Kidney cancer arises when kidney cells start to grow at an unusually fast rate and become masses known as tumors. The choice of treatment for kidney cancer depends on the extent to which the disease has spread, the aggressiveness of the tumor, and the patient’s lifestyle considerations.Surgical procedures for kidney cancer include:
- Partial or radical nephrectomy; and
- Laparoscopic nephrectomy.
Treatments for cancer when it has spread include:
- Immunotherapy;
- Chemotherapy, and
- Radiation therapy.
WHEN IS IT INDICATED?
Nephrectomy is the mainstay of kidney cancer therapy for most cancer stages. Immunotherapy, chemotherapy, and radiation therapy are indicated when cancer has spread beyond the kidneys.
PRE-TREATMENT GUIDELINES
Surgery: The patient is instructed to stop taking aspirin 1 week prior to the procedure and to avoid eating or drinking anything after midnight the night before.
Immunotherapy: Because researchers believe that interferron alpha-2a, one of the two medications used in immunotherapy, may increase the risk of depression, the patient will be asked about any history of depression.
WHAT TO EXPECT
Radical nephrectomy: The surgeon removes the kidney and the surrounding tissue, often including the adrenal gland through an open incision. Radical nephrectomy may be combined with removal of nearby lymph nodes to ensure that cancer has not spread outside of the kidney region.
Following the procedure, the patient may remain in the hospital for 5 to 7 days; recuperation may take 6 weeks.
Partial nephrectomy: A partial nephrectomy removes the tumor or tumors and a small amount of surrounding healthy kidney tissue.
The patient will remain in the hospital for up to 7 days and require 6 weeks of recuperation time.
Laparoscopic nephrectomy: The physician first inserts a tiny camera (laparoscope) through a small incision to view the kidney. Guided by this camera, the physician maneuvers other instruments to the tumor through additional small incisions. The physician then removes the kidney through another, slightly larger, incision.
The patient remains in the hospital for 3 days; recuperation takes about 2 to 4 weeks.
Immunotherapy: Patients receive high doses of immunotherapy drugs in the hospital because they may experience severe side effects, such as chills, fever, nausea, vomiting, and loss of appetite. Low-dose regimens are given in an outpatient setting.
Chemotherapy: Chemotherapy drugs destroy cancer cells or damage them in a way that will prevent them from multiplying and are injected or given in pill form.
Radiation therapy: Radiation therapy, the use of high-energy rays to prevent cancer cells from multiplying, is only occasionally used with kidney cancer patients whose health is too poor to undergo surgery.
POST-TREATMENT GUIDELINES
Tests to check for cancer recurrence include:
- Ultrasound;
- Computed tomography (CT) scan;
- Magnetic resonance imaging (MRI);
- Bone scans; and
- Blood tests.
POSSIBLE COMPLICATIONS
Radical nephrectomy: Complications from a radical nephrectomy occur in 20 percent of patients and include:
- Injury to gastrointestinal organs;
- Injury to major blood vessels;
- Injury to the membrane surrounding the lung;
- Lung collapse;
- Bleeding from inside the abdomen;
- Kidney failure; and
- Hernia.
Partial nephrectomy: Complications from a partial nephrectomy include:
- Excessive bleeding;
- Urinary fistula; and
- Decreased kidney function.
Laparoscopic nephrectomy: If there are difficulties performing the procedure, the physician may have to resort to a standard nephrectomy (radical or partial) during the procedure. Other complications include:
- Infection;
- Excessive bleeding; and
- Injury to an organ or to the surrounding tissue.
Immunotherapy: Side effects from immunotherapy include:
- Fatigue;
- Allergic reactions;
- Loss of appetite;
- Nausea and vomiting;
- Fever;
- Chills;
- Muscle aches;
- Blood pressure changes;
- Depression; and
- Skin irritation, swelling, or redness at the injection site.
Chemotherapy: Side effects of chemotherapy include:
- Nausea and vomiting;
- Appetite loss;
- Hair loss;
- Mouth sores;
- Risk of infection; and
- Fatigue.
Radiation therapy: Side effects following radiation therapy include:
- Skin irritation;
- Fatigue; and
- Reduced blood counts.
