Kidney Cancer Treatment

Active Surveillance

Active surveillance is the standard of care if you have kidney cancer and are in good health with few or no symptoms. This treatment monitors your tumor with regular appointments and advanced diagnostic tests, including:

• Computed Tomography (CT): With detailed cross-sectional images of your kidney, a CT scan provides precise information about the location, size and shape of the tumor.
• Magnetic resonance imaging (MRI): Images the kidney and major blood vessels in the abdomen to monitor the spread of kidney cancer.
• Advanced positron emission tomography (PET): Reveals if suspicious tissue is likely to be cancerous, including if kidney cancer has spread to the lymph nodes.

To determine the optimal timing and type of more advanced treatments, our team carefully monitors your individual condition, often our community locations. The radiology experts at University Hospitals also provide advanced imaging services such as diffusion-weighted MRI with contrast to better visualize tissue to determine response to therapies.

Kidney cancer treatment typically begins with surgical removal of part or all of the cancer. If the cancer is confined to the kidney, surgery may be the only treatment needed. If the cancer has spread outside of the kidney or kidneys, additional treatment may be required.

We have expertise in a variety of surgical procedures, including laparoscopic/minimally invasive partial nephrectomy (removal of only part of a kidney) and complete nephrectomy (removal of an entire kidney). We also use robotic surgical approaches to treat kidney cancer, including:

Immunotherapy and Targeted Therapy

Systemic therapy is a type of cancer treatment in which drugs travel through the patient’s bloodstream to destroy cells throughout the body. It is given intravenously (through an IV) or orally in pill form. Systemic therapies used in the treatment of kidney cancer include immunotherapy and targeted therapy.

Immunotherapy

Using the body’s own immune system to fight cancer, immunotherapy works by either stimulating your own immune cells or providing man-made immune system proteins to strengthen your immune function. The goal of immunotherapy is to help your immune system recognize and destroy kidney cancer cells.

Immunotherapy treatments for kidney cancer include:

Targeted Therapy

Targeted therapy interferes with cancer growth by targeting specific cellular activities. Targeted therapies used in the treatment of kidney cancer include:

• Tyrosine kinase inhibitors (TKIs): Taken orally as pills, TKIs block kinases (proteins that regulate how cells grow and divide), preventing them from sending signals within the cancer cells, which cause those cells to die.
• Angiogenesis inhibitors: All tumors require nutrients and oxygen from the blood to grow. A targeted therapy called angiogenesis inhibitors (or anti-angiogenics) can block blood vessel growth in kidney tumors. By preventing nutrients and oxygen from reaching the tumor, angiogenesis inhibitors effectively “starve” the cancer. Angiogenesis inhibitors are taken orally or intravenously.
• mTOR inhibitors: Mammalian target of rapamycin (mTOR) is protein known to contribute to the reproduction and survival of kidney cancer cells. mTOR Inhibitors are drugs that block the action of mTOR, which can disrupt the growth and division of kidney cancer cells.
• Other targeted therapies: Other novel targeted therapies are being developed for the treatment of RCC, including HIF inhibitors. One HIF-2a is already approved for certain types of RCC, while others are under development in different clinical trials.

Chemotherapy

Chemotherapy is the use of certain drugs to destroy cancer cells. The most common types of kidney cancer (renal cell carcinomas, or RCCs) generally don’t respond to chemotherapy, but it’s used to treat less common RCCs, such as collecting duct RCC and renal medullary carcinoma. Typically, a platinum drug (carboplatin or cisplatin) is combined with either the drug gemcitabine or paclitaxel to treat these cancers. These drugs are administered by IV infusion.

Chemotherapy is given in cycles, with each treatment period followed by a rest period to give the body time to recover. Chemotherapy cycles usually last a few weeks.

Also called radiotherapy, radiation therapy is a type of cancer treatment that uses beams of intense energy to destroy cancer cells. Most often, radiation therapy uses X-rays, but other types of radiation, including proton therapy, are also used.

Proton Therapy

Proton therapy — a type of particle therapy that uses a beam of protons to target and destroy cancer — is used to treat some kidney cancers. This noninvasive treatment targets and kills cancer cells by disrupting their DNA. Proton therapy can precisely target kidney tumors while sparing surrounding tissue and organs from radiation exposure. UH Seidman Cancer Center is the only hospital in northern Ohio with a dedicated proton therapy center.

Stereotactic Body Radiation Therapy

Through groundbreaking research and clinical trials at University Hospitals, our team offers stereotactic body radiation therapy (SBRT), also known as stereotactic ablative radiotherapy (SABR). SABR is a treatment that delivers an intense dose of radiation to the tumor while limiting exposure to surrounding organs. Available through a unique partnership between surgeons and radiation oncologists, SABR allows a maximum dose of radiation to be delivered with surgical precision and minimal side effects.

The use of heat or cold to destroy cancer cells is called ablation therapy. This treatment kills cancer cells while sparing as much surrounding tissue as possible. Ablation therapy is sometimes used to treat smaller kidney tumors of less than 1 to 2 inches in diameter.

Ablation therapy may be suitable for patients who:

• Are not healthy enough to have a kidney removed with surgery.
• May benefit from controlling pain and/or bleeding caused by a tumor that cannot be removed with surgery.
• Have one working kidney.
• Have certain inherited genetic disorders that increase the risk of developing different types of kidney cancer.

Two types of ablation therapy are used to treat kidney cancer: radiofrequency ablation and cryoablation.

Radiofrequency Ablation

Radiofrequency ablation (RFA) is the most common type of ablation therapy used for kidney cancer. RFA delivers a high-frequency electrical current into the tumor using a thin needle guided by an ultrasound or a CT scan. The electrical current creates heat that destroys the cancer cells. A local or general anesthetic may be used during the procedure.

The heat generated during RFA can damage healthy tissue surrounding the tumor. RFA is not suitable for tumors located deep inside the kidney, as it may damage healthy parts of the organ.

Cryoablation

Cryoablation kills cancer cells by freezing them. Also called cryosurgical ablation, cryosurgery or cryotherapy, this method works best for small kidney tumors. Because it causes less damage to the renal pelvis, cryoablation is used more often than RFA on kidney tumors situated deep inside the kidney.

During the procedure, a doctor delivers an extremely cold liquid or gas to the kidney tumor through a metal tube (cryoprobe) with the guidance of an ultrasound.