Treatment of Renal Cell Carcinoma
Following the diagnosis of cancerous kidney cells, a number of different treatments of renal cell carcinoma may be administered depending on the size of the tumor and degree of metastasis. Determining the renal carcinoma stage is extremely effective in creating a treatment plan. Often times, two or more treatments will be used in combination to ensure a better outcome. It is sometimes impossible to eradicate all cancerous cells in late-stage or distant metastatic kidney cancer; in these unfortunate instances, treatments of renal cell carcinoma are used in a palliative capacity to ease pain and prolong the patient’s life.
In the early stages, surgical removal of the tumor is the most common and effective treatment of renal cell carcinoma. Three types of surgery are performed for the removal of a renal cancer tumor – simple nephrectomy, partial nephrectomy and radical nephrectomy. A simple nephrectomy is performed when the tumor is extremely small and localized; only the kidney is removed in this surgery. A partial nephrectomy involves the excision of the kidney and some of the surrounding tissue. This surgery is performed when the other kidney is damaged or has previously been removed to ensure the patient retains some renal functioning. The kidney, surrounding tissues, adrenal glands and usually the nearby lymph nodes are removed when performing a radical nephrectomy.
When surgery is not possible due to individual medical reasons, arterial embolization is used as a treatment of renal cell carcinoma. The process of arterial embolization involves purposely introducing foreign elements (emboli) into the arteries to block the flow of blood. A catheter inserted into a blood vessel in the kidney injects pieces of gelatin sponge. The sponge prevents blood from flowing into the kidney, thus robbing the tumor of its essential oxygen supply. In most cases, arterial embolization will effectively shrink the renal carcinoma tumor or prevent it from growing. Percutaneous therapy is another alternative if surgery is not an option. Percutaneous (through the skin) therapy involves no cutting; instead, image-guided needles are used to destroy the tumor with heat or cold. This treatment of renal cell carcinoma is not used often because it is difficult to confirm if the tumor has been completely destroyed.
Adjuvant therapies are used after surgery to increase the chances of finding an effective treatment of renal cell carcinoma. The adjuvant therapies target the remaining cancer cells to ensure they are not lingering in other areas of the body. These additional treatments can prove to be extremely beneficial, but they can also produce a number of inconvenient side effects. The five main adjuvant therapies are chemotherapy, hormone therapy, radiation therapy, immunotherapy and targeted therapy.
Chemotherapy is the use of multiple medications used in combination to kill cancer cells. Medication can be injected or taken in pill form, generally for a period of four to six months. The drugs impair cell division and work most effectively on fast-dividing cells. Chemotherapeutic drugs can be unpredictable and cause many unwanted side effects. Scientists have not learned how to target specific cells; therefore, chemotherapy medications affect all fast-dividing cells. Hair loss, dry or discolored skin and nails, ulcers of the mouth and digestive tract problems are all side effects of chemotherapy. Another downfall of chemotherapeutic drugs is their inability to affect late-stage tumors. As tumors grow they begin to develop a solid core of unmoving cells. Because these drugs work on unstable cells, they prove to be ineffective at reaching the static center and therefore a poor treatment of renal cell carcinoma.
Hormone therapy works by either reducing the body’s natural hormone production or blocking the cancer’s ability to accept hormones. This therapy can be effective because some cancers need hormones to grow and reproduce; if the body ceases to produce certain hormones or if the cancer cannot get at those hormones, then it will be prevented from growing any larger.
Radiation therapy can be used as a cure or a palliative treatment of renal cell carcinoma. Radiation therapy uses high-energy x-rays to damage the DNA of cancerous cells. The painless procedure utilizes radiation beams aimed at the tumor from several different angles. The DNA damage is inherited through subsequent cell division and either kills the cancerous cells or causes them to reproduce more slowly. Much like chemotherapy, radiation therapy has its limitations as a late-stage treatment of renal cell carcinoma. As tumors age and solidify the oxygen supply decreases. Radiation therapy needs a steady oxygen supply to make DNA damage permanent; thus, this procedure is most effective in as an early-stage treatment of renal cell carcinoma.
Immunotherapy, also called biological therapy, stimulates the immune system to reject or destroy renal carcinoma tumors. There are two types of immunotherapy: active and passive. Active immunotherapy is performed by stimulating one’s own immune system to fight off the disease. Alternatively, passive immunotherapy relies on a man-made component to encourage an immune response. Again, immunotherapy is most effective as an early-stage treatment of renal cell carcinoma. Often it is used in combination with surgery and medication to reduce renal cell cancer symptoms.
Targeted therapies are one of the newest developments in cancer treatment. These therapies use medications to interfere with the growth of cancer cells by interfering on a much smaller scale. The targeted therapy medications attack specific molecules instead of the entire cancer cell. These therapies may be more effective at stopping cancer cell growth without harming healthy cells, which causes fewer side effects than most other adjuvant treatments of renal cell carcinoma. Anti-angiogentic agents are a form of targeted therapy that block the formation of blood vessels in a tumor. The tumor needs a constant supply of oxygen-rich blood to thrive, without which the tumor will starve and either stop growing or shrink significantly.
Currently, stem cell (immature blood cell) transplants are being tested in medical settings. Stem cells are removed from the blood or bone marrow of a healthy patient and given to a cancer patient through an infusion process. The stem cells will then grow and restore the blood cells in the body of the patient with renal cell cancer. There are many ethical and political questions associated with stem cell transplants at this time; therefore, the treatment is currently confined to the walls of a science laboratory.
The treatments of renal cell carcinoma based on the four stages are:
- Renal Carcinoma Stage I: surgery radiation therapy for those that cannot have surgery arterial embolization
- Renal Carcinoma Stage II:
- surgery (partial, radical)
- surgery + radiation
- radiation as a palliative therapy
- arterial embolization
- Renal Carcinoma Stage III:
- radical surgery
- arterial embolization + radical surgery
- radiation as a palliative therapy
- arterial embolization as a palliative therapy
- surgery as a palliative therapy
- surgery + radiation
- immunotherapy
- Renal Carcinoma Stage IV:
- targeted therapy
- immunotherapy
- targeted therapy + immunotherapy
- surgery + immunotherapy
- arterial embolization as a palliative therapy
- surgery as a palliative therapy