Therapy

The most suitable treatment option for you will depend on various factors, including your general health, the specific type of kidney cancer, the stage of the disease, and your individual preferences.

Surgery

Surgery is considered standard care for the majority of kidney cancer cases. You should be prepared for the possibility that surgery may also be necessary in your case.

Surgical procedures to treat kidney cancer may include the following:

• Removal of the affected kidney (radical nephrectomy)
  A radical nephrectomy involves the removal of the kidney, surrounding healthy tissue, regional lymph nodes, and in some cases, the adrenal gland. This procedure is most commonly performed as an open surgery via an incision along the flank. However, it can also be carried out using minimally invasive (laparoscopic) techniques, in which small surgical instruments and a camera are inserted into the abdominal cavity through several tiny incisions. In some cases, this procedure is performed with robotic assistance, meaning that the surgeon controls the robotic arms and instruments precisely via a console.
• Removal of the tumor from the kidney (partial nephrectomy)
  During a partial nephrectomy, your surgeon removes the tumor along with a small margin of surrounding healthy tissue, rather than removing the entire kidney. This procedure can be performed as open surgery, laparoscopically, or with robotic assistance. Partial nephrectomy is typically used for smaller tumors. If it is feasible, this approach is generally preferred over full kidney removal in order to preserve as much kidney tissue as possible and to reduce the risk of later complications such as kidney disease or the need for dialysis.

Your doctor will recommend the most suitable surgical approach for you based on the characteristics and stage of your cancer, as well as your overall health condition.
Surgical procedures always carry a certain risk of bleeding and wound infection.

Treatment options without surgery

In some patients, surgery must be ruled out for various reasons if it is not feasible. In such cases, one of the following treatment options may be considered:

• Treatment by freezing cancer cells (cryoablation)
  In cryoablation, a special needle is inserted through the skin into the kidney tumor under ultrasound guidance. A very cold gas is pumped through the needle, which cools or freezes the cancer cells. There are currently only a few long-term studies on the safety and effectiveness of this method for kidney cancer. Cryoablation is typically used in patients who are not candidates for surgery or in cases of small kidney tumors.
• Treatment by heating cancer cells (radiofrequency ablation)
  In this procedure, a special needle is also inserted through the skin into the kidney tumor under ultrasound guidance. The heat generated by high-frequency electrical current running through the needle causes the cancer cells to heat up and be destroyed (burned). As with cryoablation, there are only limited long-term studies on the safety and effectiveness of this method in kidney cancer. It is generally considered for patients who cannot undergo surgery, as well as for smaller kidney tumors.

Treatment options for advanced and recurrent kidney cancer

For recurrent kidney cancer and advanced, metastatic kidney cancer, a complete cure is often no longer possible. However, there are numerous treatment options available to help control the disease over the long term:

• Surgical removal of as much of the kidney tumor as possible
  Even if the tumor cannot be removed completely through surgery, it may still be beneficial in some cases to remove as much cancerous tissue as possible. This may also be an option when the cancer has already spread to other parts of the body.
• Surgical removal of metastases
  In specific cases, the surgical removal of metastases can be highly effective and associated with prolonged recurrence-free survival. This procedure is particularly considered for patients who develop metastases several years after the initial kidney cancer diagnosis. Your doctor will always keep this option in mind and suggest it if the timing is right.
• Medications that help your immune system fight the cancer (immunotherapy)
  New immunotherapies have proven to be highly effective in many types of cancer and are now an integral part of modern medicine. In fact, James P. Allison and Tasuku Honjo received the 2018 Nobel Prize in Medicine for discovering the immune mechanisms that led to the development of these therapies. Unlike chemotherapy, these modern immunotherapies do not directly attack the tumor or metastases. Instead, they empower your own immune cells to recognize and destroy the cancer more effectively. Since the introduction of these therapies, the outlook for patients with advanced renal cell carcinoma (and many other cancers) has dramatically improved. In metastatic renal cell carcinoma, immunotherapies are administered either alone or in combination with targeted drugs known as tyrosine kinase inhibitors (TKIs; see next section). Immunotherapies are typically given as outpatient intravenous infusions every three to four weeks. While they are generally well tolerated, they can cause side effects when the immune system becomes overly activated. This may lead to immune cells attacking healthy organs, resulting in conditions such as hypothyroidism, liver inflammation, skin rashes, or diarrhea. Prompt recognition by your doctor and rapid initiation of corticosteroid treatment are essential in such cases. Overall, however, the benefits far outweigh the risks—especially when treatment is provided at a center experienced in managing these therapies.
• Tyrosine kinase inhibitors (TKIs; targeted therapies)
  These medications are taken in tablet form. TKIs are not chemotherapies; they are biological therapies that block the growth signals of tumor cells. As a result, the cancer cells are deprived of oxygen and nutrients, triggering programmed cell death. TKIs can be given alone or in combination with immunotherapy. Like immunotherapy, they have significantly improved outcomes for patients with metastatic renal cell carcinoma. Potential side effects include fatigue, diarrhea, high blood pressure, skin changes on the palms and soles, and hypothyroidism. However, unlike immunotherapy, many of these side effects can be effectively managed or prevented with supportive care. Our team of experts will provide you with detailed information and guidance during your consultation. Well-known representatives of this drug class used in kidney cancer include: Cabometyx, Kisplyx, Sunitinib, Inlyta, Afinitor, and others.
• Radiation therapy
  This treatment uses high-energy radioactive rays to destroy cancer cells. Radiation therapy may be used to control or alleviate symptoms caused by kidney cancer metastases, particularly in the bones. Another growing area is stereotactic radiotherapy, which allows for the highly effective and targeted destruction of individual metastases in renal cell carcinoma. These approaches are often used in combination with drug-based therapies. Through close collaboration with our colleagues at the Department of Radiation Oncology, we are able to evaluate in our weekly tumor boards whether this treatment option is appropriate for your current stage of disease.
• Radiofrequency ablation (RFA)
  Radiofrequency ablation is another option for treating individual metastases. In this procedure, heat is applied to "burn" the metastatic tissue. It is a minimally invasive technique and not a surgical procedure. RFA is often used alongside systemic drug therapies.

Alternative healing methods

No form of complementary or alternative medicine has been proven to cure kidney cancer on its own.
However, supportive measures provided by qualified experts can still be helpful.

• Exercise
  Physical activity (both strength and endurance training) can have numerous positive effects: it strengthens the immune system, reduces side effects, and decreases fatigue. In close collaboration with the experts from the Department of Physical Medicine, Rehabilitation and Occupational Medicine, we can provide personalized advice and develop individualized training plans for you.
• Nutrition
  So far, there is no evidence that the type of diet can alter the course of an existing tumor disease. However, there is growing evidence that pre- and probiotic nutrition may positively influence gut health—and with it, the course of a cancer illness. This is particularly relevant in the context of immunotherapy. We will also address this topic in detail with you during your consultation and treatment planning.