People with cancer should be cared for by a team of specialists who work together to provide the best treatment and care, this is known as a multidisciplinary team (MDT).
The MDT often consists of:
- a specialist cancer surgeon
- an oncologist (a radiotherapy and chemotherapy specialist)
- a radiologist
- a pathologist
- a nephrologist (a kidney specialist)
- a specialist nurse.
Other members may include a physiotherapist, a dietitian, and an occupational therapist, you may also have access to clinical psychology support.
You will be assigned a key worker, usually a specialist nurse, who will be responsible for co-ordinating your care.
Your treatment plan
Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
When deciding what treatment is best for you, your doctors will consider:
- the stage and grade of your cancer (how big it is and how far it has spread)
- your age and general health
If the cancer has not spread out of your kidney (T1 or T2 kidney cancer) it can usually be cured by removing some or all of the kidney.
If the cancer has spread out of the kidney (T3 or T4 kidney cancer) a complete cure may not be possible. However, it should be possible to slow the progression of the cancer and treat any symptoms.
The main treatments for kidney cancer are:
- nephrectomy
- embolisation
- radiotherapy
- targeted therapies
- immunotherapy
These treatment options are outlined in more detail below.
Surgical treatments
Nephrectomy
A nephrectomy is an operation to remove a kidney. If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health.
If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed. Removing the kidney can help to resolve the symptoms of pain, and make other types of non-surgical treatment more effective. It is possible to live a normal life with only one kidney because the other kidney will be able to compensate.
During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure that the cancer has not spread beyond the kidney.
There are two ways that both a partial and open nephrectomy can be performed:
- open nephrectomy: where the kidney is removed through a large incision in your abdomen (tummy)
- laparoscopic or keyhole nephrectomy: where a series of smaller incisions are made in your abdomen and the kidney is removed with small surgical instruments
Both techniques have their own set of advantages and disadvantages.
A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy.
However, a practical disadvantage is that the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if you chose to have an open nephrectomy.
Also, some types of kidney cancer, where the tumour is located in the centre of the kidney, may not be suitable for a laparoscopic nephrectomy.
One of the main disadvantages of an open nephrectomy is that it is a major surgical procedure that can place a considerable amount of strain on the body. Therefore, it may not be a suitable form of treatment for people who are particularly frail or unwell.
You should discuss the pros and cons of both procedures with your surgical team.
- NICE– Single-port laparoscopic nephrectomy (PDF, 57Kb)
- NICE– Laparoscopic partial nephrectomy (PDF, 74Kb)
- NICE– Laparoscopic nephrectomy (PDF, 75Kb)
Embolisation
If you are unable to have a nephrectomy, you may benefit from an alternative operation known as embolisation.
During embolisation, the surgeon will insert a small tube, known as a catheter, into your groin. They will use X-ray images to guide the catheter into the blood supply of your kidney. A substance will then be injected through the catheter to block the blood supply to your kidney. By blocking the blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink.
Non-surgical treatments for advanced kidney cancer
Kidney cancer is one of the few types of cancer that is less responsive to chemotherapy (where powerful medication is used to kill cancerous cells).
However, there are a number of ongoing clinical trials looking at new combinations of chemotherapy medications that appear to be benefiting some people.
Read more about kidney cancer clinical trials.
There are also a number of different non-surgical treatments that can slow the spread of the cancer and help control its symptoms.
Radiotherapy
Radiotherapy cannot usually cure kidney cancer, but it can help to reduce the symptoms of pain and slow down its progress. You should only require a few minutes of radiotherapy every day for a number of days.
When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include:
- fatigue (tiredness)
- nausea (feeling sick)
- vomiting
Cryotherapy
Cryotherapy involves killing cancer cells by freezing them. This treatment is usually used if you are not fit enough for surgery or if your tumour is small.
Cryotherapy is usually classed as either percutaneous (using needles that pass through the skin) or laparoscopic (needles are placed directly into the kidney through a small incision).
Side effects include bleeding around the kidney and injury to the tube that carries urine from the kidney to the bladder (the ureter).
Want to know more?
- NICE – Percutaneous cryotherapy for renal tumours (PDF, 54Kb)
- NICE – Laparoscopic cryotherapy for renal cancer (PDF, 58Kb)
Radiofrequency ablation
Radiofrequency ablation (RFA) use heat generated by radiowaves to kill cancer cells. This is a percutaneous treatment, meaning no incision is needed.
This treatment is only available at specialist centres. It is mainly used if you are not strong enough for surgery or your kidney cancer is in the early stages.
This treatment cannot be used if the cancer is too close to other organs, such as the bowel.
Side effects include bleeding in the treatment area, a collection of blood (haematoma) near the kidney and problems passing urine due to the narrowing of the tube that joins the kidney to the bladder (the ureter).
Want to know more?
Targeted therapies
Seven new medicines have been developed for the treatment of kidney cancer. These are:
- sunitinib
- pazopanib
- axitinib
- sorafenib
- bevacizumab
- temsirolimus
- everolimus
These medicines are sometimes referred to as ‘targeted therapies’ because they are designed to target and interrupt the functions needed by cancer to grow and spread.
At the moment, only sunitinib and pazopanib have been recommended by the National Institute of Health and Clinical Excellence (NICE) and are available free of charge on the NHS for people who are still relatively healthy and have advanced kidney cancer, or kidney cancer that has spread to other parts of their body.
The use of sunitinib in people who are in poor health is not recommended because the medicine is unlikely to provide significant benefit.
NICE has not recommended sorafenib, everolimus, bevacizumab or temsirolimus because it is thought that the effectiveness of these medications is too limited to justify the costs. Therefore, if you wish to take these medications you will have to pay for them. A year’s course can range from £18,000 to £30,000.
Sunitinib
Sunitinib cannot cure kidney cancer, but it can slow its spread, help relieve symptoms, and prolong life.
Common side effects of sunitinib include:
- redness and swelling of the hands and feet
- mouth pain
- vomiting
- jaundice: where the skin and whites of the eyes have a yellowish tinge
- changes in hair colour
- skin rashes or blisters
You should contact a member of your MDT if the side effects of sunitinib become particularly troublesome. They may be able to prescribe additional treatments to help you to cope better with the side effects.
Avoid taking complementary medicines, such as St John’s Wort, because they can make sunitinib less effective. Also avoid eating grapefruit and drinking grapefruit juice for the same reason.
You should not father a child or become pregnant while taking sunitinib because the medication can damage the health of an unborn child. If you are sexually active, make sure you use an effective method of contraception while you are taking the medicine and for several months afterwards. Your GP or MDT can advise you about when it is safe to father a child or become pregnant.
Avoid breastfeeding your baby while you are taking sunitinib because the medicine could be passed on to your baby through your breast milk.
Want to know more?
Pazopanib
Pazopanib hydrochloride can slow or stop the growth of cancer cells in the kidneys.
Common side effects of pazopanib include:
- high blood pressure
- diarrhoea
- nausea or vomiting
- stomach pain
- loss of appetite
- changes in hair colour
Like sunitinib, you should not father a child or become pregnant while taking pazopanib. The effects of this have not yet been established, but there is a potential danger to an unborn child.
Breastfeeding should also be avoided, as it has not been shown that there is no risk to a breastfed child.
Pazopanib may also have an impact on fertility.
Want to know more?
Immunotherapy
Immunotherapy treatment involves taking medicines that encourage the immune system to attack cancerous cells. The immune system is the body’s natural defence against illness and infection. Medicines that are used to treat kidney cancer include:
- interferon alpha
- aldesleukin (Proleukin)
Interferon alpha is given by injection and most people will require three injections a week. Your cancer nurse will be able to teach you how to administer the injections yourself.
Most people will experience flu-like symptoms when they first start taking interferon alpha. This should improve as your body begins to get used to the medicine.
Aldesleukin can either be given by injection or through a drip (intravenously). It is usually only available at specialist cancer clinics or centres.
Possible side effects of aldesleukin include:
- headaches
- a high temperature
- low blood pressure (hypotension)
- skin rashes
Immunotherapy treatments are rarely used now because targeted therapies have proved to be more effective in controlling advanced kidney cancer, and because immunotherapy can sometimes have serious side effects.
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