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Treatments for advanced kidney cancer

Kidney cancer is called advanced if the cancer has spread away from the kidney to another part of the body. The area of cancer spread is called a secondary cancer or metastasis.

If you have advanced kidney cancer, the aim of your treatment is to try to slow down the growth of the cancer. It can also reduce or relieve any symptoms you have. The best treatment for you will depend on how much the cancer has spread, where it has spread to, the treatment you have already had, and how fit and well you are. The most commonly used treatments are biological therapies. Some people can have surgery to remove the cancer but they need to be well enough to recover from the operation.

Biological therapy

Some biological therapy drugs can control the growth of advanced kidney cancer for months or sometimes years. The most commonly used types are sunitinib (Sutent) and sorafenib (Nexavar).

Surgery

If your cancer has come back in the area close to the kidney, your doctor may suggest surgery to remove your kidney (palliative nephrectomy). If the cancer has spread to another part of the body they may also suggest removing the secondary cancer.

Other treatments

Other possible treatments for advanced kidney cancer include

  • Radiotherapy
  • Freezing therapy (called cryotherapy, cryosurgery or cryoablation)
  • Radio wave therapy (radiofrequency ablation)
  • Blocking the blood supply to the cancer in the kidney (arterial embolisation)

Chemotherapy or hormone therapy may be used but this is rare.


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What advanced kidney cancer means

Kidney cancer is called advanced if it has spread to another part of the body. It is also called a secondary cancer or metastasis. Your cancer may be advanced when you are first diagnosed. Or for some people it can come back or spread some time after surgery to remove the cancer. 

The cancer can spread into tissues or organs close to the affected kidney, such as the bowel. Or it can spread to the

Click on the links to find out more about secondary cancers.

Remember that not all kidney cancers spread – if you get aches and pains they may not be related to the cancer but may have another cause. Do check with your doctor about any symptom that is worrying you.

 

The main treatments

The most commonly used treatments for advanced kidney cancer are biological therapies. These are drugs that change the processes within cells and can stop or slow the growth of the cancer. They can sometimes shrink a cancer down. Biological therapies can control an advanced kidney cancer for months, or in some people sometimes for years. This can also help to reduce or get rid of any symptoms that you have.

In some parts of the body it is possible to have surgery to remove a secondary cancer. On this page there is information about surgery to remove cancer that has spread. This type of treatment won't be suitable for everyone. You need to be fit enough to make a good recovery. In some people the cancer comes back in the area of the kidney as well as in another part of the body. Surgery to remove the kidney to reduce symptoms is called palliative nephrectomy. Surgery to remove cancer that has spread to other parts of the body is called metastectomy.

Other treatments that can help to control symptoms include radiotherapy, cryotherapy, radio wave treatment, and arterial embolisation. Treatments that may be used in rare situations include hormone therapy and chemotherapy.

The treatment that is best for you depends on

  • How much your cancer has spread
  • Where the cancer has spread to in the body
  • The treatment you have already had

Your treatment will also depend on how fit and well you are. For treatments such as surgery you need to be in good general health to recover afterwards.

It is important to know that kidney cancer is unusual because it can sometimes stop growing or shrink temporarily, even with no treatment. Doctors call this spontaneous regression. So your doctor may advise no treatment for a while. But they will monitor you carefully with X-rays or scans because in most people the cancer will start to grow again after some time.

 

Deciding about treatment

With advanced cancer it is important to know whether the treatments will have side effects that may affect your quality of life. It is also important to know what will happen if you decide to have no treatment. Your doctor or specialist nurse can explain what can be achieved with the treatment you are offered and how the treatment may affect you. 

You may also want to talk things over with a close friend or family member. Or there may be a counsellor you can discuss your feelings with.

 

Biological therapy

Biological therapies are treatments made from natural substances from the body, or that block signals telling cells to grow. There are several different types of biological therapy used for advanced kidney cancer. Different treatments work for different patients. Your doctor will look at your general health to decide on the best treatment for you. These drugs can often stop or slow the growth of the cancer for months or sometimes years.

Sunitinib (Sutent) is the most commonly prescribed first treatment for advanced kidney cancer. Other commonly used drugs are sorafenib (Nexavar) and pazopanib (Votrient). They are drugs that block cancer growth signals in cells and are called tyrosine kinase inhibitors. You take them as tablets.

Other drugs you may have include bevacizumab (Avastin) as a drip (intravenously). You have this with another drug called interferon, which you have 3 times a week as an injection just under the skin. Your doctor may call interferon is a type of immunotherapy, because of the way it works.

If your treatment stops working your doctor may prescribe a second type of treatment (second line treatment). This may include one of the drugs above. Or your doctor may recommend that you have temsirolimus (Torisel) or everolimus (Afinitor). These drugs also block signals that tell cancer cells to grow. They are called mTOR blockers.

If your cancer has spread to your bones your doctor may suggest you have denosumab. Denosumab (pronounced den-oh-sue-mab) is a type of monoclonal antibody. When cancer spreads to the bones it can cause pain and weaken them. When the bones are weaker they break more easily. Denosumab works by helping to strengthen the bones which lowers the risk of fractures and helps to control pain. You have it as an injection just under your skin (subcutaneously).  There is more information about denosumab, including the possible side effects, in the cancer drugs section. 

There is detailed information about biological therapies for kidney cancer in this section.

Researchers are developing newer types of biological therapies and these are being tested in clinical trials. There is information about research into some new biological therapies in the kidney cancer research section. If you have advanced kidney cancer you might be offered one of these newer therapies as part of a clinical trial.

 

Surgery

If your cancer has come back in the area of your kidney and one other part of the body, such as the lungs or liver, your doctor may suggest surgery to remove either

  • Your kidney alone OR
  • Your kidney and the secondary cancer

Generally, this treatment will only be possible if you have only one secondary cancer (or a very small number). Even if it is only possible to remove your kidney, this is worth doing if you are well enough. If you are fit enough for the surgery, it may slow down the growth of the cancer and keep you in reasonable health for longer. 

If possible, your surgeon will remove the affected kidney and the secondary cancer in one operation. For example, this may be possible if the secondary is in the liver, close to the affected kidney. But in most cases, you will need to have 2 operations. Generally, the kidney will be removed first. Then, after you have recovered from that operation, you have scans, followed by surgery to remove the secondary cancer.

When deciding if this type of treatment is right for you, your doctor will take into account how healthy and fit you are. You will need to be in reasonable health to recover from a big operation. Depending on where your cancer has spread, your cancer specialist may refer you to a specialist surgeon to do your surgery. There is detailed information about surgery for secondary kidney cancer in this section.

 

Radiotherapy

Radiotherapy can be helpful in shrinking a growing cancer and controlling symptoms such as pain. If your cancer has spread to the brain, then your doctor may suggest having radiotherapy to the brain. There is detailed information about this treatment in the section about radiotherapy for kidney cancer.

 

Freezing (cryotherapy)

Cryotherapy is also called cryosurgery or cryoablation. It is a way of killing cancer cells by freezing them. The surgeon puts a cryotherapy probe into the area of cancer in the kidney. They can do this by keyhole surgery through the skin or by making a larger cut (incision in the skin). You have this treatment under local or general anaesthetic. It can shrink the cancer and help to control symptoms for some time.

You can find out about cryotherapy for kidney cancer in this section.

 

Radio wave treatment

Radiofrequency ablation (RFA) uses heat made by radio waves to kill cancer cells. Radiofrequency is a type of electrical energy. The electrical energy heats up the tumour and kills the cancer cells. The surgeon puts a probe through the skin and into the tumour in the kidney. Then an electrical current destroys the cancer cells.

You can read about radio wave treatment for kidney cancer in this section.

 

Blocking the tumour's blood supply

If the cancer is causing symptoms such as bleeding into the urine or pain, your doctor may suggest arterial embolisation. This is a procedure where the doctor injects a substance into the artery leading to the area of the cancer. The substance blocks the artery and cuts off the blood supply to the tumour, which makes it shrink. Doctors sometimes use this treatment for cancer that has spread outside the kidney (for example to the liver) as well as the cancer in the kidney.

Embolisation is explained in detail on the page about surgery for kidney cancer in this section. 

Embolisation can also be used before or during surgery to reduce the risk of bleeding during the operation. For example, it may be used before surgery for secondary cancer in the spinal bones.

 

Hormone therapy

In some people with advanced kidney cancer a hormone therapy called medroxyprogesterone (Provera) can shrink the cancer and control symptoms. But it is not commonly used now because the biological therapies tend to work better. It can also cause side effects such as 

  • Water retention
  • Weight gain
  • Indigestion
  • Sleeplessness
 

Chemotherapy

So far, chemotherapy has not been found to work very well in patients with kidney cancer. So it is not often used to treat it. Your doctor may offer you chemotherapy as part of a clinical trial of new drugs, or in combination with biological therapy.

You will need to discuss with your doctor which of these different treatments, or combinations of treatments is best for you. There is information about chemotherapy for kidney cancer in this section.

 

More information about kidney cancer treatments

If you would like more information about treatments for advanced kidney cancer you are welcome to contact the Cancer Research UK nurses. The number to call is freephone 0808 800 4040 and the lines are open from 9am to 5pm, Monday to Friday. 

You can also contact one of the kidney cancer organisations or look at our kidney cancer reading list

If you want to find people to share experiences with online, you could use Cancer Chat, our online forum.

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Updated: 13 January 2014