Methods of Treatment

Surgery is the most common treatment for kidney cancer. An operation to remove the kidney is called a nephrectomy. Most often, the surgeon removes the whole kidney along with the adrenal gland and the tissue around the kidney. Some lymph nodes in the area may also be removed. This procedure is called a radical nephrectomy. In some cases, the surgeon removes only the kidney (simple nephrectomy). The remaining kidney generally is able to perform the work of both kidneys. In another procedure, partial nephrectomy, the surgeon removes just the part of the kidney that contains the tumor.

Arterial embolization is sometimes used before an operation to make surgery easier. It also may be used to provide relief from pain or bleeding when removal of the tumor is not possible. Small pieces of a special gelatin sponge or other material are injected through a catheter to clog the main renal blood vessel. This procedure shrinks the tumor by depriving it of the oxygen-carrying blood and other substances it needs to grow.

These are some questions a patient may want to ask the doctor before surgery:

• What kind of operation will it be?
• Will further treatment be necessary? What kind?
• How will I feel after the operation?
• If I have pain, how will you help?
• When will I be able to resume my normal activities?

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Doctors sometimes use radiation therapy to relieve pain (palliative therapy) when kidney cancer has spread to the bone.

Radiation therapy for kidney cancer involves external radiation, which comes from radioactive material outside the body. A machine aims the rays at a specific area of the body. Most often, treatment is given on an outpatient basis in a hospital or clinic 5 days a week for several weeks. This schedule helps protect normal tissue by spreading out the total dose of radiation. The patient does not need to stay in the hospital for radiation therapy, and patients are not radioactive during or after treatment.

These are some questions a patient may want to ask the doctor before having radiation therapy:

• What is the goal of this treatment?
• When will the treatments begin? When will they end?
• How will I feel during therapy? What are the possible side effects?
• What can I do to take care of myself during therapy?
• How will I know if the radiation therapy is working?
• Will I be able to continue my normal activities during treatment?

Surgery and arterial embolization are local therapy; they affect cancer cells only in the treated area. Biological therapy, chemotherapy, and hormone therapy, explained below, are systemic treatments because they travel through the bloodstream and can reach cells throughout the body.

Biological therapy (also called immunotherapy) is a form of treatment that uses the body's natural ability (immune system) to fight cancer. Interleukin-2 and interferon are types of biological therapy used to treat advanced kidney cancer. Clinical trials continue to examine better ways to use biological therapy while reducing the side effects patients may experience. Many people having biological therapy stay in the hospital during treatment so that these side effects can be monitored.

These are some questions patients may want to ask the doctor before starting biological therapy:

• What is the goal of the treatment?
• What drugs will be used?
• Will the treatment cause side effects? If so, what can be done about them?
• Will I have to be in the hospital to receive treatment?
• When will I be able to resume my normal activities?

Chemotherapy is the use of drugs to kill cancer cells. Although useful in the treatment of many other cancers, chemotherapy has shown only limited effectiveness against kidney cancer. However, researchers continue to study new drugs and new drug combinations that may prove to be more useful.

Hormone therapy is used in a small number of patients with advanced kidney cancer. Some kidney cancers may be treated with hormones to try to control the growth of cancer cells. More often, it is used as palliative therapy.

These are some questions a patient may want to ask the doctor before having chemotherapy or hormone therapy:

• What is the goal of this treatment?
• What drugs will I be taking?
• Will I have side effects? What can I do about them?
• How long will I be on the treatment?

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