Kidney cancer - Treating kidney cancer

The treatment of kidney cancer depends on the size and spread of the cancer. Surgery is the most common first course of action, with the aim of removing the cancer cells.

Unlike most other cancers, chemotherapy isn't very effective in treating kidney cancer. However, there are non-surgical treatments available, such as radiotherapy or targeted drug therapies.

The main treatments for kidney cancer are covered in detail below and include:

Your treatment plan

You can expect to be cared for by a multidisciplinary team, often comprising a specialist cancer surgeon, an oncologist (who specialises in radiotherapy and chemotherapy), a radiologist, a nephrologist (a kidney specialist) and a specialist nurse.

You'll be given a key worker, usually the specialist nurse, who will be responsible for coordinating your care.

Your team will recommend what they think is the best treatment option, but the final decision will be yours.

When deciding what treatment is best for you, your doctors will consider:

the stage and grade of your cancer (how big it is and how far it's spread)
your age and general health

If the cancer hasn't spread out of your kidney (T1 or T2 kidney cancer), it can usually be cured by removing some or all of the kidney.

If the cancer has spread out of your kidney (T3 or T4 kidney cancer), a complete cure may not be possible. However, it should be possible to slow the cancer's progression and treat any symptoms.

Surgical treatments

Nephrectomy

A nephrectomy is an operation to remove a kidney.

If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health.

If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed.

Removing the kidney can help resolve the pain, and make other types of non-surgical treatment more effective.

It's possible to live a normal life with only one kidney, because the other kidney will be able to compensate.

During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure the cancer hasn't spread beyond the kidney.

There are two ways that both a partial and open nephrectomy can be performed They are an:

open nephrectomy – where the kidney is removed through a large incision in your abdomen (stomach)
laparoscopic or keyhole nephrectomy – where a series of smaller incisions are made in your abdomen, and the kidney is removed using small surgical instruments

Both techniques have advantages and disadvantages.

A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy.

However, the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if you decided to have an open nephrectomy.

Some types of kidney cancer, where the tumour is located in the centre of the kidney, may not be suitable for a laparoscopic nephrectomy.

One of the main disadvantages of an open nephrectomy is that it's a major surgical procedure that can place a considerable strain on the body. This means it may not be suitable for people who are particularly frail or unwell.

You should discuss the pros and cons of both procedures with your surgical team.

Want to know more?

NICE – Single-port laparoscopic nephrectomy (PDF, 57kb)
NICE – Laparoscopic partial nephrectomy (PDF, 74kb)
NICE – Laparoscopic nephrectomy (PDF, 75kb)

Embolisation

If you're unable to have a nephrectomy, you may benefit from an alternative operation known as embolisation.

During embolisation, the surgeon will insert a small tube called a catheter into your groin, then use X-ray images to guide the catheter into the blood supply of your kidney. A substance will then be injected through the catheter to block the blood supply to your kidney.

By blocking blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink.

Non-surgical treatments for advanced kidney cancer

Kidney cancer is one of the few types of cancer that's less responsive to chemotherapy (where powerful medication is used to kill cancerous cells).

However, a number of clinical trials are under way that are looking at new combinations of chemotherapy medications that appear to be benefiting some people.

Read more about kidney cancer clinical trials.

There are also a number of different non-surgical treatments that can slow the spread of the cancer and help control its symptoms.

Radiotherapy

Radiotherapy can't usually cure kidney cancer, but it can slow down its progress and help reduce pain. You should only need a few minutes of radiotherapy every day, for a number of days.

When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include fatigue (tiredness), nausea and vomiting

Cryotherapy

Cryotherapy involves killing cancer cells by freezing them. It may be used if a person isn't fit enough for surgery, or if their tumour is small.

Cryotherapy is usually classed as either percutaneous (where needles are passed through the skin) or laparoscopic (where needles are placed directly into the kidney through a small incision).

Side effects include bleeding around the kidney and injury to the tube that carries urine from the kidney to the bladder (the ureter).

Want to know more?

NICE – Percutaneous cryotherapy for renal cancer (PDF, 54kb)
NICE – Laparoscopic cryotherapy for renal cancer (PDF, 58kb)

Radiofrequency ablation

Radiofrequency ablation (RFA) uses heat generated by radio waves to kill cancer cells. This is a percutaneous treatment, meaning no incision is needed.

This treatment is only available at specialist centres. It's mainly used if you're not strong enough for surgery or your kidney cancer is in the early stages.

RFA can't be used if the cancer is too close to other organs, such as the bowel.

Side effects include bleeding in the treatment area, a collection of blood (haematoma) near the kidney, and problems passing urine due to the narrowing of the tube that joins the kidney to the bladder (the ureter).

Want to know more?

NICE – Percutaneous radiofrequency ablation for renal cancer (PDF, 58kb)

Targeted therapies

A number of new medicines have been developed for the treatment of kidney cancer. These are:

These medicines are sometimes referred to as "targeted therapies" because they're designed to target and interrupt the functions needed by cancer to grow and spread.

At present, only sunitinib, pazopanib and axitinib have been recommended by the National Institute for Health and Care Excellence (NICE). They're available on the NHS for people who are still relatively healthy and have advanced kidney cancer, or kidney cancer that's spread to other parts of their body.

Sorafenib, temsirolimus, everolimus and bevacizumab aren't currently recommended by NICE.

Sunitinib

Sunitinib is the most commonly prescribed treatment for kidney cancer. It’s a type of medication known as a tyrosine kinase inhibitor. Tyrosine kinase is an enzyme (protein) that helps cancer cells to grow. Sunitinib works by blocking protein kinase, stopping cancer from growing.

Sunitinib is taken as a capsule with or without food. You take it once a day for four weeks before having a two-week break. This six-week cycle is repeated for as long as the treatment is effective.

It’s very important that you take sunitinib in the exact dosage that’s been prescribed for you. Never stop taking medication for cancer without first consulting your specialist.

Common side effects of sunitinib include:

nausea
diarrhoea
high blood pressure (hypertension)
hair discolouration
mouth soreness
skin discolouration
skin rashes or blisters

The Cancer Research UK website has more information about sunitinib and its side effects.

Want to know more?

NICE – Sunitinib for the first-line treatment of advanced and/or metastatic renal cell carcinoma (PDF, 94kb)

Pazopanib

Like sunitinib, pazopanib is a tyrosine kinase inhibitor that can be used to slow down or stop the growth of cancer cells in the kidneys. It also prevents cancer cells developing blood vessels, which they need to grow.

Pazopanib is taken as a tablet once a day with a glass of water. You should take it about the same time each day, either at least an hour before eating or two hours afterwards. It’s important that you take it in the exact dosage that your specialist has prescribed for you.

Common side effects of pazopanib include:

nausea
diarrhoea
high blood pressure
hair discolouration
abnormal liver function

The Cancer Research UK website has more information about pazopanib and its side effects.

Want to know more?

NICE – Pazopanib for the first-line treatment of renal cell carcinoma (PDF, 61kb)

Axitinib

Axitinib may be recommended for treating advanced kidney cancer if sunitinib and/or pazopanib have stopped working or haven’t been effective.

Like sunitinib and pazopanib, axitinib is a tyrosine kinase inhibitor that blocks tyrosine kinase and stops cancer growing.

Axitinib is taken as a tablet with a glass of water twice a day, about 12 hours apart. Your specialist may start you on a low dose which, depending on how you feel, may be increased after two weeks. It’s very important that you take the exact dose that’s been prescribed for you.

Common side effects of axitinib include:

diarrhoea
nausea and vomiting
loss of appetite
tiredness
a decrease in thyroid hormone level (hypothyroidism)
headaches
weight loss
loss of fertility

The Cancer Research UK website has more information about axitinib and its side effects.

Sorafenib

Sorafenib is another tyrosine kinase inhibitor that blocks the protein, tyrosine kinase, which encourages cancer cells to grow. It also prevents cancer cells developing blood vessels which they need to grow.

Sorafenib is taken as tablet twice a day (at the same time each day) with a glass of water. It can also be taken with a meal, but make sure the food is low-fat, because high-fat foods make it less effective.

Again, it’s very important that you take sorafenib as instructed by your doctor at the exact dosage prescribed for you.

Common side effects of sorafenib include:

diarrhoea
fatigue
nausea and vomiting
hair thinning (in around one in four people)
increased risk of bleeding – such as nosebleeds or bleeding gums
loss of fertility
flushed skin

The Cancer Research UK website has more information about sorafenib and its side effects.

Temsirolimus

Temsirolimus is sometimes used to treat advanced kidney cancer. It’s a type of medication known as an mTOR inhibitor, which blocks a protein called mTOR, that’s usually active in cancer cells, making them reproduce and multiply. Temsirolimus also prevents blood vessels developing, which cancer cells need to grow.

Temsirolimus is a liquid that’s delivered directly into the bloodstream, either through a tube that’s put into a vein in your arm (catheter), or a tube into a large vein in your chest (a central line). The treatment takes 30-60 minutes and you have it once a week in hospital. Before each dose, an antihistamine is usually given to prevent an allergic reaction.

Common side effects of temsirolimus include:

red, dry, itchy skin
nausea and vomiting
lack of appetite
diarrhoea
a sore mouth or mouth ulcers
sleeping problems
loss of fertility

The Cancer Research UK website has more information about temsirolimus and its side effects.

Everolimus

Everolimus is a medication for advanced kidney cancer that’s returned during or following treatment. It stops some of the signals produced within cells that make them grow and divide. Everolimus prevents the mTOR protein working properly, which plays an important role in the growth of cancer cells.

Everolimus is taken as a tablet once a day at the same time each day. It should be swallowed whole with a glass of water, rather than being chewed or crushed. It can be taken with or without food. It’s very important that everolimus is taken using the exact dosage and method prescribed.

Common side effects of everolimus include:

a sore mouth
tiredness
a rash or itchy, dry skin
loss of appetite
nausea and vomiting
a lack of periods in women (this may be temporary)
loss of fertility

The Cancer Research UK website has more information about everolimus and its side effects.

Immunotherapy

As well as medications that prevent, disrupt and slow down the growth and development of kidney cancer (kinase and mTOR inhibitors), there are also treatments that work by encouraging the immune system to attack cancer cells. This type of treatment is known as immunotherapy.

Bevacizumab is a medication that’s given intravenously (into a vein, through a drip). It blocks a protein called endothelial growth factor (VEGF), which helps cancer to grow. Bevacizumab is usually used in combination with an immunotherapy treatment called interferon. Interferon is taken as an injection just under the skin (subcutaneously), three times a week. It encourages your immune system to attack and destroy the cancer cells.

Another medication called aldesleukin is sometimes used to treat kidney cancer that’s spread. It’s similar to a natural protein the body produces called interleukin-2 (IL-2), which is part of the immune system. IL-2 activates lymphocytes (a type of white blood cell), which fight illnesses and infections.

Aldesleukin works in a number of ways. It interferes with how cancer cells grow and multiply, it stimulates the immune system into attacking cancer cells, and it makes cancer cells send out chemicals that attract immune system cells. Like interferon, aldesleukin is usually given as a subcutaneous injection.

Immunotherapy treatments are now rarely used to treat advanced kidney cancer. This is because targeted therapies tend to be more effective in controlling the condition, and immunotherapy can sometimes cause serious side effects.

The Cancer Research UK website has more information about treatments for advanced kidney cancer. You can also read more about new treatments that are currently being developed and tested in clinical trials in their section about kidney cancer research (external link).