Kidney Cancer Treatment
From Kidney Cancer Resource
Contents |
Overview
This Page is something of an entry level page for facing the Challenges of Kidney Cancer, either as a patient, a friend, a carer or a family member, knowledge is power so understanding the Treatment options and probabilities is a must for most people.
The shock of diagnosis of Cancer tends to impair rational thought for a period when you need most to learn, research and diagnose facts!
When you pick yourself up off the floor you will, like most people, want to inform your family and bring them into the decision making process – the more people helping to learn and research the facts and with whom to discuss the possibilities the better.
Discussion
Never be self conscious about having a written list of Questions or asking for details. Never be embarrassed taking notes or recording conversations. Always take someone with you if you can or you want to.
Referral
Your General Practicioner will almost definitely refer you to a specialist unit most likely at your local regional hospital where you will see a Specialist Urologist with a specialist knowledge of kidneys and the urinary tract. He may refer you to a Specialist Oncologist whose specialty is cancer.
Second Opinions
A Kidney Cancer diagnosis is no small thing! You are perfectly entitled to be concerned and want a Second Opinion and no Doctor even a Consultant will in the least mind referring you for a Second Opinion. Realistically YOU are at this stage no judge of the competence of members of the medical profession and no Doctor worth his salt would be offended, should you request a Second Opinion. You may also find any Medical Insurance or Life Cover you have requires a Second Opinion.
Your Specialist can recommend you to one or more other Specialists.
In the UK
- Your Doctor’s surgery can also recommend as can Citizens Advice Bureau (CAB) or the Hospital’s own PAL structure.
- A phone call to The BMA will provide a list of all Consultants and Doctors with the relevant specialities.
You may wish to seek out the best Specialist in the field, in which case The Internet is a powerful tool.
Preparations For Treatment
Your age, general health and the stage of the disease will be the main determinants in how your disease is treated. It is the responsibility of your medical team to discuss treatments and alternatives with you explaining the effects and prognoses when you ask.
Before Your Treatment Starts You May Wish To Ask Your Medical Team:
1. What stage has the disease reached? Has the Primary Cancer spread out of the kidney? If so where have you found it or where do you expect to find it? Where next?
2. What are my choices of treatment? Do you envisage more than one type of treatment? Which treatment(s) do you recommend for me?
3. What benefits do you expect from the treatment you recommend? What are the risks of that treatment? Are we talking of the treatment curing the disease or merely controlling it?
4. What are the side effects of the treatment? Can the side effects be controlled? Does control of the side effects diminish the effects of the treatment? Does using this treatment preclude any options in the future?
5. How long and how often is the treatment required?
6. Do I have the treatment at home, at my Doctor’s or do I come into the hospital? Does treatment require hospitalisation at any stage?
7. Is the treatment covered by NHS in this Region or do I need to move to a more enlightened Region? What is the cost of the treatment if the NHS refuse the money in the belief that I am not cost effective?
8. Will the treatment affect my normal life? When can I expect to return to work?
9. When will we know if the treatment has worked? How often after the treatment will I need check-ups?
10. Am I suitable for a clinical trial of this drug or any new drug?
Many of these questions may not be appropriate for you but may act to jog your memory – Most would be unsuited for instance if the first course of action is a Nephrectomy to remove the diseased kidney!
Method Of Treatment
A diagnosis of Kidney Cancer may be dealt with by Surgery, Chemotherapy, Radiation Therapy, Biological Therapy, Arterial Embolization, Cryo Therapy. You and your medical team may decide to use only a single treatment or a combination of these treatments.
During Treatment
At any stage of development of Kidney Cancer before, during or after treatment there may be a need to consider control of pain or other symptoms including psychological assistance. These treatments are palliative, symptom management or supportive care respectively. The psychological side effects of a cancer diagnosis are as medically real as any other symptom or side effect and help can be obtained through your Doctors or via various charities who can help.
At any stage of treatment as a patient you have every right to be kept informed and ask questions. You may wish to halt and think your treatment schedule out again or investigate other treatments and the possibility of clinical drug trials.
Surgery
Surgery in one form or another is the most common course of action after a Kidney Cancer diagnosis and should be carried out as rapidly as possible to avoid additional risk of development. Your medical team will explain the surgical options and why they recommend the particular one for you. Kidney Removal is called a Nephrectomy and one could say they come in several sizes!
A Radical Nephrectomy: This is the most common operation and is normally removes the entire kidney, the Adrenal Gland and a Margin of tissue around the affected area. Additionally sometimes the Ureter is removed all the way to the Bladder. Also the surgeon may plan to remove some Lymph Nodes in the area or make that decision based on his physical investigation during the procedure.
A Simple Nephrectomy: This is where the surgeon removes only the kidney, this is only done for some patients with Stage 1 Kidney Cancer.
A Partial Nephrectomy: This operation is where the surgeon removes only a part of the kidney usually because the patient has only one kidney or where the patient has cancer affecting both kidneys. This operation is also sometimes done if the cancer is under ¾ inch and isolated.
Surgical Methods
Open Nephrectomy: This is when under full anaesthetic the surgical team make an incision right around your flank from almost your tummy button to the band of muscle supporting your spinal column. This requires cutting through three levels of muscle and upwards to liberate the kidney which is firmly positioned just inside the lower rib cage. Sometimes your surgeon may have to remove one or more of your ribs to access the kidney and ensure the removal of a Margin]].
Partial Laparoscopic Nephrectomy: This is when the surgeon believes that he can conduct the operation by Key Hole (Laparoscopy) techniques but wishes to remove the kidney whole through a supporting aperture. This aperture permits the insertion of either a hand or part of a hand and the kidney can be extracted ensuring no leakage of cancerous tissue.
Laparascopic Nephrectomy: This is when the surgeon considers that the cancer is so small as to be safely removed with a laparoscope. This normally requires upto 5 small incisions for the insertion of instruments. This operation is also used in the case of patients who are not fit enough to survive an open nephrectomy.
Before Your Operation You May Wish To Ask Your Medical Team:
1. Which operation do you recommend for me and by which method?
2. Why do you recommend this versus the alternatives?
3. What exactly do you intend to remove and why?
4. Do you believe that there is lymph node involvement? How do you arrive at this opinion?
5. What are the risks of this surgery and the possible chances?
6. How will I feel after the surgery? And for how long?
7. How long will I be likely to stay in hospital?
8. How long will it be before I can get back to normal & work?
9. Do you envisage additional treatment immediately or in the future?
10. What are the long term effects of this surgery I can expect?
For additional information on Surgery click here
Chemotherapy
Chemotherapy has proved of very poor efficacy in cases of Kidney Cancer. Chemotherapy is a form of systemic therapy where anti cancer drugs are introduced into the blood stream and travel throughout the body. There have however been great breakthroughs recently with a new generation of drugs including the newly proven Nexavar and Sutent, which have been shown beyond doubt to be effective in keeping Kidney Cancer under control for many patients.
Currently the British health service, due in the main to the break up of the NHS into EU Regional Organisations and poor management, is proving incompetent to supply these drugs with fatal consequences. The failure to supply these drugs when clinically advocated is a measure of the incompetence of management which shelters its ineptitude behind their own failure to make adequate provision for funding.
Before Your Chemotherapy You May Wish To Ask Your Medical Team:
1. How does this particular treatment work?
2. Why do you feel this treatment is appropriate for me?
3. What benefits do you expect me to gain from this treatment?
4. What side effects and risks are there of this treatment?
5. What can we do to mitigate the side effects & risks?
6. When will treatment start and how long will it continue?
7. Will I need to be in hospital at any stage and for how long?
8. What effect will the treatment have on my normal activities and for how long?
9. Does this treatment preclude any particular treatments in the future?
10. Is there a better drug available and could I get it via a trial?
For additional information on Chemotherapy click here
Radiation Therapy
Radiation Therapy which is often called Radio Therapy is a local therapy. A highly specialist piece of equipment is used to direct a high energy ray to kill or at least shrink cancer cells and tumours. The rays are very finely targeted and the dosage finely tuned. The normal treatment requires several weeks attending a hospital clinic at a specialist hospital for 5 days a week.
Sometimes this treatment is used before Surgery to shrink tumors. Sometimes the radiation is administered after Surgery to seek to kill any residual cancer cells.
Radiation is also sometimes used for those who are not suitable for surgery to seek to control the development of determined tumors and to assist in pain control.
Before Your Radiation Therapy You May Wish To Ask Your Medical Team:
1. How does this particular treatment work?
2. Why do you feel this treatment is appropriate for me?
3. What benefits do you expect me to gain from this treatment?
4. What side effects and risks are there of this treatment?
5. What can we do to mitigate the side effects & risks?
6. When will treatment start and how long will it continue?
7. Will I need to be in hospital at any stage and for how long?
8. What effect will the treatment have on my normal activities and for how long?
9. Does this treatment preclude any particular treatments in the future?
10. Is there a better treatment available and could I get it via a trial?
For additional information on Radiation Therapy click here
Biological Therapy
Biological Therapy functions in a similar way to Chemotherapy in that it is systemic. It uses chemicals that spread throughout the body through the blood stream.
The efficacy of such drugs has proved far from satisfactory in the case of Kidney Cancer. That said, in the case of metastatic Kidney Cancer such treatment may be the only treatment available.
The drugs of choice your specialist may advocate are likely to be Interferon Alpha or Interleukin-2 (often called: IL-2 or Aldesleukin). These chemicals are similar to those naturally produced in trace elements in the body to combat infections and some other diseases.
In the case of cancer these drugs, manufactured in a laboratory, are introduced into the body in large doses.
Before Your Biological Therapy You May Wish To Ask Your Medical Team:
1. How does this particular treatment work?
2. Why do you feel this treatment is appropriate for me?
3. What benefits do you expect me to gain from this treatment?
4. What side effects and risks are there of this treatment?
5. What can we do to mitigate the side effects & risks?
6. When will treatment start and how long will it continue?
7. Will I need to be in hospital at any stage and for how long?
8. What effect will the treatment have on my normal activities and for how long?
9. Does this treatment preclude any particular treatments in the future?
10. Is there a better treatment available and could I get it via a trial?
For additional information on Biological Therapy click here
Arterial Embolization
Arterial Embolization is a form of local therapy which shrinks Tumors. This treatment is a process of introducing a Catheter, usually at a blood vessel in the groin, and steering it to a position where your specialist can block the renal artery to prevent blood reaching the kidney. This is aimed at starving the tumor of a blood supply and the oxygen and nutrients that supply its growth.
This practice is carried out mainly in the elderly or those who can not sustain an operation.
This practice is also carried out in some instances before a nephrectomy to shrink a tumor to render it more operable.
Before Your Arterial Embolization You May Wish To Ask Your Medical Team:
1. How does this particular treatment work?
2. Why do you feel this treatment is appropriate for me?
3. What benefits do you expect me to gain from this treatment?
4. What side effects and risks are there of this treatment?
5. What can we do to mitigate the side effects & risks?
6. When will treatment start and how long will it continue?
7. Will I need to be in hospital at any stage and for how long?
8. What effect will the treatment have on my normal activities and for how long?
9. Does this treatment preclude any particular treatments in the future?
10. Is there a better treatment available and could I get it via a trial?
For additional information on Arterial Embolization click here
Cryo Therapy
Cryo Therapy is a relatively new therapy for the treatment of Kidney Cancer and involves introducing a needle into the tumor in the kidney and freezing it thus killing the cells in the Tumor.
It may prove necessary to laparoscopically enter the kidney at a later stage to remove the dead tissue.
Before Your Cryo Therapy You May Wish To Ask Your Medical Team:
1. How does this particular treatment work?
2. Why do you feel this treatment is appropriate for me?
3. What benefits do you expect me to gain from this treatment?
4. What side effects and risks are there of this treatment?
5. What can we do to mitigate the side effects & risks?
6. When will treatment start and how long will it continue?
7. Will I need to be in hospital at any stage and for how long?
8. What effect will the treatment have on my normal activities and for how long?
9. Does this treatment preclude any particular treatments in the future?
10. Is there a better treatment available and could I get it via a trial?
For additional information on Cryo Therapy click here
References
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Disclaimer
Kidney Cancer Resource (KCR) is not influenced by sponsors. The information contained herein is not intended as a substitute for the advice of an appropriately qualified and licensed physician or other licensed health care provider. The information provided here is for educational and information purposes only. Early accurate Diagnosis (Dx.) saves lives. Please check with a physician if you suspect you are ill, never ignore Symptoms. To help your health care specialist make an accurate Diagnosis please keep notes of dates, times and details of your Symptoms. We are not offering medical advice nor do we consider links, individuals or articles accessed through this site to be offering medical advice.
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