Kidney Cancer Treatment Options

Kidney Cancer Surgery

There are various procedures for surgical treatment of kidney cancer. Kidney Cancer UK have gathered the latest surgical treatment information to assist patients, carers and health professionals.

Surgical treatments:

• Partial nephrectomy
• Nephrectomy
• Radical nephrectomy
• Nephrectomy with Inferior vena cava (IVC) thrombectomy
• Ablative therapies
  • Cryotherapy
  • Radiofrequency ablation (RFA)
  • Microwave ablation

Surgery to remove the affected kidney (total, or radical nephrectomy) or to remove the part of the kidney (partial nephrectomy) containing the tumour is usually the first thing doctors consider and it is performed with an intention to cure if the cancer is at an early stage and has not spread. Even some more advanced cancers may be cured if all the cancer can be removed. However, removing a kidney or part of a kidney is a major operation so you need to be fit enough to cope and recover afterwards. That’s why this treatment may not be possible for everyone. Surgery can also be used to remove metastases in some cases of advanced kidney cancer.

Partial nephrectomy

Removing part of the kidney containing the tumour is called a partial nephrectomy or kidney/nephron sparing surgery. The aim of this surgery is to remove the whole tumour while leaving as much normal tissue as possible, aiming to preserve kidney function. It means that some working kidney is left behind. Specialist surgeons now treat most early stage (stage 1) kidney tumours that are less than seven cm in size with partial nephrectomy, if possible. This is usually performed using a ‘keyhole’ (laparoscopic or robot assisted laparoscopic’ approach.

Nephrectomy

During a nephrectomy the whole kidney is removed.

Radical nephrectomy

During a radical nephrectomy the whole kidney and the surrounding fatty tissue, the adrenal gland, and nearby lymph nodes are usually removed, although the extent of a radical nephrectomy can vary between patients. This is usually performed using a ‘keyhole’ (laparoscopic or robot assisted laparoscopic’ approach.
You can live perfectly well with just one working kidney, but if both kidneys are removed because of bilateral renal cell carcinoma, or because they are not working you will need dialysis for the rest of your life or a kidney transplant.

Nephrectomy with Inferior vena cava (IVC) tumour thrombectomy

This surgery is complex and is performed when the kidney tumour has extended into the major vein of the body (the inferior vena cava). This is usually performed using a traditional (open) surgical approach.
The surgeon will discuss/recommend the most appropriate treatments and technical approach on a case-by-case basis. If laparoscopic or robotic surgery is offered but not performed at your local hospital you will need a referral to a specialist urological surgeon with expertise in laparoscopic or Robotic kidney surgery.

Open radical nephrectomy, open nephrectomy, and open partial nephrectomy

During open radical nephrectomy, open nephrectomy or open partial nephrectomy, the surgeon usually makes a large incision which may be like a ‘L’ or inverted ‘L’ shape, or below the ribs in the abdomen on the side of the affected kidney. The whole kidney and surrounding tissues are removed through this incision.

Laparoscopic (keyhole) surgery

Laparoscopic radical nephrectomy, laparoscopic nephrectomy, and laparoscopic partial nephrectomy.

The operation is carried out using several small incisions or cuts in the skin of the abdomen (tummy), rather than one large incision. A thin tube with a camera and a light at the end is inserted into the abdomen through one of the cuts. This instrument is called a laparoscope, and it enables the doctor to see inside your abdomen. Other small instruments are inserted through the other cuts and used to remove the kidney or part of the kidney containing the tumour.

There may be some advantages to having laparoscopic surgery. For example, you may experience less pain after the operation, need a shorter stay in hospital and have smaller scars. However, keyhole surgery, like any operation, has some risks, so you should discuss the options with your specialist before surgery.

Robot Assisted surgery (RAS)

Robot Assisted surgery is a type of laparoscopic surgery in which a special machine or robot is used by the surgeon to help carry out the surgery. The surgeon has a 3D view of the inside of your abdomen and the area can be magnified 20 times. Robotic surgery is only available at specialist centres in the UK.

For further information on surgery and recovery click on the link to access Kidney Cancer-Understanding surgery and recovery booklet.

Other Surgical Treatments

Ablative Therapies

Ablative therapies include cryotherapy and radiofrequency ablation. These treatments are less invasive ways of treating kidney tumours. These treatments can be used to treat[CT1] small tumours (less than four cm in size) and for people who are unable to have surgery or who want to avoid surgery. They may also be used to treat people with multiple kidney tumours or tumours in both kidneys (bilateral disease).

Cryotherapy

Cryotherapy kills the cancer cells by freezing the tumour. The doctor inserts one or more fine needles or probes through the skin (percutaneous) and into the tumour. Argon gas is passed through the needles to freeze the tumour. Regular CT scans are carried out during the procedure to ensure the needles are positioned correctly in the tumour and the entire tumour has been frozen. Cryotherapy is usually carried out under general anaesthetic. Complications[CT2] or side-effects after cryotherapy include pain, infection, and bleeding. A small number of people experience damage to the bowel and a blockage or damage to the ureter, the tube from the kidney to the bladder through which urine passes. However, in specialist centres that perform a lot of cryotherapy procedures, these complications are minimal.

National Institute for Health and Care Excellence (NICE) has issued guidance for percutaneous cryoablation; however, this procedure is only available at specialist centres in the UK.
Further research is needed to compare the long-term outcomes of cryotherapy with those of other treatments for kidney cancer.

Radiofrequency ablation

Radiofrequency ablation (RFA) uses heat from an electric probe to destroy the tumour; however, there is only limited data to prove how effective this procedure is. Fine needles are inserted through the skin (percutaneous) and into the tumour. An electric current is passed through the needles to heat the cancer cells and destroy them. Regular CT or ultrasound scans are carried out during the procedure to ensure the needles are positioned correctly[CT3] . RFA is usually carried out using local anaesthetic.
Complications or side-effects after RFA include pain, infection, and bleeding. A small number of people experience damage to the kidney causing urine leakage and a narrowing of the ureter, making it difficult to pass urine. However, in specialist centres that have a lot of experience of RFA procedures, these complications are minimised.

National Institute for Health and Care Excellence (NICE) has issued guidance for percutaneous RFA; however, this procedure is only available at specialist centres in the UK. Further research is needed to compare the long-term outcomes of RFA with those of other treatments for kidney cancer.

High intensity focused ultrasound

High intensity focused ultrasound (HIFU) directs strong beams of sound at the tumour, which heats up the cancer cells and kills them. HIFU is only available in clinical trials for the treatment of kidney cancer in the UK, and research is ongoing to determine the effectiveness of this technique.

These treatments may be repeated if not successful the first time.

For further information on Image guided renal ablation and other treatments click on the link to access the Image Guided renal ablation and other ablative treatments booklet.

If your surgeon is confident that all your cancer has been removed during surgery, you won’t need any further treatment. However, if there is concern that some cancer cells were left behind after surgery, you may require further treatment with Systemic Anti-Cancer Treatments (SACT) called targeted therapy or a course of radiotherapy. Your doctor or clinical nurse specialist (specialist nurse) will discuss this with you.