Kidney cancer - symptoms and treatment

The tactics of treating a patient with RP can be chosen only after the diagnosis is established and the stage of tumor development is determined. In this case, the doctor must take into account the age of the patient, his general condition, the prevalence of metastases. Renal cell carcinoma can be treated with surgery, chemotherapy, immune therapy, radiation and Hormone therapy.

Surgical method

Laparoscopic and robotic surgical methods are available. The choice of one of them depends on the volume of the tumor. There are two types of surgery: organ-removing and organ-preserving.

In 1961, Charles Robson formulated the idea of using radical nephrectomy in the treatment of kidney cancer. This method consisted in the removal of the kidney and the surrounding tissue without going beyond the fascia of Gerota, while the adrenal gland (adrenalectomy) and regional lymph nodes (extended lymphadenectomy) are also removed through the thoracoabdominal access.

Is surgery always necessary for kidney cancer

Surgery is still the only way to get rid of renal cell carcinoma. 134

However, it should be borne in mind that radical nephrectomy is no longer the optimal treatment for small renal neoplasms, and extended lymphadenectomy has ceased to be used in cases of removal of a kidney affected by cancer (in accordance with the latest recommendations of the EAU - European Association of Urology). Therefore, to date, nephrectomy is not considered the "gold standard" treatment of RP.4 Removal of the adrenal glands during nephrectomy is not necessary, since according to statistics, a tumor in the adrenal gland occurs quite rarely (in 19% of cases) and is mostly benign. And metastases in the adrenal gland occur only in 1.5% of patients with RP. Today, it is possible to preserve the adrenal gland, focusing on the results of multislice CT and intraoperative revision.4

According to the same EAU recommendations, laparoscopic nephrectomy is indicated for stage T2 kidney cancer and small intrarenal neoplasms, when organ-sparing surgery is not feasible.6 Extended nephrectomy is advisable to perform in tumor thrombosis.

It should be noted that the category of T1 kidney tumor is quite heterogeneous, as among these tumors there are 20% of benign tumors, 20% of aggressive forms of cancer and 60% of tumors of low malignant potential. Therefore, modern oncourology offers a wide range of minimally invasive surgical interventions:6

• temperature exposure (radiofrequency ablation, cryodestruction);
• laparoscopic and robotic surgery (resection);
• active observation and search techniques (laser, focused ultrasound - HIFU).

Depending on the extent of the tumor, the following methods of treatment for kidney cancer are used:

• surgical (if the tumor does not extend beyond the kidney);
• surgical method + adjuvant (prophylactic) therapy (if the tumor affects surrounding organs and vessels);
• symptomatic , surgical method, chemotherapy, hormone therapy, cytokine immunotherapy and targeted therapy (for metastasis).

Immune therapy

Immunotherapeutic drugs are capable of destroying cancer cells:

• cytokines (interleukin-2, interferon alpha);
• immune checkpoint inhibitors (nivolumab, pembrolizumab, etc.).

Cytokines are substances similar to natural immune system activating proteins. Such a drug in this group as interleukin-2 (IL-2) is often used in the treatment of kidney cancer. It stimulates growth and activates T-lymphocytes (immune cells), which contribute to the destruction of cancer cells. But this drug has serious side effects. Interferon alfa-2a is considered to be a more effective cytokine. In this case, the combined use of this and the above drug will help to achieve the maximum effect of the treatment. The use of immune checkpoint inhibitors is well tolerated by the patient's body, with almost no side effects.6

Targeted drug therapy targets certain biological targets and factors that promote kidney tumor growth. The uniqueness of targeted drugs is in their targeted effect on the affected cells of the body and minimal impact on the general condition of the patient. They are the least toxic. In addition to the above, drugs such as angiogenesis inhibitors have been invented to help treat metastases in renal cell carcinoma. These include sunitinib, sorafenib, and others. They prevent the formation of new microvessels.

Chemotherapy

Chemotherapeutic drugs are not usually the first line of treatment for renal cell carcinoma, but they may be recommended if other treatment options are not adequate.This method is used before and after the operation. However, it should be recognized that none of these agents is sufficiently effective in the treatment of renal cell carcinoma.6

Radiation therapy

This method should be used to reduce the risk of recurrence of the local form of RP after surgery. Most often, radiation therapy for renal cell carcinoma is designed to improve the patient's quality of life. For example, it reduces pain symptoms in the event of bone metastases (in about 80% of cases). Radiation doses in this case can be as follows:

• 10 times 3 Gy for two weeks;
• 5 times 4 Gy for one week.

Hormonal therapy

Hormone therapy slows down the growth of tumor cells. For this, hormonal drugs such as medroxyprogesterone, tamoxifen are used.

Effective treatment of RP involves the use of several therapeutic methods. However, the most effective is surgical intervention.

Treatment of kidney cancer in children

The treatment of children with nephroblastoma is combined - it consists of surgery and chemotherapy. More often, chemotherapy is given first to shrink the tumor and make it more operable. Sometimes treatment begins immediately with surgery. The goal is to remove the tumor and possible metastases. As a rule, chemotherapy is continued (or started) after the operation.

The chances of curing a child from nephroblastoma are very high. The prognosis in children with nephroblastoma depends on the stage of the disease and the histological variant of the tumor.

The prognosis is unfavorable for tumor rupture and for high-risk tumors (stage IV) 10.