Treatment

Renal Cell Carcinoma Nomogram Our nomogram helps physicians and patients decide which treatment approaches will result in the greatest benefit more

Surgery is the most common form of treatment for kidney tumors, and it is often the only treatment necessary. Memorial Sloan-Kettering's urologic surgeons have expertise in all surgical approaches to kidney tumors, including kidney-sparing and laparoscopic and robotically assisted laparoscopic surgery.

If an operation is necessary, our team of specialists will evaluate the patient and, based on the size and location of the tumor, recommend either removal of the tumor (partial nephrectomy) or removal of the entire tumor-bearing kidney (complete, or radical, nephrectomy).

Partial Nephrectomy: Kidney-Sparing Surgery

Kidney-sparing (or nephron-sparing) surgery is the term used to describe the procedure in which a kidney tumor is removed, leaving a margin of normal kidney tissue in order to preserve the function of the remaining kidney. Studies conducted at Memorial Sloan-Kettering and other institutions have demonstrated that partial nephrectomy yields comparable results to complete nephrectomy in patients with small tumors (less than 4 centimeters), while maintaining functioning kidney tissue. Our surgeons are experienced in performing these technically demanding operations. In appropriate situations, our team can offer laparoscopic partial nephrectomy. In 2009, our surgeons performed 280 partial nephrectomy procedures, 80 of which were done laparoscopically.

Complete (Radical) Nephrectomy

In some situations, the entire kidney needs to be removed. Tumors that require complete nephrectomy tend to be larger in size and to have advanced locally, though sometimes they have spread to another part of the body. Our team can help determine whether patients with such tumors may be best served by laparoscopic or open nephrectomy. Because we are able to offer all possible modes of treatment, we can tailor the approach to each individual patient.

For transitional cell carcinoma of the kidneys and ureters, surgical approaches include removing the kidney and ureter (nephroureterectomy) and partially removing the ureter (segmental resection). These procedures can also be performed laparoscopically, including with robotic-assisted surgery using smaller incisions. When transitional cell carcinoma is found on the surface of the renal pelvis or ureter, it may be possible to spare the kidney with laser surgery, which uses a narrow beam of light to remove cancer cells from inside the kidney.

During the surgery, the doctor may remove nearby lymph nodes to examine them for cancer cells. Pathologists will examine the cells of the tumor to determine which type of cancer is present.

For patients with small tumors who may not be ideal surgical candidates, we offer image-guided ablation of kidney cancers. Instead of surgical incisions, small needles are placed through the skin and guided into the cancer using x-rays. These needles can then freeze (cryoablation) or boil (radiofrequency ablation, or RFA) the cancer and kill it with temperature changes. The body is then able to remove the dead tissue, leaving scar tissue behind in its place. These procedures are well tolerated, making ablation a good alternative in nonsurgical patients.

Thermal ablation can also be used to relieve painful symptoms if kidney cancer involves the bone. In these cases the freezing temperatures "anesthetize" the painful site.

Find a Clinical Trial Find out about new research studies for kidney cancer more

Conventional, or clear cell, renal cancer does not respond to traditional chemotherapy, but it does respond to immunotherapy or drugs referred to as targeted therapies (also known as signal transduction inhibitors). In contrast, transitional cell carcinoma is sensitive to chemotherapy, and chemotherapy is used to treat patients with advanced cancer of this type. More information on treating transitional cell carcinoma can be found on our Web site in the section on bladder cancer.

Targeted therapies take advantage of recent information about how conventional clear cell kidney cancer develops. For clear cell kidney cancer, clinical studies have compared several targeted therapies (sunitinib, temsirolimus, sorafenib, and the combination of bevacizumab plus interferon) with interferon and have shown that these treatments are as good as or better than interferon alone. For non-clear cell subtypes, less is known about the effectiveness of such therapies. For patients whose tumor has grown while on a targeted therapy, less is known about how best to treat the tumor. Results of a clinical study have shown that everolimus slows tumor growth after sunitinib or sorafenib have stopped working.

For kidney tumors that have spread widely to other parts of the body, Memorial Sloan-Kettering's medical oncologists have access to the latest systemic therapies available. Two older drugs that stimulate the immune system -- interleukin 2 (IL-2) and interferon -- have shown promise in treating some renal cancers. Antibodies that target molecules on the outside of kidney cancer cells are also being studied.

Investigational approaches are sometimes offered to eligible patients through the clinical trial process.

Sidney Kimmel Center for Prostate & Urologic Cancers Our state-of-the-art outpatient facility offers comprehensive care more

Radiation therapy is sometimes given as primary treatment for patients who are not well enough to undergo surgery. Image-guided radiation therapy (IGRT) has been used very successfully at Memorial Sloan-Kettering Cancer Center to treat kidney cancers that have metastasized. IGRT employs high-precision radiation beams to kill cancer cells and has been used in many parts of the body, including the brain, spine, lung, and liver. IGRT is not an invasive treatment, and almost always can be given on an outpatient basis. Because the radiation is very focused and given with high precision, side effects are usually mild. The radiation dose with IGRT is very concentrated, which is the best way to kill most kidney cancer cells. It can also be given in a limited number of treatments (usually between one and five daily treatments), and in coordination with chemotherapy or between cycles of chemotherapy.