Surgery
- Under general anesthesia, radical nephrectomy or complete removal of the kidney and fat around the kidney is performed when it is not possible to perform a partial nephrectomy, or to just remove the cancerous portion of the kidney. This is often performed through a minimally invasive/laparoscopic approach which requires an overnight hospital stay except with larger renal masses, in which an open surgical incision may be required.
- Because the other kidney has normal function in most individuals, there are usually no functional consequences. However, whenever possible, a partial nephrectomy is performed to maximize kidney function.
- In comparison with a radical nephrectomy, a partial nephrectomy is associated with a higher risk of bleeding, requiring blood transfusion and urine leak as a consequence of wedging out the cancerous portion of the kidney. Robotic-assisted partial nephrectomy via a minimally invasive approach is used for renal masses generally up to 7 cm depending on surgeon experience, and open partial nephrectomy is performed for larger masses.
- With both partial and radical nephrectomy, the kidney cancer is removed, allowing the pathologist to examine the tissue and determine the pathologic stage. This allows additional prognosis, or prediction in terms of recurrence-free survival.
Thermal Ablation
- Heat (radioablation) or cold (cryotherapy) may be used to kill the kidney cancer with image guidance, typically under general anesthesia.
- Several probes are inserted through the skin and abdominal wall muscles.
- With this approach, the mass is not removed, but rather left in place.
- Population-based studies demonstrate that more imaging was performed after thermal ablation compared to surgical removal of kidney cancers.
Chemotherapy
- For cancer that has spread beyond the kidney, chemotherapies include:
- Sunitinib
- Sorafenib
- Pazopanib
- Axitinib
- Temsirolimus
- Everolimus
- Bevacizumab in combination with interferon
