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Renal Cell Cancer
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of renal cell cancer.
Renal Cell Cancer
General Information About Renal Cell Cancer
Renal cell cancer is a disease in which malignant (cancer) cells form in
tubules of the kidney.
Renal cell cancer (also called kidney cancer or renal adenocarcinoma ) is a disease in which malignant (cancer) cells are found in the lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on each side of the backbone, above the waist. The tiny tubules in the kidneys filter and clean the blood , taking out waste products and making urine . The urine passes from each kidney into the bladder through a long tube called a ureter . The bladder stores the urine until it is passed from the body.
Cancer that starts in the ureters or the renal pelvis (the part of the kidney that collects urine and drains it to the ureters) is different from renal cell cancer. Refer to the PDQ summary on Transitional Cell Cancer of the Renal Pelvis and Ureter Treatment for more information).
Smoking and misuse of certain pain medicines can affect the risk of developing renal cell cancer.
Risk factors include the following:
Possible signs of renal cell cancer include blood in the urine and a lump in the abdomen.
These and other symptoms may be caused by renal cell cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages . Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:
- Blood in the urine .
- A lump in the abdomen .
- A pain in the side that doesn't go away.
- Loss of appetite.
- Weight loss for no known reason.
- Anemia .
Tests that examine the abdomen and kidneys are used to detect (find) and diagnose renal cell cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. A history of the patient’s health habits and past illnesses and treatments will also be taken.
- Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances released into the blood by organs and tissues in the body. An unusual (higher or lower than normal) amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Urinalysis : A test to check the color of urine and its contents, such as sugar, protein , red blood cells , and white blood cells .
- Liver function test : A procedure in which a sample of blood is checked to measure the amounts of enzymes released into it by the liver . An abnormal amount of an enzyme can be a sign that cancer has spread to the liver. Certain conditions that are not cancer may also increase liver enzyme levels.
- Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder to find out if cancer is present in these organs. A contrast dye is injected into a vein. As the contrast dye moves through the kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- Ultrasound exam: A procedure in which high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make echoes. The echoes form a picture of body tissues called a sonogram .
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. To do a biopsy for renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is withdrawn.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the disease.
- The patient's age and general health.
Stages of Renal Cell Cancer
After renal cell cancer has been diagnosed, tests are done to find out if cancer cells have spread within the kidney or to other parts of the body.
The process used to find out if cancer has spread within the kidney or to other
parts of the body is called staging . The information gathered from the
staging process determines the stage of the disease. It is important to know
the stage in order to plan treatment. The following tests and
procedures may be used in the staging process:
- CT scan (CAT
scan): A procedure that makes a series of detailed pictures of areas inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.
- MRI (magnetic
resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
- Chest x-ray : An x-ray of the organs and bones inside the chest. An x-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.
- Bone scan : A procedure to check if there are rapidly dividing cells , such as cancer cells, in the bone. A very small amount of radioactive material is injected into a vein and travels through the bloodstream. The radioactive material collects in the bones and is detected by a scanner .
The following stages are used for renal cell cancer:
Stage I
In stage I , the tumor is 7 centimeters or smaller and is found only in the kidney .
Stage II
In stage II , the tumor is larger than 7 centimeters and is found only in the kidney .
Stage III
In stage III , cancer is found:
- in the kidney and in 1 nearby lymph node ; or
- in an adrenal gland or in the layer of fatty tissue around the kidney, and may be found in 1 nearby lymph node; or
- in the main blood vessels of the kidney and may be found in 1 nearby lymph node.
Stage IV
In stage IV , cancer has spread:
- beyond the layer of fatty tissue around the kidney and may be found in 1 nearby lymph node ; or
- to 2 or more nearby lymph nodes; or
- to other organs , such as the bowel , pancreas , or lungs , and may be found in nearby lymph nodes.
Recurrent Renal Cell Cancer
Recurrent renal cell cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back many years after initial treatment, in the kidney or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with renal cell cancer.
Different types of treatments are available for patients with renal cell cancer . Some treatments are standard (the currently used treatment), and some are being tested in clinical trials . Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Five types of standard treatment are used:
Surgery
Surgery to remove part or all of the kidney is often used to treat renal cell cancer. The following types of surgery may be used:
- Partial nephrectomy : A surgical procedure to remove the cancer within the kidney and some of the tissue around it. A partial nephrectomy may be done to prevent loss of kidney function when the other kidney is damaged or has already been removed.
- Simple nephrectomy : A surgical procedure to remove the kidney only.
- Radical nephrectomy : A surgical procedure to remove the kidney, the adrenal gland , surrounding tissue, and, usually, nearby lymph nodes .
A person can live with part of 1 working kidney, but if both kidneys are removed or not working, the person will need dialysis (a procedure to clean the blood using a machine outside of the body) or a kidney transplant (replacement with a healthy donated kidney). A kidney transplant may be done when the disease is in the kidney only and a donated kidney can be found. If the patient has to wait for a donated kidney, other treatment is given as needed.
When surgery to remove the cancer is not possible, a treatment called arterial embolization may be used to shrink the tumor . A small incision is made and a catheter (thin tube) is inserted into the main blood vessel that flows to the kidney. Small pieces of a special gelatin sponge are injected through the catheter into the blood vessel. The sponges block the blood flow to the kidney and prevent the cancer cells from getting oxygen and other substances they need to grow.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given chemotherapy or radiation therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy .
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the spinal column , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.
Targeted therapy
Targeted therapy uses drugs or other substances that can find and attack specific cancer cells without harming normal cells. Antiangiogenic agents are a type of targeted therapy that may be used to treat advanced renal cell cancer. They keep blood vessels from forming in a tumor, causing the tumor to starve and stop growing or to shrink.
New types of treatment are being tested in clinical trials. These include the following:
Stem cell transplant
Stem cells (immature blood cells) are removed from the blood or bone marrow of a donor and given to the patient through an infusion . These reinfused stem cells grow into (and restore) the body's blood cells.
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Treatment Options for Renal Cell Cancer
Stage I Renal Cell Cancer
Treatment of stage I renal cell cancer may include the following:
Information about ongoing clinical trials is available from the NCI Web site.
Stage II Renal Cell Cancer
Treatment of stage II renal cell cancer may include the following:
Information about ongoing clinical trials is available from the NCI Web site.
Stage III Renal Cell Cancer
Treatment of stage III renal cell cancer may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Stage IV and Recurrent Renal Cell Cancer
Treatment of stage IV and recurrent renal cell cancer may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Changes to This Summary (01/11/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
For more information from the NCI, please write to this address:
- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
2004-02-202007-01-11
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