Renal Cell Cancer (cont.)

Medical Author:

Kush Sachdeva, MD

Coauthor:

Brendan Curti, MD

Medical Editor:

Winston W Tan, MD

Medical Editor:

Mary L Windle, PharmD

Medical Editor:

Koyamangalath Krishnan, MD, FRCP

Surgery

Removal of the diseased kidney (nephrectomy) is the standard treatment of renal cell carcinoma. People can live normally with one kidney if that kidney is healthy. The 3 main types of nephrectomy are as follows:

• Partial nephrectomy: The tumor and part of the kidney around the tumor are removed. The partial nephrectomy is performed mainly in people who have problems with their other kidney. This treatment is being investigated by surgeons to determine if it is as effective as the standard procedures to remove the kidney, as described below.
  
  
• Simple nephrectomy: The cancerous kidney is removed.
  
  
• Radical nephrectomy: The cancerous kidney, adrenal gland, and surrounding tissue are removed.

Nephrectomy may be performed with a large incision or via laparoscopy. Laparoscopy is a technique that removes the kidney through a very small incision. Laparoscopy leaves a smaller scar and requires less time in the hospital. It is used for people with small kidney cancers.

Nephrectomy may cure the disease if it has not spread to other parts of the body. Sometimes people with metastatic disease undergo a nephrectomy to relieve symptoms such as bleeding, pain, high blood pressure, high levels of calcium in the blood. Nephrectomy alone cannot cure metastatic renal cell carcinoma, but recent studies suggest that selected patients who receive immunotherapy after a nephrectomy for metastatic disease have a longer survival rate than those who do not undergo nephrectomy. In some cases, a solitary metastatic tumor can be removed, increasing chances of remission.

Another procedure called arterial embolization (plugging up the artery) is sometimes used for people who cannot undergo surgery. Different methods have been used to embolize kidneys, including injection ofsmall pieces of a special gelatin sponge, plastic microspheres, ethanol, or chemotherapy. The injected agent can block the artery and prevent blood from getting through to the kidney and the tumor. The tumor cannot live without blood, and it dies.