City of Hope's multidisciplinary kidney cancer team includes urologists, urologic surgeons, medical oncologists, nephrologists, palliative care specialists, case managers and more, working cooperatively to provide the most effective kidney cancer treatment protocol.
Depending on the size and location of the kidney mass and the patient’s overall health, the cancer can be treated with cryosurgery (freezing the tumor) or high frequency radio ablation (using heat to destroy the affected tissue). In many cases, the mass can be surgically removed.
Minimally Invasive Surgery
At City of Hope, our urologists specialize in minimally invasive procedures performed by laparoscopy. In fact, more than 95 percent of our surgeries are performed using these techniques. The procedures involve the use small keyhole incisions rather than the large incisions used in traditional open surgery. Laparoscopy results are comparable to open surgery, but the patient experiences less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of post-operative complications.
City of Hope urologists are also highly skilled in robotic-assisted surgery, using the most advanced da Vinci S Surgical System. A urologist directs and controls the movements of a specially designed robot equipped with a camera and miniature surgical tools. At the same time, a sophisticated computerized imaging system provides real-time, three-dimensional views of the surgical area, with better visualization than can be achieved with the urologist’s unaided eye alone.
Some patients with small transitional carcinomas of the kidney can be treated endoscopically, which is performed using thin, flexible instruments that are passed into the urinary tract. Our surgeons also use state-of-the-art imaging techniques during nephron-sparing surgery, including fluorescence using indocyanine green (ICG).
Although surgery is usually the standard treatment for most primary kidney cancers, some patients could benefit from a non-surgical, minimally invasive, kidney-sparing treatment option. This option is typically elected for patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function or only have one kidney.
Cryosurgery or Cryoablation
Kidney cancer can now be treated with a new, less invasive form of treatment that freezes and destroys small tumors without more extensive open surgery. Metal probes are placed into the tumor either through the skin under radiology guidance or through an incision in the abdomen. With the patient under general anesthesia, liquid nitrogen is circulated through the metal tips to destroy the tissue by freezing the lesion. Patients can usually be discharged from the hospital the same day or the following day. Although success with this procedure is good, the treatment is a new form of therapy and patients need to be actively followed for several years to assure there is no recurrence.
Radiofrequency ablation (RFA)
This procedure is another new minimally invasive form of treatment that uses a special probe to destroy cancer cells with electrical current. The destroyed tumor cells are not removed but are gradually replaced by fibrosis and scar tissue. The probe is usually inserted directly through the skin under radiology guidance while the patient is under general anesthesia. Although no long-term prospective randomized trials have been reported, early results are optimistic. Nevertheless, patients need to be actively followed to assure effectiveness.
One of the most exciting new developments in recent years is the introduction of drugs that interfere with the growth of cancer cells at a molecular level. By focusing on specific molecular growth pathways, these drugs prevent cell replication, or disrupt the blood flow supply to the cell. City of Hope’s kidney cancer experts play a leading role in the investigation of these exciting new therapies.
For malignant tumors to expand and metastasize, they must be able to form new blood vessels by a process called angiogenesis. Two recent FDA-approved medications, Sorafenib and Sunitinib, disrupt the angiogenesis process. Temisrolimus is another drug that disrupts the angiogenesis process but targets a different pathway than Sorafenib and Sunitinib. RAD001 is an investigational drug therapy that is effective for patients who do not respond to either of the other two therapies. At City of Hope, all of these drugs are used when appropriate.
An antibody is a protein produced by the body’s immune system that fights infections and foreign substances in the body. Monoclonal antibodies are genetically engineered antibodies designed to attach to particular sites on a tumor. Future clinical trials on monoclonal antibodies will offer more information about the potential benefit of investigational drugs, such as Bevacizumab, for kidney cancer.
Kidney cancers may respond to immune-based therapy, sometimes called biologic therapy, using the body’s own defense system to help destroy cancer cells. City of Hope is a national leader in immunotherapy, which is considered one of the standard treatment options for kidney cancer patients with advanced metastatic disease. The building blocks of immunotherapy are biologic response modifiers. These are substances that enhance the body’s immune system and improve its ability to fight cancer. A biologic response modifier can be either a man-made drug or a natural substance produced by the body, and include Interleukin-2 and Interferons.
Radiation therapy uses energy beams to destroy cancer cells. Although not considered a primary form of therapy for kidney cancer, radiation is used in situations where cancer has spread outside the kidney. At City of Hope, our radiation oncologists work with highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing the exposure of healthy tissues.
Several procedures may be useful in these cases:
Stereotactic radiosurgery -This treatment uses sophisticated three-dimensional computerized imaging to deliver a concentrated dose of radiation to the affected area while protecting the surrounding healthy tissue from exposure. Stereotactic radiosurgery is not “surgery” in the usual sense because there are no incisions, and anesthesia is not required.
Intensity-modulated radiation therapy (IMRT) - This procedure administers therapeutic X-rays to patients with great precision. High-energy X-ray machines linked with imaging systems deliver targeted radiation doses that are sculpted to the tumor’s exact shape by modulating the radiation beam intensity and aiming beams from many directions.
Helical TomoTherapy - This advanced radiation therapy system combines precision spiral CT scanning with IMRT, allowing doctors to match the highest dose of radiation to fit the exact shape of the tumor. The system provides effective treatment while reducing unwanted exposure to normal tissues, and reducing potential complications.
Chemotherapy is standard treatment for many tumors; however, kidney cancer is generally resistant to chemotherapy. Chemotherapy is typically used in combination with other therapies or reserved for patients entering clinical trials to test new agents and for patients who failed to respond to immunotherapy.