Kidney Cancer Treatment

Kidney cancer originates in the kidneys, two bean-shaped excretory organs located on either side of the spine, just below the ribcage. The kidneys are responsible for filtering waste from the blood and producing urine. For reasons not well understood, kidney cells sometimes undergo harmful changes that cause them to grow uncontrollably. The excess cells then bind together and form tumors, leading to kidney cancer. The most common type is renal cell carcinoma, which accounts for the majority of kidney cancer cases in adults.

Early-stage kidney cancer often has no noticeable symptoms. However, as the tumor progresses, it may begin to cause pain, usually on one side of the lower back, which may be accompanied by blood in the urine or a lump that can be felt in the abdomen. Although the exact cause of kidney cancer is not always identifiable, certain factors may increase the risk, including smoking, obesity, high blood pressure, certain inherited genetic conditions and prolonged exposure to harmful substances, such as asbestos or cadmium. The condition is most frequently diagnosed in adults older than 50 and affects more men than women. The reason is unknown.

Typically, kidney cancer is diagnosed through a combination of imaging studies and lab tests. To check for abnormal growths in the kidneys, the physician may order an ultrasound, magnetic resonance imaging (MRI) or computed tomography (CT) scan. The diagnostic process may also include blood and urine testing to help the physician assess kidney function and identify cancer markers. If a tumor is found, the physician will likely order a biopsy, which involves taking a small sample of suspicious tissue for microscopic examination by a pathologist, who can detect cancerous cells.

Once a kidney cancer diagnosis is confirmed, the next step is to develop a treatment plan. Options may include:

Surgery for kidney cancer

Surgery is often the cornerstone of kidney cancer treatment, particularly when the tumor is confined to the kidneys and the area immediately surrounding them. The goal is to remove the cancerous tissues while preserving as much kidney function as possible. The specific surgical approach can vary depending on several factors, including the location, size and stage of the tumor, whether one or both kidneys are affected and the patient’s overall health.

What does surgery for kidney cancer involve?

Typically, kidney cancer surgery involves one of two procedures:

• Partial nephrectomy – The surgeon will remove the tumor and a slim margin of surrounding healthy tissue, preserving the rest of the kidney. This option may be appropriate if the tumor is small and localized.
• Radical nephrectomy – The surgeon will remove the entire kidney along with some nearby structures, which may include the adrenal gland and some surrounding lymph nodes or fatty tissues.

Both partial and radical nephrectomy can be performed using traditional open surgical techniques or minimally invasive surgical techniques, such as laparoscopy or robot-assisted surgery.

What are the potential benefits of surgery for kidney cancer?

For early-stage kidney cancer, surgical removal of the tumor often offers the best opportunity for a cure. In many cases, this approach can eliminate the cancer, lower the risk of recurrence and support long-term survival. If the tumor has spread beyond the kidney but remains resectable, surgery may help relieve the symptoms and enhance the patient’s quality of life. When a partial nephrectomy is possible, preserving kidney function is a key advantage, especially for a patient at increased risk for kidney disease.

What are the risks and possible complications of surgery for kidney cancer?

As with any major surgical procedure, kidney cancer surgery carries some risks. Possible complications include:

• Bleeding
• Blood clots
• Hernia
• Infection
• Injury to surrounding organs

Though rare, the patient may also experience a decline in kidney function, especially if one kidney is removed and the remaining kidney is not functioning optimally.

What is the recovery process like?

Recovery from kidney cancer surgery can vary depending on the surgical techniques used and the patient’s general health. The post-operative hospital stay can range from a few days to a week or longer. In general, minimally invasive kidney cancer surgery is often associated with a faster recovery, less pain and smaller incisions compared to traditional open kidney cancer surgery.

For several weeks after kidney cancer surgery, the patient will be advised to avoid heavy lifting and other strenuous physical activities. Follow-up appointments and imaging tests will be important to assess kidney function and monitor for recurrence. With proper care and support, most patients can gradually return to their normal daily activities.

Radiation therapy for kidney cancer

Radiation therapy uses high-energy beams to target and destroy cancerous cells with a high level of precision. Although kidney cancer is generally less sensitive to radiation treatment than some other cancers, such as leukemia, lymphoma and cervical cancer, it may be used in certain cases to manage symptoms or shrink an inoperable tumor. There are two main types of radiation therapy for kidney cancer: external beam radiation therapy (EBRT) and internal radiation therapy (brachytherapy). Each has distinct uses, benefits and considerations depending on the stage and location of the tumor.

External beam radiation therapy for kidney cancer

EBRT for kidney cancer involves the use of a linear accelerator (LINAC), a special machine located outside the patient’s body. The LINAC generates powerful radiation beams focused directly on the tumor.

Before external beam radiation therapy begins, the patient will participate in a planning session (simulation), which will involve imaging scans to help the physician precisely map the targeted area and develop a personalized treatment plan. Radiation therapy is typically administered in daily sessions, five days per week, over several weeks. During each session, the patient will lie on a special table while the linear accelerator rotates around their body, delivering radiation beams to the tumor with pinpoint accuracy.

What are the potential benefits of external beam radiation therapy for kidney cancer?

In select cases, EBRT may be used before surgery to shrink the tumor and make it easier to remove, or after surgery to target any remaining microscopic cancer cells and help prevent recurrence. Advanced radiation delivery techniques, such as intensity-modulated radiation therapy (IMRT) and stereotactic body radiation therapy (SBRT), allow for highly precise targeting, minimizing any exposure to the surrounding healthy tissues.

EBRT can also be used to relieve kidney cancer symptoms, such as bone pain or bleeding, which may develop if the tumor has spread beyond the kidneys. Additionally, it may be a supportive option for a patient who is not a candidate for surgery or other treatments.

What are the possible side effects of external beam radiation therapy for kidney cancer?

Common side effects of EBRT for kidney cancer include:

• Diarrhea
• Fatigue
• Nausea
• Skin irritation in the treated area
• Urinary discomfort

Usually, these effects are temporary and resolve once the treatment ends, although some—such as fatigue—may persist for a short time afterward. Though rare, some patients may experience more serious side effects depending on the radiation field, such as changes in kidney or liver function.

What is the recovery process like?

Recovery from EBRT for kidney cancer is generally gradual. While receiving treatment, many patients can continue their daily activities with some adjustments for fatigue. Follow-up appointments will be scheduled to assess the response to therapy and monitor for late-onset side effects. Proper hydration, rest and nutrition can support recovery and help manage any discomfort.

Internal radiation therapy for kidney cancer

Brachytherapy involves the surgical placement of a small radioactive source directly inside or near a cancerous tumor. The procedure is typically performed in a hospital setting and may require anesthesia or sedation. Although it is less commonly used for kidney cancer than EBRT, internal radiation therapy may be considered in select clinical scenarios or as part of a clinical trial. This treatment technique allows for the precise delivery of a high dose of radiation directly to the tumor while sparing nearby organs and tissues.

What are the potential benefits of internal radiation therapy for kidney cancer?

Brachytherapy is a localized kidney cancer treatment that can minimize any damage to the surrounding structures. It may be a feasible alternative to nephrectomy for a patient who has a difficult-to-access tumor or cannot tolerate surgery. Internal radiation therapy can also be used to enhance the effectiveness of other treatments or manage certain metastatic lesions.

What are the possible side effects of internal radiation therapy for kidney cancer?

The side effects of brachytherapy for kidney cancer can vary depending on the location of the tumor and other factors. Some patients may experience:

• Localized pain and swelling
• Mild bleeding at the site of insertion
• Infection or damage to nearby structures (rare)

Because internal radiation therapy is confined to a small area of the body, systemic side effects are uncommon.

What is the recovery process like?

Brachytherapy for kidney cancer may involve a short hospital stay followed by a brief recovery period at home. Most patients can resume their normal activities within a few days. Follow-up care, including imaging scans and lab tests, will be scheduled to monitor the treatment response and ensure the absence of complications. The healthcare team will offer detailed post-procedure instructions, including any temporary precautions related to radiation exposure.

Chemotherapy for kidney cancer

Chemotherapy is a systemic cancer treatment that uses powerful medications to destroy rapidly dividing cells throughout the body. While it is a mainstay of treatment for many types of cancer, it is generally less effective for most forms of kidney cancer, particularly clear cell renal cell carcinoma. However, chemo may be used in specific clinical scenarios, especially those involving rare kidney cancer subtypes, such as transitional cell carcinoma (also known as urothelial carcinoma of the renal pelvis) or collecting duct carcinoma (CDC). Chemotherapy may also be considered when other treatment options, such as targeted therapy and immunotherapy, are not appropriate or have been exhausted.

What does chemotherapy for kidney cancer involve?

Chemotherapy for kidney cancer typically involves a combination of cancer-fighting drugs, which may be administered either intravenously (through an IV line) or orally. Treatment is given in cycles, with each cycle consisting of a period of active treatment followed by a period of rest to allow the body time to recover. The length and number of cycles can vary depending on the specific drugs used, the patient’s response to treatment and their overall health.

A medical oncologist will oversee the treatment and monitor the patient for side effects. Chemotherapy can be used alone or in combination with other therapies. In some cases, it is administered after surgery to help reduce the risk of cancer recurrence.

What are the potential benefits of chemotherapy for kidney cancer?

While chemotherapy is not usually a first-line treatment for kidney cancer, it may be beneficial for:

• Targeting cancer cells that have spread to other parts of the body (metastatic kidney cancer)
• Shrinking a tumor before surgery (in select cases)
• Treating non-clear cell subtypes of kidney cancer that tend to be more responsive to chemo
• Relieving symptoms caused by advanced kidney cancer

For a patient with limited treatment options, chemotherapy may offer a way to slow the progression of the tumor, potentially leading to a better quality of life.

What are the possible side effects of chemotherapy for kidney cancer?

Because chemotherapy affects all rapidly dividing cells—including healthy cells in the bone marrow, digestive tract and hair follicles—it can cause a variety of side effects. These include:

• Anemia and easy bruising
• Diarrhea or constipation
• Fatigue
• Hair thinning or hair loss
• Increased risk of infection due to low white blood cell counts
• Mouth sores
• Nausea and vomiting
• Reduced appetite

While the severity of these side effects can vary depending on the specific drugs used and the individual characteristics of the patient, most can be effectively managed with supportive medications and lifestyle modifications during treatment.

What is the recovery process like?

Recovery from chemotherapy for kidney cancer can vary depending on the length and intensity of the treatment and the patient’s general health. Side effects typically diminish after chemo ends, but it may take several weeks or months for the body to fully recover. The patient will be encouraged to maintain a balanced diet, stay well hydrated and rest as needed. In some cases, additional therapies, such as physical rehabilitation, counseling or nutritional support, may be recommended to aid in the recovery process. Regular follow-up appointments will be necessary to monitor blood counts, assess the effectiveness of treatment and manage any lingering side effects.

While chemotherapy is not usually the primary treatment for kidney cancer, it may be an option for select patients with specific cancer subtypes. A medical oncologist can determine whether chemo is appropriate based on the characteristics of the tumor and the patient’s treatment goals.

Targeted therapy for kidney cancer

Targeted therapy is an innovative cancer treatment approach that focuses on the specific molecular pathways involved in tumor growth, survival and spread. For kidney cancer—particularly clear cell renal cell carcinoma—targeted therapy has significantly advanced the standard of care. These specialized medications are designed to interfere with the proteins or receptors that tumors rely on to grow new blood vessels or resist cell death. Unlike traditional chemotherapy, which affects all rapidly dividing cells throughout the body, targeted therapy is more selective, aiming to damage cancer cells while minimizing harm to healthy tissues.

What does targeted therapy for kidney cancer involve?

Targeted therapy for kidney cancer typically involves oral medications taken daily or as otherwise prescribed by a medical oncologist. Commonly used drugs include tyrosine kinase inhibitors (TKIs), such as sunitinib, axitinib or pazopanib, which can block the signals that promote cancer cell growth and blood vessel formation. Another class of drugs known as mTOR inhibitors, such as everolimus and temsirolimus, can disrupt cancer cell replication and survival mechanisms.

Targeted therapy can be used alone or in combination with other kidney cancer treatments, such as immunotherapy. The treatment plan will be precisely tailored to the patient based on the type and stage of the tumor, any previous treatments and other health factors.

What are the potential benefits of targeted therapy for kidney cancer?

Targeted therapy can be beneficial for a patient with advanced or metastatic kidney cancer in several ways:

• It can slow the growth of the tumor and reduce cancer spread to other parts of the body.
• It is typically administered as a daily oral medication, offering convenience and flexibility.
• In some cases, it can shrink the tumor enough to make surgery a viable option.
• It can improve the outcome and quality of life for a patient with limited treatment options.

For many patients, targeted therapy provides a way to manage kidney cancer as a chronic condition, often allowing for prolonged periods of tumor control.

What are the possible side effects of targeted therapy for kidney cancer?

Although targeted therapy is more selective in targeting cancer cells than chemotherapy, it may still cause side effects, such as:

• Diarrhea
• Fatigue
• High blood pressure
• Liver function changes
• Mouth sores
• Nausea or decreased appetite
• Skin rashes or hand-foot skin reactions, such as redness, swelling and pain

The severity of these side effects can vary based on the specific medication used and the patient’s response. During treatment, the patient will be encouraged to report any new or worsening symptoms to the healthcare team promptly. Regular monitoring and dose adjustments can help manage any discomfort.

What is the recovery process like?

Because targeted therapy is often administered over an extended period, the concept of “recovery” differs from that of surgery or chemotherapy. Many patients continue targeted therapy as long as it remains effective and the side effects are manageable. Periodic imaging scans and blood tests can be used to evaluate the treatment response and monitor for complications.

To cope with the chronic side effects of targeted therapy, the patient may need to make lifestyle changes, such as managing their blood pressure or modifying their diet. Ongoing communication with the healthcare team and regular follow-up visits will be essential for maintaining the best possible quality of life during treatment.

Targeted therapy plays an important role in the treatment of advanced kidney cancer. By focusing on the unique characteristics of cancer cells, it offers a highly precise and personalized approach to care.

Immunotherapy for kidney cancer

Immunotherapy is a promising and increasingly common treatment option for kidney cancer, particularly in cases where the tumor has advanced or metastasized. Unlike traditional treatments, such as surgery and chemotherapy, which directly target the cancerous cells, immunotherapy works by stimulating the body’s own immune system to recognize and attack the tumor. It can be used alone or in combination with other treatments, depending on the type and stage of the cancer, as well as the patient’s overall health.

What does immunotherapy for kidney cancer involve?

Immunotherapy for kidney cancer typically involves the administration of immune checkpoint inhibitors. These specialized drugs can “release the brakes” on the immune system, helping T-cells recognize and destroy cancer cells more effectively. Usually, immunotherapy is delivered via intravenous infusion at regular intervals, which may vary from every few weeks to monthly, depending on the specific treatment regimen.

Before beginning immunotherapy, the patient will undergo lab work and imaging to help the physician assess their baseline health and cancer status. During treatment, the patient will be monitored closely through periodic testing to evaluate the response and manage any side effects.

What immunotherapy drugs can be used for kidney cancer?

Several FDA-approved immunotherapy drugs can be used alone or in combination to treat kidney cancer. Options may include:

• Ipilimumab (Yervoy) – This CTLA-4 inhibitor can be paired with nivolumab for enhanced immune system activation.
• Nivolumab (Opdivo) – This PD-1 inhibitor may be used as monotherapy or in combination with ipilimumab.
• Pembrolizumab (Keytruda) – This PD-1 inhibitor is often used in combination with targeted therapies.

These immunotherapy agents are often used for advanced renal cell carcinoma. The treatment regimen is highly personalized based on the characteristics of the tumor and the patient’s response to any prior therapies.

What are the potential benefits of immunotherapy for kidney cancer?

Immunotherapy can potentially improve the outcome and quality of life for a kidney cancer patient in several ways:

• It can help the immune system mount a sustained response against the tumor, potentially leading to long-term remission.
• When used in combination with other treatments, it can enhance the overall therapeutic effect.
• Some patients experience a durable treatment response, even after immunotherapy has ended.
• It can be a valuable treatment option when surgery and chemotherapy are ineffective or inappropriate.

What are the possible side effects of immunotherapy for kidney cancer?

Because immunotherapy stimulates the immune system, it can sometimes cause it to erroneously attack healthy tissues. Possible side effects include:

• Coughing and shortness of breath
• Diarrhea and inflammation of the colon (colitis)
• Fatigue and weakness
• Inflammation of the lungs (pneumonitis), liver (hepatitis) or thyroid (thyroiditis)
• Joint or muscle pain
• Skin rash or itching

These immune-related side effects can range from mild to severe and are typically managed with corticosteroids or other immunosuppressive medications. Prompt reporting of any new or worsening symptoms is crucial to prevent complications.

What is the recovery process like?

The recovery process during and after immunotherapy varies by individual. Some patients tolerate the treatment well with minimal side effects, while others may require ongoing management of immune-related side effects. Regular monitoring is essential to track the response and detect complications early.

Although immunotherapy does not require recovery in the traditional sense, the patient may experience fluctuating energy levels and may need time to adapt to their new treatment routine. Supportive care, such as nutrition counseling, stress management and physical therapy, can aid in maintaining overall well-being during treatment.

Immunotherapy has transformed the treatment landscape for kidney cancer, offering a powerful tool that harnesses the body’s natural defenses. It is now a fundamental part of care for many patients with advanced renal cell carcinoma.

Benefit from world-class care at Moffitt Cancer Center

Moffitt’s renowned Urologic Oncology Program is firmly positioned on the leading edge of kidney cancer research and treatment. Through our robust portfolio of clinical trials, our patients have unique opportunities to benefit from promising new therapies that are not yet available in other settings. For these reasons and many others, the National Cancer Institute (NCI) has designated Moffitt a Comprehensive Cancer Center.

If you would like to learn more about kidney cancer treatment, you can request an appointment with a specialist in the Urologic Oncology Program at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.

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