Treatment

Your doctor can describe treatment choices, discuss the expected results and will work together with you to develop a treatment plan that fits your needs.

Your treatment will depend on your age, overall health and how advanced the cancer is and may include surgery, radiation, chemotherapy or biologic therapy which boosts your body’s own ability to fight cancer.

Recent advances in diagnosis, surgical procedures and treatment options will allow even more patients to live with this disease, continuing to maintain their normal schedules and lifestyles. This marks the beginning of an important new era for kidney cancer patients, with the recent approval of new drugs to treat their advanced disease. These drugs target cancer cells in different ways than current drugs used to treat kidney cancer, and will have a very positive impact for many patients. Continued research efforts will improve our understanding of the disease even more and increase the options available to fight kidney cancer.

CHOICE OF TREATMENT – BECOME AN EXPERT PATIENT

Getting smarter about kidney cancer is an important step in effectively fighting your disease. Become an ‘expert patient’, ask questions, research the web and learn more about your disease and the details of treatment options available. This will help you better communicate with your doctor and nurse and increase your confidence in the treatment that you receive.

Some patients are diagnosed before the cancer has metastasized (spread) to other parts of the body, while others have metastatic disease when their cancer is initially diagnosed.

You may want to ask your doctor these questions before treatment begins:

  • What is the stage of the disease? Has the cancer spread? If so, where?
  • What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
  • What are the expected benefits of each kind of treatment? Will it cure or control the disease?
  • What are the risks and possible side effects of each treatment? Will I be given anything to control side effects?
  • How long will treatment last?
  • Will I have to stay in the hospital?
  • What is the treatment likely to cost?
  • How will treatment affect my normal activities?

Other questions you may want to ask before having surgery, if it has been recommended:

  • What are the risks of surgery if recommended? Will I have any long-term effects? Will I need dialysis?
  • Should I store some of my own blood in case I need a transfusion?
  • How will I feel after the operation?
  • How long will I need to stay in the hospital?
  • When can I get back to my normal activities?

METHODS OF TREATMENT

All treatment has benefits and side effects, which need to be discussed with your doctor.

Surgery is usually the first course of treatment
Surgical resection remains the only known effective treatment for localized renal cell carcinoma and it also is used for palliation in metastatic disease. If surgery is done first, additional treatment may be recommended to delay the cancer’s return, or to treat metastatic disease.

Surgery that either removes parts of the kidney, or the entire kidney is called nephrectomy. A laparoscopic nephrectomy, also known as keyhole surgery, can be performed in patients that developed small tumours confined to the kidney, which results in a shorter hospital stay and quicker recovery with less post operative pain than the standard open surgical approach.

If you lose one kidney your remaining kidney gets bigger and heavier. It works harder and provides up to 75% of normal kidney function rather than the expected 50%. So if one kidney is damaged or diseased, the other kidney is usually able to take up the extra work. Many people are able to live quite normally with just one functioning kidney.

TREATMENT FOR ADVANCED KIDNEY CANCER

In people with advanced kidney cancer, surgery does not usually cure the cancer, but it may allow you to have fewer symptoms. For people with advanced or metastatic renal cell carcinoma, treatment with a medicine may be recommended instead of, or as well as, surgery. Medical treatment may also be recommended if your cancer recurs after surgery.

The commonly used medical treatments for advanced kidney cancer are:

Targeted therapies is a treatment approach designed to slow the growth of tumour cells are called “targeted” because they work by interfering with a step in the cancer’s growth process. Targeted therapies cannot cure the cancer, but they may allow you to live longer and have fewer symptoms. This includes antiangiogenic therapies which uses drugs to reduce the blood supply to the tumour, slowing or stopping it’s growth.

Biological therapy or Immunotherapy uses substances that are naturally produced within the body, such as interferon and interleukin, to encourage the immune system to fight disease. Immunotherapy is not a standard treatment in Australia for kidney cancer, but is available in some centres.

Radiation therapy uses high-energy radiation to kill cancer cells, is not used to treat primary renal cell carcinoma. However, it is sometimes used if the cancer has spread into the bone, particularly for treatment of pain and prevention of broken bones.

Palliative care for cancer patients involves easing the symptoms and slowing the cancer’s spread to preserve quality of life and to live as independently and comfortably as possible. For kidney cancer patients, biological therapy, in combination with pain medication, seems to be the most promising avenue of palliative care. It can also involve the management of other physical and emotional symptoms. Treatment may include radiotherapy, chemotherapy or other medication.

CONSIDERING COMPLEMENTARY AND ALTERNATIVE MEDICINE

Complementary therapies include many different healing approaches people may use to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease. It is often known as ‘complementary’ treatment when used in addition to treatments prescribed by your doctor. Complementary therapies have not been scientifically proven to increase the likelihood of cancer shrinking, or improving patient survival. Research has shown more than half of all people with a history of cancer, use one or more of these approaches.

Some common methods include imagery or relaxation techniques, acupressure and massage, homeopathy, vitamins or herbal products, special diets, psychotherapy, prayer, yoga, and acupuncture. If you are thinking about using any of these methods either during or following cancer treatment, discuss it with your doctor or nurse first. Some complementary and alternative therapies (methods used instead of prescribed treatment) may interfere or be harmful when used with medicines normally prescribed by a doctor.

WHAT ABOUT A CLINICAL TRIAL – IS THIS RIGHT FOR ME?

A clinical trial is a scientific study, or an organised test of medicines and new treatment options involving patient and non-patient human volunteers. Clinical trials confirm whether medicines are safe and effective to introduce as new treatments for a particular disease or condition.

Clinical trials are a vital part of the search to find better treatments for cancer, to test new or modified treatments and see if they are better than existing treatments. Many people all over the world have taken part in clinical trials that have resulted in improvements to cancer treatment.

If you have just found out that you have cancer, the time to think about joining a trial is before you have any treatment. Ask your oncologist who can help you decide if a clinical trial is right for you. The decision to take part in a clinical trial is entirely yours alone to make.

Researchers conducting these trials are hoping to find improved cancer treatments for people with newly diagnosed disease. Other treatment trials are looking for people who have already been treated for their cancer. If you have already had one or more forms of cancer treatment and are looking for a new treatment option, there are still clinical trials for you to think about.

If your doctor has suggested you take part in a clinical trial, make sure that you fully understand the reasons for the trial and what it means for you. Before making a final decision, you may want to ask these questions:

  • How quickly do you need to make a treatment decision?
  • What treatments are being tested in the trial and why?
  • What tests are involved?
  • What are the possible risks or side effects?
  • How long will the trial last?
  • Will I need to go into hospital for treatment?
  • What will I do if any problems occur while I am in the trial?

If you decide to join a randomised clinical trial, you will be given either the best existing treatment or a promising new treatment. You will be allocated at random to receive one treatment or the other. In clinical trials, people’s health and progress are carefully monitored.

Some Australian websites which offer information on Clinical Trials being conducted here are:

Australian New Zealand Clinical Trials Registry (ANZCTR) www.anzctr.org.au
Australian & New Zealand Urogenital and Prostate (ANZUP) Trials Group www.anzup.org.au
ANZUP’s mission is to conduct clinical trial research to improve treatment of bladder, kidney, testicular and prostate cancers

YOUR TREATMENT TEAM

Allied health staff: depending on the needs of the individual patient, health care professionals such as dietitians, social workers, psychologists, physiotherapists and occupational therapists may contribute to the care of patients with kidney cancer.

Dietitian: can recommend the best diet to follow while you are in treatment or in recovery, help you choose appropriate food and nutritional supplements, resolve any digestive disturbances, such as poor appetite, nausea or constipation. Your dietitian can assess and help you manage any eating and swallowing problems, help you to gain or lose weight with healthy eating. Patients need to eat well during cancer therapy and need enough calories to maintain a good weight and protein to keep up strength. Good nutrition often helps people with cancer feel better and have more energy.

General Practitioner or family doctor: will continue to see you for day-to-day health care issues if you are being cared for at home, liaise with your nurse and/or specialist about the coordination of your ongoing care and can make home visits. Your GP can refer you back to the palliative care specialist or organise your admission to hospital or a hospice if your circumstances have changed and can assist your family and carers with grief issues.

Nephrologist: a physician who specialises in diseases of the kidneys.

Nurses: play a large role in providing care, support, and administering treatment, particularly while inpatient (hospital) care is required. Some nurses specialise in oncology (cancer) and are experts in managing side effects of therapy and the disease itself.

Oncologist: specialist cancer doctor who coordinates the care for individuals with kidney cancer. The oncologist will make decisions regarding immunotherapy, molecularly targeted therapy, and chemotherapy.

Palliative Care specialists: doctors and nurses who may become involved if the cancer is not curable. This team specialises in providing care that aims to treat symptoms and improve quality of life, rather than cure the disease itself.

Radiation oncologist: may be involved in individuals for whom radiotherapy is thought to be an appropriate treatment. Specialist technicians are involved to deliver the radiotherapy.

Renal physician: a specialist kidney doctor may become involved in treatment if overall kidney function is significantly damaged, especially if the kidney cancer involves both kidneys, or the function of the remaining kidney is poor.

Surgeon: a general surgeon, possibly one who specialises in kidney surgery, will play a key role in the treatment of kidney cancer if surgery is thought to be appropriate.

Urologist: a surgeon who specialises in surgery of the genital-urinary system, including the kidneys, bladder and adrenal gland.
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Kidney Cancer Support Service – 1800 454 363or email kidneycancer@kidney.org.au if you have questions about kidney cancer

You may wish to refer to and download our summary Kidney Cancer Fact Sheet or other Kidney Health Education Resources

Updated 12 December 2013