
Sarcomatoid is the type of cell that grows the fastest. It may be found associated with clear cell or papillary type. It is called sarcomatoid because it resembles sarcoma under the microscope.
Collecting duct is a rare cancer that behaves similar to transitional cell carcinoma. It is best treated with chemotherapy. However, many doctors believe that it is less responsive to chemotherapy than transitional cell carcinoma, but more responsive than clear cell or sarcomatoid types.
Chromophobe is another rare cancer that is pathologically and genetically different.
Oncocytoma is a slow-growing type that rarely, if ever, spreads.
Angiomyolipoma is a benign (not cancerous) tumor that has a unique appearance on the computed tomography (CT) scan (see Diagnosis) and under the microscope; these tend to be less aggressive and are best managed surgically.
Statistics
In 2007, an estimated 51,190 adults (31,590 men and 19,600 women) in the United States will be diagnosed with kidney cancer. It is estimated that 12,890 deaths (8,080 men and 4,810 women) from this disease will occur this year. The five-year relative survival rate (percentage of patients who survive at least five years after the cancer is detected, excluding those who die from other diseases) of patients with kidney cancer is about 66%.
Cancer survival statistics should be interpreted with caution. These estimates are based on data from thousands of cases of this type of cancer in the United States each year, but the actual risk for a particular individual may differ. It is not possible to tell a person how long he or she will live with kidney cancer. Because the survival statistics are measured in five-year (or sometimes one-year) intervals, they may not represent advances made in the treatment or diagnosis of this cancer.
Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2007.
A risk factor is anything that increases a person's chance of developing cancer. Some risk factors can be controlled, such as smoking, and some cannot be controlled, such as age and family history. Although risk factors can influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and communicating them to your doctor may help you make more informed lifestyle and health-care choices.
Not enough is known about kidney cancer to determine exactly how to prevent it. There are some steps people can take to lower their risk, such as quitting smoking, lowering blood pressure, controlling body weight, and eating a diet high in fruit and low in fat.
The following factors may raise a person's risk of developing kidney cancer:
Smoking. Smoking doubles the risk of developing kidney cancer and is believed to cause about 30% of kidney cancer cases in men and approximately 25% of cases in women.
Gender. Kidney cancer occurs two to three times more often in men than it does in women.
Race. The incidence of kidney cancer is highest among black people.
Age. Kidney cancer is primarily a disease of adults and is usually diagnosed between the ages of 50 and 70.
Diet and weight. Research has consistently demonstrated a link between kidney cancer and obesity caused by a high-fat diet.
Hypertension (high blood pressure). A connection has been made between high blood pressure and kidney cancer in men.
Overuse of certain medications. Painkillers containing phenacetin, once popular over-the-counter medications, have been banned in the United States since 1983 because of their link to kidney cancer. Also, other medications, such as diuretics and analgesic pain pills, have been linked to kidney cancer.
Exposure to cadmium. Some studies have shown a connection between kidney cancer and exposure to the metallic element cadmium. Working with such products as batteries, paints, or welding materials may increase the risk as well; this risk is especially strong for smokers exposed to cadmium.
Long-term dialysis. Patients using dialysis for an extended period of time may develop cancerous cysts in their kidneys. These growths are usually found early and can often be removed before the cancer spreads.
Genetic and hereditary risks. A hereditary risk of developing kidney cancer has been recognized, but only a few specific genes that increase risk have been found. One of those genes is responsible for an inherited genetic disorder called Von Hippel-Lindau syndrome; 40% of people with this disorder develop kidney cancer.
Consequence of other diseases. People with tuberous sclerosis, a complex genetic disorder, have an increased risk of kidney cancer, as do people with Von Hippel-Lindau syndrome (see genetic risk above).
Often, kidney cancer is found incidentally when a person has an x-ray or ultrasound test for another reason. In its earliest stages, kidney cancer causes no pain. Therefore, symptoms of the disease usually appear when the tumor is quite large and begins to affect nearby organs.
People with kidney cancer may experience the following symptoms. Sometimes, people with kidney cancer do not show any of these symptoms. Or, these symptoms may be caused by a medical condition that is not cancer. If you are concerned about a symptom on this list, please talk with your doctor.
Hematuria (blood in the urine)
Pain or pressure in the side or back
A mass or lump in the side or back
Swelling of the ankles and legs
High blood pressure, or anemia (low red blood cell count)
Fatigue
Loss of appetite
Unexplained weight loss
Recurrent fevers (not from cold, flu, or other infections)
In a man, a rapid development of a varicocele (a cluster of enlarged veins) around the testicle
Routine screening tests to detect early kidney cancer are not available. Doctors may suggest that people at high risk for the disease undergo imaging tests to look inside the body. In patients with a family history of kidney cancer, CT scans will sometimes be used to search for early-stage kidney cancer. However, CT scans have not been proven to be a useful screening tool for kidney cancer in the general community.
Doctors use many tests to diagnose cancer and determine if it has metastasized. Some tests may also determine which treatments may be the most effective. For most types of cancer, a biopsy is the only way to make a definitive diagnosis of cancer. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis. Imaging tests may be used to find out whether the cancer has metastasized. Your doctor may consider these factors when choosing a diagnostic test:
Age and medical condition
The type of cancer
Severity of symptoms
Previous test results
In addition to a physical examination, the following tests may be used to diagnose kidney cancer:
Blood and urine tests. A blood test to check the number of red blood cells, and a urine test to detect blood, bacteria, or cancer cells, may be performed. These tests may suggest that kidney cancer is present, but cannot make a definite diagnosis.
Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. The sample removed from the biopsy is analyzed by a pathologist Then the pathologist issues a pathology report (a written report) that becomes a permanent part of the medical record. Doctors must have a pathology report before they use radiation therapy or chemotherapy to treat the cancer. The pathology report will identify the type of cell involved in the kidney cancer. This is important in planning treatment. For instance, people with clear cell tumors have mutations of the Von Hippel-Lindau (VHL) gene (a tumor suppressor gene [a type of gene that prevents tumors from growing]), making the cancer susceptible to antivascular endothelial growth factor (VEGF) therapy (see Treatment). The type of biopsy performed will depend on the location of the cancer. A biopsy may not be needed if the cancer is discovered on the CT scan.
If surgery is recommended based on the results of other medical tests, such as the CT scan, many doctors will do the biopsy after the tumor is removed during surgery, rather than a separate procedure beforehand. The patient should carefully discuss the reasoning for a recommended biopsy option with his or her doctor.
Imaging tests
Intravenous pyelogram (IVP). A dye is injected into the patient's bloodstream to highlight the kidney, urethra, and bladder when an x-ray is taken. The picture produced can show changes in these organs and in the nearby lymph nodes.
Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient's vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer, appear dark.
Computed tomography (CT or CAT) scan. A CT scan creates a three-dimensional picture of the inside of the body with an x-ray machine. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. Sometimes, a contrast medium (a special dye) is injected into a patient's vein to provide better detail.
Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body.
Positron emission tomography (PET). In a PET scan, radioactive sugar molecules are injected into the body. Cancer cells absorb sugar more quickly than normal cells, so they light up on the PET scan. PET scans are often used to complement information gathered from CT scan, MRI, and physical examination. Though recent reports suggest that PET scanning may be helpful in monitoring tumor shrinkage in response to treatment of metastases, it is often experimental because most kidney cancer does not pick up the radioactive sugar molecules.
X-ray. An x-ray is a picture of the inside of the body. For instance, a chest x-ray can help doctors determine if the cancer has spread to the lungs.
Cystoscopy/nephro-ureteroscopy. In rare cases of renal (kidney) pelvic cancers, a special test called a cystoscopy and nephro-ureteroscopy may be done. During these procedures, the patient is sedated while a tiny, lighted tube is inserted into the bladder through the urethra and up into the kidney. The device can remove samples of cells and, in some cases, small tumors.
Staging is a way of describing a cancer, such as where it is located, if or where it has spread, and if it is affecting the functions of other organs in the body. Doctors use diagnostic tests to determine the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis (chance of recovery). There are different stage descriptions for different types of cancer.
One tool that doctors use to describe the stage is the TNM system. This system uses three criteria to judge the stage of the cancer: the tumor itself, the lymph nodes around the tumor, and if the tumor has spread to other parts of the body. The results are combined to determine the stage of cancer for each person. There are five stages: stage 0 (zero) and stages I through IV (one through four); stage 0 kidney cancer is extremely rare. The stage provides a common way of describing the cancer, so doctors can work together to plan the best treatments.
It is important for doctors to learn as much as possible about the tumor because this information can help them predict the cancer's behavior in the future. This information includes details from the pathology report (for example, the cell subtype, the grade [describes how closely the cancer cells resemble normal tissue under a microscope] of the cancer, and the presence of certain proteins on the cancer cells, such as carbonic anhydrase IX or HLA B7) and information from the patient (his or her activity level, the amount of weight loss, and the presence or absence of fevers and sweats, among other symptoms).
TNM is an abbreviation for tumor (T), node (N), and metastasis (M). Doctors look at these three factors to determine the stage of cancer:
How large is the primary tumor and where is it located? (Tumor, T)
Has the tumor spread to the lymph nodes? (Node, N)
Has the cancer metastasized to other parts of the body? (Metastasis, M)
Tumor. Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. If there is more than one tumor, the lowercase letter "m" (multiple) is added to the "T" stage category. Specific tumor stage information for kidney cancer is listed below.
TX: The primary tumor cannot be evaluated.
T0: There is no evidence of a primary tumor in the kidney(s).
T1: The tumor is found only in the kidney and is 7 centimeters (cm) or smaller in size at its greatest dimension (its largest area). Note: There has been much discussion whether this classification should only include a tumor 5 cm and under.
T1a: The tumor is found only in the kidney and is 4 cm or smaller in size at its greatest dimension.
T1b: The tumor is found only in the kidney and is between 4 cm and 7 cm at its greatest dimension.
T2: The tumor is found only in the kidney and is larger than 7 cm in size at its greatest dimension.
T3: The tumor has grown into major veins or it has invaded the adrenal gland (gland on top of each kidney that produces hormones and adrenaline to help control heart rate, blood pressure, and other body functions) or perinephric tissue (connective, fatty tissue around the kidneys). It has not reached beyond Gerota's fascia (an envelope of tissue that surrounds the kidney).
T3a: The tumor has invaded the adrenal gland or perinephric tissue, but the tumor has not spread beyond Gerota's fascia.
T3b: The tumor extends into the renal vein(s) (the large vein leading out of the kidney) or vena cava (the large vein leading out of the heart) below the diaphragm (the muscle under the lungs that helps breathing).
T3c: The tumor extends into the renal vein(s) or vena cava above the diaphragm.
T4: The tumor has invaded areas beyond Gerota's fascia.
Node. The "N" in the TNM staging system stands for lymph nodes, the tiny, bean-shaped organs that help fight infection. Lymph nodes near the kidneys are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.
NX: The regional lymph nodes cannot be assessed.
N0: No regional lymph node metastasis exists (meaning that the cancer did not spread into the regional lymph nodes).
N1: There is metastasis in a single regional lymph node area.
N2: There is metastasis in more than one regional lymph node area.
Distant metastasis. The "M" in the TNM system indicates whether the cancer has spread to other parts of the body. Common areas where kidney cancer may spread include the bones, liver, lungs, brain, and distant lymph nodes.
MX: Distant metastasis cannot be evaluated.
M0: The disease has not metastasized.
M1: There is distant metastasis (the cancer has spread to other parts of the body beyond the kidney area).
Cancer stage grouping
Doctors assign the stage of the cancer by combining the T, N, and M classifications.
Stage I: The tumor is 7 cm or smaller and is in the kidney only. It has not invaded the lymph nodes or distant organs of the body (T1, N0, M0).
The tumor has spread to one nearby lymph node, but not distant lymph nodes or other organs (T1, T2, T3; N1; M0).
The tumor has spread to fatty tissue around the kidney and/or has spread into the renal vein, but has not spread to any lymph nodes or other organs (T1, T2, T3; N0; M0).
Recurrent: Recurrent kidney cancer means that the cancer has come back after it has been treated. It may be found in the kidney area or in another part of the body.
Used with permission of the American Joint Committee on Cancer (AJCC), Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Sixth Edition (2002) published by Springer-Verlag New York, www.springer-ny.com.
The treatment of kidney cancer depends on the size and location of the tumor, whether the cancer has spread, and the patient's overall health. In many cases, a team of specialists that may include an urologist (a doctor who specializes in urinary tract problems), an oncologist, a pathologist, a diagnostic radiologist, and a radiation oncologist will work with the patient to determine the best treatment plan.
When the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes may be the only treatment necessary.
Surgery
Surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy. If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection (removal) is performed. If the cancer has spread to the adrenal gland or nearby blood vessels, the surgeon may remove the adrenal gland, called an adrenalectomy, and parts of the blood vessels.
Partial nephrectomy is surgery that removes a tumor while preserving kidney function and lowering the risk of kidney disease after surgery (called hyperfiltration injury). It is appropriate for a small tumor, even when the other kidney functions normally.
In laparoscopic surgery, the surgeon makes several small incisions, instead of one larger incision in the abdomen used in conventional surgery. The surgeon uses telescoping equipment to remove the kidney completely or perform a partial nephrectomy. This surgery may take longer, but it is less painful and patients recover more quickly.
Another type of treatment for kidney cancer is cryoablation. Cryoablation (also called cryotherapy or cryosurgery) involves freezing cancer cells with a metal probe inserted through a small incision, and its tip is placed into the cancerous tissue using CT and ultrasound guidance. The U.S. Food and Drug Administration (FDA) approved this treatment for kidney cancer, but research studies are needed to measure long-term outcomes.
Targeted therapy
Targeted therapies are treatments that target cancer cells while minimizing damage to healthy cells. These drugs are becoming more important in the treatment of kidney cancer.
Anti-angiogenic drugs block the formation of new blood vessels that are needed for a tumor to grow and spread. Sunitinib (Sutent) and sorafenib (Nexavar), called tyrosine kinase inhibitors (TKIs), are two anti-angiogenic drugs that may be used to treat clear cell kidney cancer. Clear cell kidney cancer has a mutation of the VHL gene that causes the cancer to make too much of a certain protein, known as vascular epithelia growth factor (VEGF). VEGF controls the formation of new blood vessels, which is necessary for tumor growth and metastasis. Side effects of TKIs may include diarrhea, high blood pressure, and tenderness and sensitivity in the hands and feet.
In 2007, temsirolimus (Torisel) was approved by the FDA for use in people with advanced kidney cancer. Temsirolimus targets another protein that controls tumor growth and blood vessel formation. In clinical trials, it slowed or stopped tumor growth, or in some cases, reduced tumor size. Side effects may include skin rash, weakness, nausea, mouth sores, and loss of appetite.
Immunotherapy
Immunotherapy (also called biologic therapy) is designed to boost the body's immune system. It uses materials either made by the body or in a laboratory to strengthen or restore immune system function. Evidence exists that kidney cancer is one of the few cancers that the human body can fight, which often makes immunotherapy effective in treating kidney cancer.
Interleukin-2 (IL-2) is currently the most effective drug used to treat advanced kidney cancer. It is a cellular hormone (cytokine) produced by activated white blood cells and is central to the function of the human immune system, including the destruction of tumor cells. It can successfully treat about 10% of patients who receive it.
High-dose IL-2 can produce side effects that can be severe, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attacks, bleeding, chills, and fever, so patients may need to stay in the hospital for up to 10 days. Only centers with expertise in high-dose IL-2 or kidney cancer should recommend IL-2. Some centers use low-dose IL-2 because it has fewer side effects, though it is not as effective.
Alpha-interferon is another biologic agent widely used in the treatment of metastatic kidney cancer. Interferon appears to alter the surface proteins of cancer cells and slow their growth. Although it has not proven to be as beneficial as IL-2, it has been proven to extend life compared with an older agent called megestrol acetate. Researchers have tested many combinations of IL-2 and alpha-interferon in advanced kidney cancer, and these treatments have also been combined with chemotherapy. No proof exists that these combinations are superior to IL-2 or interferon alone.
Radiation therapy
Radiation therapy is the use of high-energy x-rays or other particles to kill cancer cells. It is not considered effective as a primary treatment for kidney cancer. It is used alone only rarely to treat kidney cancer because of the high rate of damage that it causes to the normal kidney. It is used only if a patient cannot have surgery and, even then, usually on a metastasis and not the primary kidney tumor itself. Most often, radiation therapy is used after the cancer has spread to help ease symptoms, such as bone pain or swelling in the brain.
The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
A recent advance is stereotactic radiosurgery, designed to optimize the dose of radiation therapy given to a specific area without damaging nearby tissue. Radiofrequency ablation uses a needle inserted into the tumor to destroy the cancer with an electrical current. The procedure, performed by a radiation oncologist, lasts several hours and requires brief sedation and local anesthesia to numb the area.
Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Internal radiation therapy (delivered by means of hollow needles that doctors use to put radioactive seeds directly into a tumor) may produce some bleeding, infection, and risk of injury to nearby tissue. Most side effects go away soon after treatment is finished.
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. While useful in treating most types of cancer, kidney cancer is often resistant to chemotherapy. Researchers continue to study new drugs and new combinations. In some cases, the combination of gemcitabine (Gemzar) and fluorouracil (5-FU, Efudex) or capecitabine (Xeloda) will temporarily shrink a tumor. It is important to remember that transitional cell kidney cancer and Wilms tumor are much more sensitive to chemotherapy (see Bladder Cancer and Wilms Tumor ). The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk or infection, nausea and vomiting, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications you've been prescribed, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions through Cancer.Net's Drug Information Resources, which provides links to searchable drug databases.
In the most advanced stage (stage IV), kidney cancer cells have broken away from the original tumor and have traveled through the lymphatic system or blood to other parts of the body, where they begin growing tumors. The most common site of distant metastasis is in the lungs, but cancer can spread to the opposite kidney, the bones, liver, brain, skin, and a variety of other locations.
If the cancer has widely metastasized outside of the kidneys, it is more difficult to treat. Since 1% of all kidney cancers spontaneously shrink or disappear, scientists have focused on the body's immune system as a useful tool to treat advanced kidney cancer.
If the kidney cancer spreads, radiation therapy, as well as systemic treatments such as immunotherapy, and chemotherapy may be used alone or in combination. The best treatment to date for metastatic kidney cancer is with the use of targeted therapies that slow or prevent tumor growth and blood vessel formation. They have been shown to prolong life compared with standard treatment.
For More Information
The National Comprehensive Cancer Network (NCCN) has a series of treatment guidelines that have been translated into patient-friendly language. In accordance with Cancer.Net's Linking Policy, please note that this link does not imply ASCO's endorsement of the content, but rather it is an effort to provide additional information that may be helpful to people living with cancer and their families. The NCCN treatment guide for kidney cancer can be found at www.nccn.org.
Doctors and scientists are always looking for better ways to treat patients with kidney cancer. A clinical trial is a way to test a new treatment in order to prove that it is safe, effective, and possibly better than a standard treatment. Patients who participate in clinical trials are among the first to receive new treatments before they are widely available. However, there is no guarantee that the new treatment will be safe, effective, or better than a standard treatment.
Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that finding new drugs and other therapies is the only way to make progress in treating kidney cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with kidney cancer.
To join a clinical trial, patients must complete a learning process known as informed consent. During informed consent, the doctor should list all of the patient's options, so the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment. Learn more about clinical trials, including patient safety, phases of a clinical trial, deciding to participate in a clinical trial, questions to ask the research team, and links to find cancer clinical trials.
Cancer and its treatment can cause a variety of side effects. However, doctors have made major strides in recent years in reducing pain, nausea and vomiting, and other physical side effects of cancer treatments. Many treatments used today are less intensive but as effective as treatments used in the past. Doctors also have many ways to provide relief to patients when such side effects do occur.
Fear of treatment side effects is common after a diagnosis of cancer, but it may be helpful to know that preventing and controlling side effects is a major focus of your health-care team. Before treatment begins, talk with your doctor about possible side effects of the specific treatments you will be receiving. The specific side effects that can occur depend on a variety of factors, including the type of cancer, its location, the individual treatment plan (including the length and dosage of treatment), and the person's overall health.
Ask your doctor which side effects are most likely to happen (and which are not), when side effects are likely to occur, and how they will be addressed by the health-care team if they do happen. Also, be sure to communicate with your doctor about side effects you experience during and after treatment. For more information on the most common side effects of cancer and different treatments, along with ways to prevent or control them, visit Cancer.Net's section on Managing Side Effects, based on ASCO's curriculum.
In addition to physical side effects, there may be psychosocial (emotional and social) effects as well. Learn more about the importance of addressing these needs in Cancer.Net's section on Caring for the Whole Patient.
For more information on late effects or long-term side effects, please read the After Treatment section or talk with your doctor.
After treatment for kidney cancer ends, talk with your doctor about developing a follow-up care plan. This plan may include regular physical examinations and/or medical tests to monitor your recovery for the coming months and years. As part of this follow-up care, patients should receive periodic blood tests to check kidney function, in addition to chest x-rays, CT scans of the abdomen and chest, and other imaging tests to watch for recurrence or metastasis. Patients should have a checkup every three months for the first year, every four months for the second to fifth year, and yearly thereafter.
Because people treated for kidney cancer often have a single kidney, they will need to be monitored for possible declining kidney function for the rest of their lives. Long-term side effects are minimal, though some chronic pain from the surgical scar is possible. Also, people with kidney cancer seem to have a slightly higher chance of developing cancers of the colon and prostate.
People recovering from kidney cancer are encouraged to follow established guidelines for good health, such as maintaining a healthy weight, not smoking, eating a balanced diet, and having recommended cancer screening tests. Talk with your doctor to develop a plan that is best for your needs. Moderate physical activity can help rebuild your strength and energy level. Your doctor can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about Healthy Living After Cancer.
Research for kidney cancer is ongoing. The following advances may still be under investigation in clinical trials and may not be approved or available at this time. Always discuss all diagnostic and treatment options with your doctor.
Because kidney cancer does not respond well to traditional chemotherapy, the emphasis for treatment of kidney cancer involves using new and novel agents, immunotherapy, and other biologic therapies.
Targeted therapy. New drugs have been developed that cause kidney cancer to shrink. Axitinib (AG 013736) is still in clinical trials, but is showing substantial promise. Another anti-angiogenic drug approved by the FDA to treat colon, lung, and breast cancers, bevacizumab (Avastin), has been shown to slow tumor growth in people with metastatic renal carcinoma. Bevacizumab is an antibody that blocks the action of VEGF. A large phase III study in the United States comparing interferon with interferon plus bevacizumab was completed in July 2005, and the results are being analyzed. A second phase III study has also been completed in Europe. A recently published study reported on adding the drug erlotinib (Tarceva), another cell-growth regulating agent, to bevacizumab, and about 40% of the cancers shrank. However, a phase II clinical trial comparing bevacizumab alone with bevacizumab plus erlotinib showed no benefit for adding erlotinib to bevacizumab. This means that there are a number of newly discovered drugs, which act by turning on or turning off parts of the process of developing blood vessels or controlling cancer cell growth, being tested as treatments for kidney cancer. Preliminary results are encouraging, and this is an area of rapid scientific change.
Cancer vaccines. Cancer vaccines are experimental treatments that help the patient's own immune system to fight cancer. Doctors are testing the use of a number of cancer vaccines in people with advanced renal cell carcinoma to treat the established cancer and prevent recurrence of the disease. One vaccine is made from a person's tumor and given after surgery, while others are made from proteins found on the surface of kidney cancer cells or blood vessel cells found in the cancer.
Allogeneic stem cell transplantation or mini-transplant. Allogeneic stem cell transplantation or mini-transplant is another example of immunotherapy. Patients are first given high-dose chemotherapy to suppress their immune system, and stem cells from a human leukocyte antigen (HLA)-matched donor (usually a brother or sister of the patient) are then transferred to the patient. Additional powerful drugs are then given to suppress the patient's existing immune system until the stem cells can form a new immune system (a process called engraftment). The new cells from the donor's immune system destroy the cancerous cells; this is called the graft-versus-tumor effect, but the new immune system may also attack the patient's normal tissues, causing a potentially serious side effect called graft-versus-host disease (GVHD).
Regular communication with your doctor is important in making informed decisions about your health care. Consider asking the following questions of your doctor:
What type of kidney cancer do I have?
Can you explain my pathology report to me?
What is the stage of my cancer? What does this mean?
What are my treatment options?
What clinical trials are open to me?
What treatment do you recommend? Why?
Who will be doing the surgery? How experienced is this person with this type of cancer?
Can I have a partial nephrectomy? If no, why not?
What are the side effects of treatment, both in the short term and the long term?
Will I need treatment after surgery?
What role, if any, do the new anti-angiogenic agents have in my treatment plan?
Does this center have expertise in using high-dose IL-2? If not, what is the nearest center with that expertise?
What are the chances the cancer will recur?
What follow-up tests will I need, and how often will I need them?
How can I keep myself as healthy as possible during treatment?
What support services are available for me? for my family?
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