At Mount Sinai, we are often able to diagnose kidney cancer in the early stages, while tumors are still confined to the kidneys. For those with more advanced disease, we use another set of techniques. Once we know your diagnosis, we craft an individualized treatment plan for the individual and tumor characteristics.
Treatment for Early Disease
Here are some of our most common approaches to treating kidney cancer.
- Active surveillance is appropriate for selected patients with small early cancers that are growing slowly (indolent). We also use this approach for patients who are older or have other health problems that make them poor candidates for surgery. Active surveillance is different than “watchful waiting.” With active surveillance, we see you regularly to monitor and assess your condition.
- Partial nephrectomy is surgically removing cancerous kidney tissue while leaving the healthy kidney intact. We can perform a partial nephrectomy with a robotic, laparoscopic, or open procedure. Robotic procedures take less time, which means that the kidneys do not lack blood flow (called ischemic time) for very long. By avoiding extended lack of blood flow, we lessen the chances of kidney damage. In addition, robotic procedures generally involve less blood loss, shorter procedure time, and faster recovery. We have found that robotic surgery produces the lowest blood transfusion and infections rates while vastly increasing our ability to spare the healthy kidney. Partial nephrectomy is preferable, when possible.
- Radical nephrectomy is useful if your kidney tumor is large or located close to the main kidney artery or vein. In these cases, we may perform a radical nephrectomy to completely remove the cancerous kidney. Fortunately, if your other kidney is healthy, it shouldn’t affect your quality of life. We only do a radical nephrectomy if a partial nephrectomy is not safe or possible.
- Ablation is appropriate for patients who are too ill or fragile for a surgical procedure or those whose tumors are very small. Ablation involves destroying tumors cold or heat. These procedures are relatively quick, preserve healthy tissue, and do not involve a large incision if we perform them through the skin (percutaneously). Only limited data exists on the long-term effectiveness of the procedure, so we may perform active surveillance, possibly including periodic biopsies, after the procedure. We use two types of ablation, depending on your individual situation.
- Cryoablation is freezing the tumor using needles that we insert through small incisions. We have found that this works just as well as partial nephrectomy for small kidney cortical tumors. We have also found that using a standard needle core biopsy before laparoscopic cyroablation for small renal cortical tumors and for young patients with large tumors results in the most accurate tumor diagnosis.
- Radiofrequency ablation uses high-energy radio waves, delivered by a special catheter, to heat the tumor. The intense heat can kill the tumor and prevent release of chemicals that cause pain.
Treatment for Advanced Disease
For those diagnosed with either locally advanced kidney cancer (where the cancer has spread beyond the confines of the kidney) or metastatic disease (where cancer has traveled to other areas of the body), we have several types of treatment, which we individualize based on your specific situation.
- Targeted therapy uses a family of drugs that specifically block or attack specific molecular and genetic changes in cells that promote cancer cell growth. You take these drugs as a pill, so you do not require hospitalization or intravenous infusion. Most people tolerate this medication very well and it has become the most common approach for advanced kidney cancer. We try one drug at a time or use them in combination. These drugs include sorafenib (Nexavar®), sunitinib (Sutent®), temsirolimus (Torisel®), everolimus (Afinitor®), and bevacizumab (Avastin®).
- Immunotherapy is often more effective than traditional chemotherapy. With immunotherapy, we boost your body’s own immune system to fight cancer cells. We generally use Interleukin-2 (IL-2) for this purpose.
- Cytoreductive nephrectomy is a surgical procedure that can be part of the treatment program for advanced kidney cancer. We can perform this procedure robotically, which offers improved survival for selective patients with metastatic kidney cancer who are on either immunotherapy or targeted medications.
After surgery, we will want to see you for regular check-ups, generally every 6 to 12 months. We determine the frequency of follow-up based upon your diagnostic profile and the pathology of your tumor, among other factors. At these visits, we will conduct at least one imaging study. We use magneticresonance imagining, or renal ultrasound studies. You likely will not experience any symptoms post-surgery, so it is imperative that we regularly perform imaging studies.