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Memorial Sloan-Kettering takes a multidisciplinary team approach to providing the best possible diagnosis, treatment, and palliative care for patients with kidney cancer. Our team of doctors and other specialists, known as the Genitourinary Disease Management Team, includes:
- urologists and urologic surgeons
- medical oncologists, who treat cancer with chemotherapy and novel biologic therapy
- radiation oncologists, who use radiation therapy to shrink tumors
- diagnostic radiologists, who use imaging to diagnose diseases
- interventional radiologists, who deliver nonsurgical, minimally invasive therapies
- pathologists, who identify diseases by studying cells and tissues under a microscope
- nurses
- psychiatrists
- social workers
- complementary medicine specialists
- nutritionists
The members of our kidney cancer team are experts in the diagnosis and management of both localized and advanced kidney tumors, offering the most current and advanced forms of therapy.
Not all masses in the kidney are malignant (cancerous) tumors. As many as 30 percent of kidney tumors are benign (noncancerous). Often, our doctors may repeat radiological imaging using specialized imaging techniques aimed at the kidney alone, to diagnose a benign mass, thereby avoiding the need for a biopsy or surgery.
Researchers have found that kidney tumors have varying degrees of aggressiveness. Our pathologists are experts in examining kidney cells to determine whether cancer is present, and, if so, the specific type of cancer. In fact, they have been leaders in establishing the modern classification of these tumors. From many years of correlating the various types of kidney cancer with specific treatment outcomes, we are now better able to select the most appropriate therapy for each patient.
Surgical Decision-Making
Renal Cell Carcinoma Nomogram Our nomogram helps physicians and patients decide which treatment approaches will result in the greatest benefit
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If an operation is necessary, our team of specialists will evaluate the patient and, based on tumor size and location, recommend either the removal of the tumor (partial nephrectomy) or removal of the entire kidney (radical nephrectomy). In 2009, Memorial Sloan-Kettering surgeons performed 97 radical nephrectomies and 280 partial nephrectomies. Numerous studies have shown that, when possible, partial nephrectomy is preferable to radical nephrectomy because partial removal allows for preservation of kidney function with rates of cure similar to those achieved with removal of the entire kidney.1
Our team has the capacity to perform kidney operations using either standard open surgical approaches or minimally invasive techniques, depending on the individual patient and his or her disease. Minimally invasive surgery, also known as laparoscopic surgery, is done through small incisions in the abdominal wall using a camera that transmits images to a video monitor. The procedure can, in some cases, reduce postsurgery recovery time, and surgeons at Memorial Sloan-Kettering have expertise in the latest laparoscopic and robotic approaches for kidney cancer. The removal of certain, more advanced kidney tumors that have invaded adjacent organs or major vascular structures (arteries, veins, and smaller vessels), or that have begun to spread to the lungs, may require the assistance of Memorial Sloan-Kettering's general, vascular, or thoracic (chest) surgeons.
Because our team includes experts in all aspects of the surgical approach to kidney cancer, we can offer our patients a balanced perspective in helping them to make decisions about treatment. Memorial Sloan-Kettering surgeons have been instrumental in pioneering research in kidney-sparing surgery, and we make every effort to preserve as much of the healthy kidney as possible.2 3 Our team has extensive experience in these technically demanding surgeries, using both open and laparoscopic approaches.
New Ablation Techniques
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 offer a treatment alternative that is well tolerated, making ablation a good alternative in nonsurgical patients.
New Approaches to Systemic Therapy
Our Publications Visit PubMed for listing of journal articles from our kidney cancer experts
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For kidney tumors that may have spread, or metastasized, outside the kidney, our surgeons consult with medical oncologists to determine if systemic (whole-body) treatment, such as chemotherapy, is required before or after surgical removal of the kidney.
Recent evidence suggests that even patients with metastatic kidney cancer can benefit from surgical removal of the primary tumor before starting systemic therapy.4 Together with Memorial Sloan-Kettering surgeons, our medical oncologists can help determine the best treatment approach for each individual patient.
For patients who need systemic therapy, Memorial Sloan-Kettering investigators have established an active program of clinical trials designed to explore novel treatment approaches. Kidney cancer does not, in general, respond well to traditional chemotherapy drugs. Until recently, treatment relied upon interleukin-2 (IL-2) and interferon, drugs that boost the immune system while helping it to recognize and attack kidney cancer cells. Improved understanding of how kidney cancer develops has led to recent advances in what are called targeted therapies. As a result, treatment options have improved dramatically over the last few years as new inhibitors and antibodies that block factors important to kidney cancer growth have shown excellent responses and/or prolonged survival compared to interferon and IL-2.
Sidney Kimmel Center for Prostate & Urologic Cancers Our state-of-the-art
outpatient
facility offers
comprehensive care
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Since 2005, five therapies have been approved by the US Food and Drug Administration (FDA) for the treatment of advanced kidney cancer: sorafenib (Nexavar®, FDA approved in December 2005), sunitinib (Sutent®, FDA approved in January 2006), temsirolimus (Torisel™, FDA approved in May 2007), everolimus (Afinitor®, FDA approved in March 2009), and the combination of interferon with bevacizumab (Avastin®, FDA approved July 2009). Our clinical investigation program includes strategies to improve upon the responses of kidney cancer to these new drugs, to determine in what order to use them, and to study new agents. Our experience has led to the development of a prediction tool that can help patients determine their individual prognosis and help guide treatment selection.
For kidney tumors that have spread widely to other parts of the body, our medical oncologists have access to the latest treatments available and pursue an active program of clinical research. Among the approaches under evaluation are new antibodies that directly target kidney cancer cells and new drugs that block other kidney cancer growth factors.
Radiation Therapy
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 as an outpatient procedure. Because the radiation is precisely focused, 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.
1Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV, Scardino PT, Russo P. Chronic Kidney Disease After Nephrectomy in Patients with Renal Cortical Tumours: a Retrospective Cohort Study. Lancet Oncology. 2006 Sep;7(9):735-40. [PubMed Abstract]
2Russo P. Renal Cell Carcinoma: Presentation, Staging, and Surgical Treatment. Semin Oncol. 2000 Apr;27(2):160-76. [PubMed Abstract]
3Russo P. Partial nephrectomy achieves local tumor control and prevents chronic kidney disease. Expert Rev Anticancer Ther. 2006 Dec;6(12):1745-51. [PubMed Abstract]
4Flanigan RC, Mickisch G, Sylvester R, Tangen C, Van Poppel H, Crawford ED. Cytoreductive nephrectomy in patients with metastatic renal cancer: a combined analysis.J Urol. 2004 Mar;171(3):1071-6. [PubMed Abstract]
Last Updated: Feb. 3, 2010
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