Treatment

Kidney Cancer

Kidney cancer treatments

The treatment of renal cancer will depend on the stage of the cancer, the patient's age and other health problems he/she may have. Whenever technically and oncologically possible, an attempt will be made to remove only the tumor while preserving the kidney.

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

Treatment of localized tumors:

Partial nephrectomy or nephron-sparing surgery:

It is the recommended treatment in 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 to say, 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. This is the most appropriate treatment, whenever technically possible, in tumors smaller than 7cm, in patients with tumors in both kidneys or in patients with only one kidney. Surgery can be performed by open, laparoscopic or robotic approach, depending on the characteristics of the case.

Robotic surgery in the treatment of localized renal cancer by means of partial nephrectomy allows to approach tumors of any complexity through a minimally invasive technique of high precision and excellent oncologic result, adding a faster recovery, lower risk of bleeding, less postoperative pain and shorter hospital stay. At ROC Clinic we have the two robotic systems available in the market: Da Vinci and Hugo RAS.

Radical nephrectomy:

This is the recommended treatment in patients in whom partial surgery is not possible. It consists of the total removal of the affected kidney respecting the adrenal gland, unless this is infiltrated by the tumor. In cases where the lymph nodes have been found to be affected, lymphadenectomy (removal of the lymph nodes close to the kidney) will be performed. Radical nephrectomy can also be performed by open, laparoscopic or robotic approach, depending on the characteristics of each case.

Active surveillance:

Sometimes surgery may not be the best option for you. Both in very elderly patients, as well as in those who are in poor health or who have tumors smaller than 3-4 cm, close surveillance of the tumor can be performed.

During this active surveillance period, periodic visits with imaging tests will be scheduled. To determine if active surveillance is an option and to properly refine the 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 that the disease is progressing, the urologist will immediately plan salvage treatment, primarily based on surgery.

Ablative therapies:

In people who are not suitable for surgery because it poses a significant risk, either because they are at a very advanced age or because they suffer from other diseases, kidney cancer can be treated by ablation. This procedure applies energy to the tumor laparoscopically or percutaneously by means of radiofrequency or cryotherapy. It can also be performed in people with tumors smaller than 3 cm in certain locations.

Treatment of locally advanced or metastatic tumors:

Nephrectomy of renal tumor with cava thrombus:

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

Cytoreductive nephrectomy combined with systemic therapies:

It is performed in cases of metastatic renal tumor, that is, when the renal cancer spreads to other organs or lymph nodes. In metastatic disease, the renal tumor is called the primary tumor and secondary tumors in other organs are called metastases. When this happens, a cytoreductive nephrectomy is performed with the intention of curing the patient or prolonging his survival, combining surgery with systemic therapies (immunotherapy, antiangiogenics). It consists of removing as much of the tumor as possible in order to increase the chances of success in immunotherapy treatments and other targeted drugs. This removal also makes it possible to eliminate surrounding tissue that may contain cancerous cells.

Systemic therapies:

Chemotherapy is of little use in the treatment of kidney tumor. However, immunotherapy and drugs aimed at activating the immune system help to attack the cancer cells and achieve great survival benefits. Immunotherapy can cause side effects, depending on the drug, which usually disappear at the end of treatment: tiredness, stomach upset, fever, chills and skin rashes.

Once any of these treatments have been completed, it is important to have periodic check-ups to follow up with diagnostic tests.