©
2013 City of Hope
1500 East Duarte Road
Duarte, CA 91010
626-256-HOPE (4673)
1500 East Duarte Road
Duarte, CA 91010
626-256-HOPE (4673)
A National Cancer Institute-designated Comprehensive Cancer Center
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Kidney Cancer
Kidney Cancer
Driven to provide patients with the best possible outcomes, City of Hope’s kidney cancer specialists bring together two powerful approaches – the latest Kidney Cancer surgery techniques and the most aggressive therapies – to aid in diagnosis and kidney cancer treatments.
Our extensive clinical trials program also provides kidney cancer patients the possibility of accessing investigational drugs and therapies not available elsewhere.
About Kidney Cancer
Patients are often referred to City of Hope following the discovery of a kidney mass, which may or may not be a malignant tumor (cancer). Some masses are benign (not cancerous). A careful diagnosis is needed to confirm the health problem and assess its extent.
City of Hope specializes in research designed to improve the care of patients with many kinds of cancer, including kidney cancer. Our services encompass all aspects of care, including prevention, early diagnosis and effective treatment.
In addition, through our active clinical trials program, we can often provide patients with access to promising new anticancer drugs and technologies that are not available to the general public.
There are several types of kidney (renal) cancer, including:
Doctors need to identify the specific sub-type of kidney cancer or cell type to decide the best treatment strategy. Generally, the success of cancer treatment depends on whether or not the malignancy can be completely removed through surgery.
There are several types of kidney (renal) cancer, including:
- Renal cell carcinoma (RCC), which accounts for 85 percent of malignant kidney tumors. The most common subtype is called clear cell RCC.
- Transitional cell carcinomas, which are cancers of the lining of the kidneys, urine collecting system and sometimes the bladder.
- Wilm’s tumor, which most commonly affects children.
Doctors need to identify the specific sub-type of kidney cancer or cell type to decide the best treatment strategy. Generally, the success of cancer treatment depends on whether or not the malignancy can be completely removed through surgery.
- Benign (noncancerous) kidney tumors include:Renal adenomas, very small, slow growing, benign tumors that can resemble early renal cell carcinomas.
- Oncocytomas, a type of benign tumor that can grow quite large.
- Angiomyolipoma, a rare benign tumor.
Kidney Cancer Symptoms
Risk Factors
Certain factors can increase your risk of developing kidney cancer:
- Smoking tobacco
- Obesity
- High blood pressure
- Long-term dialysis
- Sedentary life style
- Von Hippel-Lindau syndrome
- Workplace exposure to chemicals and substances
- Males are more likely than females to be diagnosed with kidney cancer.
Symptoms
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:
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
- Abdominal mass
- Back or flank pain
- Weight loss
- Low blood counts (anemia)
- Tumor calcification on x-ray
- Symptoms of metastases
- Fever
- High calcium in blood
- High blood counts
Diagnosing Kidney Cancer
A variety of different tests and procedures may be used to detect and diagnose kidney tumors, as well as to determine their stage – specifically, how advanced the cancer is, and whether it has metastasized (spread outside the kidney).
- Physical exam and history
- Laboratory blood tests
- Urine test
- IVP (intravenous pyelogram): This procedure uses a contrast dye given through a vein to obtain an X-ray of the kidneys, ureters and bladder. The x-rays can show a kidney tumor or other problems.
- Angiography: Similar to an IVP, this test uses a contrast dye which outlines blood vessels.
- CT or CAT (computerized axial tomography) scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
- MRI (magnetic resonance imaging): MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
- PET (positron emission tomography) scan: This scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. A small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more frequently than normal cells, they take up more glucose than normal cells and appear brighter in the scan.
- Ultrasound: This device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram.
- Radionuclide scanning: This technique uses small amounts of radiation which are detected by a special camera to assess kidney blood flow (renogram).
- Biopsy: Tissue samples are examined under a microscope to determine what types of cells are present.
Treatments
Many innovative and advanced treatments are available for patients with kidney cancer.
Our well-coordinated team includes urologists, medical oncologists, and radiation oncologists working cooperatively to provide the most effective kidney cancer treatment.
Depending on the size and location of the kidney mass and the patient’s overall health, the mass can be treated with cryosurgery (freezing the tumor) or high frequency radio ablation (using heat to destroy the affected tissue). In many cases the mass can be surgically removed.
At City of Hope, our urologists specialize in minimally invasive procedures performed by laparoscopy. These procedures use small keyhole incisions rather than the large incisions used in traditional open surgery. Results with laparoscopy are comparable to open surgery, but with less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of post-operative complications.
City of Hope urologists are also highly skilled in robotic-assisted surgery, using the most advanced da Vinci S Surgical System. A urologist directs and controls the movements of a specially designed robot, equipped with a camera and miniature surgical tools. At the same time, a sophisticated computerized imaging system provides real-time three-dimensional views of the surgical area, with better visualization than can be achieved with the urologist’s unaided eye alone.
Some patients with small transitional carcinomas of the kidney can be treated endoscopically, which is performed using thin, flexible instruments that are passed into the urinary tract.
Ablative Technologies
Although surgery is usually the primary treatment for most primary kidney cancers, some patients could benefit from a non-surgical minimally invasive, kidney-sparing treatment option. This includes patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function, or only have one kidney.
Although surgery is usually the primary treatment for most primary kidney cancers, some patients could benefit from a non-surgical minimally invasive, kidney-sparing treatment option. This includes patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function, or only have one kidney.
Cryosurgery or Cryoablation
The mass can be treated with a new, less invasive form of treatment that freezes and destroys small kidney tumors without more extensive open surgery. Several metal probes are placed into the tumor either through the skin under radiology guidance or directly through an incision in the abdomen. With the patient under general anesthesia, liquid nitrogen is then circulated through the metal tips to destroy the tissue by freezing the lesion. Patients can usually be discharged from the hospital either the same day or the following day. Although success of this procedure is good, the treatment is a new form of therapy and patients need to be actively followed for several years to assure there is no recurrence.
The mass can be treated with a new, less invasive form of treatment that freezes and destroys small kidney tumors without more extensive open surgery. Several metal probes are placed into the tumor either through the skin under radiology guidance or directly through an incision in the abdomen. With the patient under general anesthesia, liquid nitrogen is then circulated through the metal tips to destroy the tissue by freezing the lesion. Patients can usually be discharged from the hospital either the same day or the following day. Although success of this procedure is good, the treatment is a new form of therapy and patients need to be actively followed for several years to assure there is no recurrence.
Radiofrequency ablation (RFA)
This procedure is another new minimally invasive form of treatment that uses a special probe that destroys cancer cells with electrical current. The destroyed tumor cells are not removed but are gradually replaced by fibrosis and scar tissue. The probe is usually inserted directly through the skin under radiology guidance with the patient under general anesthesia. Although no long term prospective randomized trials have been reported, early results are optimistic. Nevertheless, patients need to be actively followed to assure its effectiveness.
This procedure is another new minimally invasive form of treatment that uses a special probe that destroys cancer cells with electrical current. The destroyed tumor cells are not removed but are gradually replaced by fibrosis and scar tissue. The probe is usually inserted directly through the skin under radiology guidance with the patient under general anesthesia. Although no long term prospective randomized trials have been reported, early results are optimistic. Nevertheless, patients need to be actively followed to assure its effectiveness.
Targeted Therapies
One of the most exciting new developments in recent years is the introduction of drugs that interfere with the growth of cancer cells at a molecular level. By focusing on specific molecular growth pathways, these drugs prevent cell replication, or disrupt the blood flow supply to the cell.
One of the most exciting new developments in recent years is the introduction of drugs that interfere with the growth of cancer cells at a molecular level. By focusing on specific molecular growth pathways, these drugs prevent cell replication, or disrupt the blood flow supply to the cell.
City of Hope’s kidney cancer experts play a leading role in the investigation of these exciting new therapies.
Angiogenesis Inhibitors
For malignant tumors to expand and metastasize, they must be able to form new blood vessels by a process called angiogenesis. Two recent FDA approved medications, Sorafenib and Sunitinib, disrupt the angiogenesis process. Temisrolimus is another drug that disrupts the angiogenesis process but targets a different pathway than Sorafenib and Sunitinib. RAD001 is an investigational drug therapy that is effective for patients who do not respond to either of those two therapies. At City of Hope, all of these drugs are used when appropriate.
For malignant tumors to expand and metastasize, they must be able to form new blood vessels by a process called angiogenesis. Two recent FDA approved medications, Sorafenib and Sunitinib, disrupt the angiogenesis process. Temisrolimus is another drug that disrupts the angiogenesis process but targets a different pathway than Sorafenib and Sunitinib. RAD001 is an investigational drug therapy that is effective for patients who do not respond to either of those two therapies. At City of Hope, all of these drugs are used when appropriate.
An antibody is a protein produced by the body’s immune system that fights infections and foreign substances in the body. Monoclonal antibodies are genetically engineered antibodies designed to attach to particular sites on a tumor. Future clinical trials will offer more information about the potential benefit of investigational drugs, such as Bevacizumab, for kidney cancer.
Immunotherapy
Kidney cancers may respond to immune-based therapy, sometimes called biologic therapy, using the body’s own defense system to help destroy cancer cells. City of Hope is a national leader of Immunotherapy which is considered one of the standard treatment options for kidney cancer patients with advanced metastatic disease. The building blocks of immunotherapy are biologic response modifiers. These are substances that enhance the body’s immune system and improve its ability to fight cancer. A biologic response modifier can be either a manmade drug or a natural substance produced by the body and include Interleukin-2 and Interferons.
Radiation Therapy
Radiation therapy uses energy beams to destroy cancer cells. Although not considered a primary form of therapy for kidney cancer, radiation is used in situations where cancer has spread outside the kidney. At City of Hope, our radiation oncologists work with highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing the exposure of healthy tissues.
Radiation therapy uses energy beams to destroy cancer cells. Although not considered a primary form of therapy for kidney cancer, radiation is used in situations where cancer has spread outside the kidney. At City of Hope, our radiation oncologists work with highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing the exposure of healthy tissues.
Several procedures may be useful in these cases:
Stereotactic radiosurgery
This treatment uses sophisticated three-dimensional computerized imaging to deliver a concentrated dose of radiation to the affected area while protecting the surrounding healthy tissue from exposure. Stereotactic radiosurgery is not “surgery” in the usual sense because there are no incisions, and anesthesia is not required.
IMRT (intensity modulated radiation therapy) This procedure administers therapeutic x-rays to patients with great precision. High-energy x-ray machines linked with imaging systems deliver targeted radiation doses that are sculpted to the tumor’s exact shape by modulating the radiation beam intensity and aiming beams from many directions.
Helical TomoTherapy
This advanced radiation therapy system combines precision spiral CT scanning with IMRT, allowing doctors to match the highest dose of radiation to fit the exact shape of the tumor. The system provides effective treatment while reducing unwanted exposure of normal tissues, and reducing potential complications.
Chemotherapy
Chemotherapy is standard treatment for many tumors, however, kidney cancer is generally resistant to chemotherapy. Chemotherapy is generally used in combination with other therapies or reserved for patients entering clinical trials to test new agents and for patients who failed to respond to immunotherapy.
Chemotherapy is standard treatment for many tumors, however, kidney cancer is generally resistant to chemotherapy. Chemotherapy is generally used in combination with other therapies or reserved for patients entering clinical trials to test new agents and for patients who failed to respond to immunotherapy.
For additional information about kidney cancer and kidney cancer treatment please review the Kidney Cancer Association’s booklet, We Have Kidney Cancer.
Kidney Cancer Resources
All of our patients have access to the
Sheri & Les Biller Patient and Family Resource Center,
which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
Additional Resources
American Urological Association
1-866-746-4282
The American Urological Association (AUA) is the premier professional association for the advancement of urologic patient care, and works to ensure that its members are current on the latest research and practices in urology.
1-866-746-4282
The American Urological Association (AUA) is the premier professional association for the advancement of urologic patient care, and works to ensure that its members are current on the latest research and practices in urology.
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
Support groups at City of Hope for patients with specific types of cancer or specific needs. View our calendar for specific groups and meeting times.
Kidney Cancer Association
The Kidney Cancer Association is the only global organization serving the needs of kidney cancer patients and their families.
The Kidney Cancer Association is the only global organization serving the needs of kidney cancer patients and their families.
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.
Kidney Cancer Team
People
http://forms.cityofhope.org/directorysearch/
/physician-bio
Kidney Cancer Care
City of Hope specializes in research designed to improve the care of patients with many kinds of cancer, including kidney cancer. Our services encompass all aspects of care, including prevention, early diagnosis and effective treatment.
Treatments and Clinics
A national leader in cancer treatment and prevention, City of Hope is steadfast in its drive to offer more positive outcomes to patients everywhere. Our research innovations become advances in patient care without delay, because people fighting cancer need better options – now.
To make an appointment for yourself, a family member or a friend, please complete and submit our Become a Patient Request Form, or call City of Hope at
800-826-HOPE (4673).
The
Sheri & Les Biller Patient and Family Resource Center
embodies the heart and soul of City of Hope’s mission to care for the whole person.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials. Last year, City of Hope conducted more than 300 studies enrolling almost 5,000 patients. Find out more about City of Hope's Clinical Trials.
Situated just northeast of Los Angeles, City of Hope combines the best science and the most innovative and highly compassionate patient care. Stretched across more than 100 acres in the City of Duarte, lushly landscaped gardens surround state-of-the-art facilities.
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