TREATMENTS

The treatment of renal cell carcinoma will depend on the stage and the patient's overall physical health. If there is uncertainty as to management, a second opinion is always reasonable and can provide information to the patient to help make a decision.

Surgery is the main treatment for renal cell carcinoma because it has the highest chance of cure. On the other hand, surgery is typically performed in lower stage disease with the expectation that all tumor can be removed. The most commonly performed surgery is called a radical nephrectomy. Radical nephrectomy removes not only the kidney but also often the adrenal gland and fatty tissue around the kidney. Sometimes a regional lymphadenectomy or removal of adjacent lymph nodes is also performed. A newer procedure called a partial nephrectomy is becoming much more common, particularly with small tumors, so that only a portion of the kidney is removed. The patient is then left with additional kidney tissue so that if another tumor were to arise, more renal tissue would still be available to the patient. Occasionally, doctors consider arterial embolization, as these tumors can sometimes be very vascular. The blood supply can then be occluded to these tumors and this maneuver may facilitate nephrectomy in select circumstances. The risks associated with surgery include bleeding, later incisional hernia, or damage to other organs such as the spleen, pancreas, vena cava, bowel, pneumothorax (collapsed lung requiring a chest tube).

Chemotherapy uses anti-cancer drugs typically given into a vein or by mouth which enter the bloodstream and reach all areas of the body. This type of treatment is typically given when there has been spread of cancer. Unfortunately, kidney cancer tends to be very resistant to chemotherapy. Wilms' tumor in children, however, is generally sensitive to chemotherapy but the adult renal cell carcinoma typically is not. Chemotherapeutic drugs can 0 cancer cells but they also damage normal cells. The damage to the normal cells may produce side effects which include upset stomach, vomiting, loss of appetite, loss of hair, sores in the mouth or vagina and an increase in infection, bleeding and infertility.

Radiation therapy is also used to kill cancer cells but typically this form of treatment is used more commonly when there is spread of tumor to bone. Sometimes if is also used if there is spread of cancer to the brain. It is not typically used for primary treatment of the original cancer in the kidney.

RESULTS OF TREATMENT

In stage I to II the overall survival rate is between 70 and 100%. In stage III, when there is more widespread disease, the survival rate can vary between 40 and 80%. In stage IV where there is spread of tumor clearly away from the kidney, the overall five year survival rate is in the 15 to 18% range.      After treatment, the patient will need to be followed carefully with x-rays and blood tests. If there are new symptoms, then the patient should report them to the doctor immediately.

NEW FORMS OF TREATMENT IN KIDNEY CANCER AND KIDNEY CANCER RESEARCH

There are many new forms of diagnostic tests and treatment for kidney cancer. One of the genes causing clear cell renal cell carcinoma has been identified on chromosome 3. Ultimately this may improve diagnosis although it is not available on a widespread basis at this time. There are constant improvements in imaging techniques which help doctors diagnose not only the main tumor but also potential spread of cancer. Undoubtedly in the future there will be improved blood tests to help monitor patients.

Many advances have occurred in the surgical management of renal cell carcinoma. Smaller tumors are being managed by preserving a portion of the kidney.

Laparoscopic crysurgery is a new, less invasive form of treatment that freezes and destroys small kidney tumors without more extensive open surgery. Patients can be rapidly discharged from the hospital and recover rapidly. Larger tumors, including tumors that extend into the vena cava and into the heart, are now potentially surgically removable, whereas before they were thought to be inoperable.

New forms of inummotherapy are also being developed along with investigation of new chemotherapeutic agents. The goal of immunotherapy is to boost the body's immune system to fight cancer cells. Compounds such as Interleukin 2 and gamma Interferon have been used to stimulate the body's immune system to fight these cancer cells. More recently, a new approach includes tumor vaccines. This approach involves adding activated genes or cytokines which can stimulate the body's immune system. Adding a cytokine to these vaccines is a form of gene therapy which hopefully Will stimulate the body's immune system in a very specific way to fight the patient's tumor. Because of the specificity of this % treatment approach, there is less toxicity than occurs with many forms of chemotherapy. In the, future bad genes that are discovered in cells changing to cancer may be effectively combated by adding normal genes into tumor cells to reverse their cancerous behavior. These are examples of multiple new processes that are being investigated for the treatment of renal cell carcinoma.

Many of these techniques of radical nephrectomy, partial nephrectomy, excision of caval tumors, cryosurgery and gene therapy were partially developed and pioneered at Johns Hopkins.