Kidney Cancer

The treatment for kidney cancer will depend on the stage of the cancer, the patient's age, and any other health problems they may have. Whenever technically and oncologically feasible, the aim will be to remove only the tumor while preserving the kidney.

For treatment, it is necessary to differentiate between localized and metastatic tumors:

Treatments for localized tumors:

Partial nephrectomy or nephron-sparing surgery:

It is the recommended treatment for patients whose disease is in stage I. It consists of removing the entire renal tumor, preserving as much of the organ as possible to avoid subsequent renal failure; that is, only the tumor is removed and the rest of the healthy renal tissue is preserved.

This treatment achieves 80-100% disease-free survival rates at 5 years. It is the most appropriate treatment, whenever technically feasible, for tumors smaller than 7 cm, in patients with tumors in both kidneys, or in patients with a single kidney. Surgery can be performed via open, laparoscopic, or robotic approaches, depending on the specific case.

Robotic surgery for the treatment of localized kidney cancer using partial nephrectomy allows for the treatment of tumors of any complexity using a minimally invasive technique with high precision and excellent oncological outcomes. This approach also offers faster recovery, a lower risk of bleeding, less postoperative pain, and a shorter hospital stay. At ROC Clinic, we have both of the two robotic systems available on the market: d a Vinci and Toumai.

Radical nephrectomy:

This is the recommended treatment for patients in whom partial surgery is not possible. It consists of the complete removal of the affected kidney, preserving the adrenal gland unless it is infiltrated by the tumor. In cases where lymph nodes are found to be affected, a lymphadenectomy (removal of lymph nodes near the kidney) will be performed. Radical nephrectomy can also be performed via open, laparoscopic, or robotic approaches, depending on the characteristics of each case.

Active Surveillance:

Sometimes, surgery may not be the best option for you. Close monitoring of the tumor can be performed on very elderly patients, those in poor health, or those with tumors smaller than 3-4 cm.

During this period of active surveillance, regular visits with imaging tests will be scheduled. To determine if active surveillance is appropriate and to refine your individualized diagnosis, your urologist may recommend a biopsy of the kidney tumor. If tests performed during active surveillance show that the tumor is growing rapidly, or if you develop symptoms that may indicate the disease is progressing, the urologist will immediately plan salvage treatment, primarily involving surgery.

Ablative therapies:

In people who are not suitable for surgery due to significant risk, either because they are very old or have other illnesses, kidney cancer can be treated through ablation. This procedure applies energy to the tumor laparoscopically or percutaneously using radiofrequency or cryotherapy. It can also be performed in people with tumors smaller than 3 cm in certain locations.

Treatments for locally advanced or metastatic tumors:

Nephrectomy for renal tumor with thrombus in the vena cava:

When the tumor progresses locally, a thrombus with a tumor component may appear in the renal vein, or even in the vena cava. In these cases, nephrectomy and excision (removal) of the entire tumor thrombus are necessary, sometimes requiring the collaboration of cardiac surgeons.

Cytoreductive nephrectomy combined with systemic therapies:

This procedure is performed in cases of metastatic kidney cancer, meaning when kidney cancer has spread to other organs or lymph nodes. In metastatic disease, the kidney tumor is called the primary tumor, and secondary tumors in other organs are called metastases. When this occurs, a cytoreductive nephrectomy is performed with the aim of curing the patient or prolonging their survival, combining surgery with systemic therapies (immunotherapy, anti-angiogenic drugs). It involves removing as much of the tumor as possible to increase the chances of success with immunotherapy and other targeted therapies. This removal also allows for the elimination of surrounding tissue that may contain cancer cells.

Systemic therapies:

Chemotherapy has limited use in treating kidney cancer. However, immunotherapy and drugs that stimulate the immune system help attack cancer cells and significantly improve survival rates. Immunotherapy can cause side effects, depending on the medication, which usually disappear after treatment ends: fatigue, upset stomach, fever, chills, and skin rashes.

Once any of these treatments is completed, it is important to attend regular check-ups to monitor progress through diagnostic tests.