Treatment for kidney cancer depends on the stage of the disease, the patient's general health and age, and other factors. The doctor develops a treatment plan to fit each patient's needs.

People with kidney cancer are often treated by a team of specialists, which may include a urologist, an oncologist, and a radiation oncologist. Kidney cancer is usually treated with surgery, radiation therapy, biological therapy, chemotherapy, or hormone therapy. Sometimes a special treatment called arterial embolization is used. The doctors may decide to use one treatment method or a combination of methods.

Some people take part in a clinical trial (research study) using new treatment methods. Such studies are designed to improve cancer treatment.

Getting a Second Opinion

Before starting treatment, the patient may want a second pathologist to review the diagnosis and another specialist to review the treatment plan. A short delay will not reduce the chance that treatment will be successful. Some insurance companies require a second opinion; many others will cover a second opinion if the patient requests it.

There are a number of ways a person can find a doctor who can give a second opinion:

• The person's doctor may be able to suggest pathologists and specialists to consult.
• People can get the names of doctors from a local medical society, a nearby hospital, or a medical school.
• The Directory of Medical Specialists lists doctors' names along with their specialty and their background. This book is in most public libraries.

Preparing for Treatment

Many people with cancer want to learn all they can about their disease and their treatment choices so they can take an active part in decisions about their medical care. When a person is diagnosed with cancer, shock and stress are natural reactions. These feelings may make it difficult for patients to think of everything they want to ask the doctor.

Often, it helps to make a list of questions. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. Some patients also want to have a family member or friend with them when they talk to the doctor--to take part in the discussion, to take notes, or just to listen.

These are some questions a patient may want to ask the doctor before treatment begins:

• What type of kidney cancer do I have?
• What is the stage of the disease?
• What are the treatment choices? Which do you recommend? Why?
• What are the risks and possible side effects of each treatment?
• What are the chances that the treatment will be successful?
• Would a clinical trial be appropriate?
• How long will treatment last?
• Will I have to stay in the hospital?
• Will treatment affect my normal activities? If so, for how long?
• What is the treatment likely to cost?
  

People do not need to ask all their questions or remember all the answers at one time. Questions may arise throughout the treatment process. Patients may wish to ask doctors, nurses, or other members of the health care team to explain things further or to provide more information.

Methods of Treatment

Surgery is the most common treatment for kidney cancer. An operation to remove the kidney is called a nephrectomy. Most often, the surgeon removes the whole kidney along with the adrenal glands and the tissue around the kidney. Some lymph nodes in the area may also be removed. This procedure is called a radical nephrectomy. In some cases, the surgeon removes only the kidney (simple nephrectomy). The remaining kidney generally is able to perform the work of both kidneys. In another procedure, partial nephrectomy, the surgeon removes just the part of the kidney that contains the tumor.

Arterial embolization is sometimes used before an operation to make surgery easier. It also may be used to provide relief from pain or bleeding when removal of the tumor is not possible. Small pieces of a special gelatin sponge or other material are injected through a catheter to clog the main renal blood vessel. This procedure shrinks the tumor by depriving it of the oxygen-carrying blood and other substances it needs to grow.

These are some questions a patient may want to ask the doctor before surgery:

• What kind of operation will it be?
• Will further treatment be necessary? What kind?
• How will I feel after the operation?
• If I have pain, how will you help?
• When will I be able to resume my normal activities?
  

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Doctors sometimes use radiation therapy to relieve pain (palliative therapy) when kidney cancer has spread to the bone.

Radiation therapy for kidney cancer involves external radiation, which comes from radioactive material outside the body. A machine aims the rays at a specific area of the body. Most often, treatment is given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect normal tissue by spreading out the total dose of radiation. The patient does not need to stay in the hospital for radiation therapy, and patients are not radioactive during or after treatment.

These are some questions a patient may want to ask the doctor before having radiation therapy:

• What is the goal of this treatment?
• When will the treatments begin? When will they end?
• How will I feel during therapy? What are the possible side effects?
• What can I do to take care of myself during therapy?
• How will I know if the radiation therapy is working?
• Will I be able to continue my normal activities during treatment?
  

Surgery and arterial embolization are local therapy; they affect cancer cells only in the treated area. Biological therapy, chemotherapy, and hormone therapy, explained below, are systemic treatments because they travel through the bloodstream and can reach cells throughout the body.

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's natural ability (immune system) to fight cancer. Interleukin-2 and interferon are types of biological therapy used to treat advanced kidney cancer. Clinical trials continue to examine better ways to use biological therapy while reducing the side effects patients may experience. Many people having biological therapy stay in the hospital during treatment so that these side effects can be monitored.

These are some questions patients may want to ask the doctor before starting biological therapy:

• What is the goal of the treatment?
• What drugs will be used?
• Will the treatment cause side effects? If so, what can be done about them?
• Will I have to be in the hospital to receive treatment?
• When will I be able to resume my normal activities?
  

Chemotherapy is the use of drugs to kill cancer cells. Although useful in the treatment of many other cancers, chemotherapy has shown only limited effectiveness against kidney cancer. However, researchers continue to study new drugs and new drug combinations that may prove to be more useful.

Hormone therapy is used in a small number of patients with advanced kidney cancer. Some kidney cancers may be treated with hormones to try to control the growth of cancer cells. More often, it is used as palliative therapy.

These are some questions a patient may want to ask the doctor before having chemotherapy or hormone therapy:

• What is the goal of this treatment?
• What drugs will I be taking?
• Will I have side effects? What can I do about them?
• How long will I be on the treatment?

Many people with kidney cancer take part in clinical trials (treatment studies). Doctors conduct clinical trials to learn about the effectiveness and side effects of new treatments. In some clinical trials, all patients receive the new treatment. In other trials, doctors compare different therapies by giving the new treatment to one group of patients and the standard therapy to another group.

People who take part in these studies have the first chance to benefit from treatments that have shown promise in early research. They also make an important contribution to medical science.

In clinical trials for kidney cancer, doctors are studying new ways of giving radiation therapy and chemotherapy, new drugs and drug combinations, biological therapies, and new ways of combining various types of treatment. Some trials are designed to study ways to reduce the side effects of treatment and to improve quality of life.
Patients who are interested in taking part in a trial should talk with their doctor.

Side Effects of Treatment

It is hard to limit the effects of therapy so that only cancer cells are removed or destroyed. Because treatment also damages healthy cells and tissues, it often causes unwanted side effects.

The side effects of cancer therapy depend mainly on the type and extent of the treatment. Also, side effects may not be the same for each person, and they may even change from one treatment to the next. Doctors and nurses can explain the possible side effects of therapy, and they can help relieve problems that may occur during and after treatment. Patients should notify a doctor of the side effects they are having, as some may require immediate medical attention.

Surgery

The side effects of kidney surgery depend on the type of operation, the patient's general health, and other factors. Nephrectomy is major surgery, and after the operation most people have pain and discomfort. Patients may find it difficult to breathe deeply due to discomfort from surgery; they may have to do special coughing and breathing exercises to help keep their lungs clear. It is also common for patients who have had surgery to feel tired or weak for a while.

In addition, patients may need intravenous (IV) feeding and fluids for several days before and after the operation. When a kidney is removed, the one remaining kidney takes over the work of both. Nurses will monitor the amount of fluid a person takes in and the amount of urine produced. The length of time it takes to recover from an operation varies for each person.

Arterial Embolization

Arterial embolization can cause pain, fever, nausea, or vomiting. Often, people need IV fluids as the body recovers from this procedure.

Radiation Therapy

With radiation therapy, the side effects depend on the treatment dose and the part of the body that is treated. Patients are likely to become very tired, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay as active as they can.

It is common for the skin in the treated area to become red, dry, tender, and itchy. There may be permanent darkening or "bronzing" of the skin in the treated area. Radiation to the kidney and nearby areas may cause nausea, vomiting, diarrhea, or urinary discomfort. It may also cause a decrease in the number of white blood cell, cells that help protect the body against infection.

Biological Therapy

The side effects caused by biological therapy vary with the type of treatment. These treatments may cause flu-like symptoms such as chills, fever, muscle aches, weakness, loss of appetite, nausea, vomiting, and diarrhea. Patients often feel very tired after treatment, and they may bleed or bruise easily. Some people also get a skin rash. In addition, interleukin therapy can cause swelling and can interfere with normal liver or kidney function. These problems can be severe, but they go away after the treatment stops.

Chemotherapy

The side effects of chemotherapy depend on the drugs that are given. In general, anticancer drugs affect rapidly growing cells, such as blood cells that fight infection, cells that line the digestive tract, and cells in the hair follicles. As a result, patients may have side effects such as lower resistance to infection, loss of appetite, nausea, vomiting, or mouth sores. They may also have less energy and may lose their hair.

Hormone Therapy

The side effects of hormone therapy are usually mild. Progesterone is the hormone most often used to treat kidney cancer. Drugs containing progesterone may cause changes in appetite and weight. They may also cause swelling or fluid retention. These side effects generally go away after treatment.

Possible Causes and Prevention

Scientists at hospitals and medical centers all across the country are studying kidney cancer. They are trying to learn what causes this disease and how to prevent it. At this time, scientists do not know exactly what causes kidney cancer, and they can seldom explain why one person gets this disease and another does not. However, it is clear that this disease is not contagious; no one can "catch" kidney cancer from another person.

Researchers study patterns of cancer in the population to look for factors that are more common in people who get kidney cancer than in people who don't get this disease. These studies help researchers find possible risk factors for kidney cancer. It is important to know that most people with these risk factor do not get cancer, and people who do get kidney cancer may have none of these factors.

As with most other types of cancer, studies show that the risk of kidney cancer increases with age. It occurs most often between the ages of 50 and 70. It affects almost twice as many men as women. In addition, kidney cancer is somewhat more common among African American men than White men.

Other risk factors for kidney cancer include:

• Tobacco use: Research shows that smokers are twice as likely to develop kidney cancer as nonsmokers. In addition, the longer a person smokes, the higher the risk. However, the risk of kidney cancer decreases for those who quit smoking.
• Obesity: Obesity may increase the risk of developing kidney cancer. In several studies, obesity has been associated with increased risk in women. One report suggests that being overweight may be a risk factor for men, too. The reasons for this possible link are not clear.
• Occupational exposure: A number of studies have examined occupational exposures to see whether they increase workers' chances of developing kidney cancer. Studies suggest, for example, that coke oven workers in steel plants have above-average rates of kidney cancer. In addition, there is some evidence that asbestos in the workplace, which has been linked to cancers of the lung and mesothelium (a membrane that surrounds internal organs of the body), also increases the risk of some kidney cancers.
• Radiation: Women who have been treated with radiation therapy for disorders of the uterus may have a slightly increased risk of developing kidney cancer. Also, people who were exposed to thorotrast (thorium dioxide), a radioactive substance used in the 1920s with certain diagnostic x-rays, have an increased rate of kidney cancer. However, this substance is no longer in use, and scientists think that radiation accounts for an extremely small percentage of the total number of kidney cancers.
• Phenacetin: Some people have developed kidney cancer after heavy, long-term use of this drug. This painkilling drug is no longer sold in the United States.
• Dialysis: Patients on long-term use of dialysis to treat chronic kidney failure have an increased risk of developing renal cysts and renal cancer. Further study is needed to learn more about the long-term effects of dialysis on patients with kidney failure.
• Von Hippel-Lindau (VHL) disease: Researchers have found that people who have this inherited disorder are at greater risk of developing renal cell carcinoma, as well as tumors in other organs. Researchers have found the gene responsible for VHL, and they believe that the isolation of this gene may lead to improved methods of diagnosis, treatment, and even prevention of some kidney cancers.

People who think they may be at risk for developing kidney cancer should discuss this concern with their doctor. The doctor may suggest ways to reduce the risk and help plan an appropriate schedule for checkups

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