Metastatic Renal Cell Carcinoma

How is renal cell carcinoma treated?

Right through diagnosis, treatment and intermittent waiting time, there is nothing more important than mentally deciding to stay positive throughout.

The overall treatment plan is planned based on factors that include stage of the disease and patient’s medical history. Treatment plan that is the standard of care for renal cell carcinoma includes:

I. Active surveillance

The patient may, upon doctor’s recommendation, have to go through regular diagnostic tests and clinical appointments to closely monitor the tumour. Further treatment plan is planned and re-planned based on the results of the said tests and other related factors.

II. Surgery

Based on the stage of the cancer, the doctor could either do a partial nephrectomy (removal of tumour and some surrounding tissue within the kidney, so as to prevent loss of complete kidney function), simple nephrectomy (removal of kidney) or a radical nephrectomy (removal of kidney, adrenal gland and usually, nearby lymph nodes). It is possible survive with at least one kidney working. But if both the kidneys are removed, one will have to go for either dialysis or kidney transplant to cope up with the loss of function of the organ. For better outcome, surgery is often combined with chemotherapy and radiation therapy. For cancers that recur after initial surgery, further surgery might be an option.

III. Non-surgical treatment

At times, when surgery is not practically possible due to patient’s health condition, doctors may use some alternate means to shrink or kill the tumour. Some means used are:

i. Arterial embolization

One way to do this is by injecting small pieces of gelatin into the main blood vessel that carries blood to the kidney. With this, flow of blood, oxygen and nutrients into the area is blocked, leading to tumour shrinkage with time.

ii. Radiofrequency ablation (RFA)

During RFA, a needle is inserted into the tumour and cells killed using electric current.

iii. Cryoablation

By image-guided means, a needle is inserted into the tumour and cancer cells are killed by freezing.

IV. Treatment using medication:

i. Chemotherapy

Drugs that are administered orally or injected into bloodstream as a part of cancer treatment act by either killing the cells or stopping them from dividing further. Although chemotherapy is useful for most types of cancers, kidney cancer is often resistant to chemotherapy. A drug combination usually recommended for tumour shrinkage in case of kidney cancer is gemcitabine, capecitabine and 5-flurouracil.

ii. Targeted therapy

In targeted therapy, cancer cells are specifically targeted based on some specific molecular markers on these cells and destroyed, leaving normal cells with minimal damage. This kind of therapy is also often recommended for recurrent cancers. Targeted therapy in case of kidney cancer are currently focused around:

• Anti-angiogenesis treatment: Angiogenesis, or development of blood vessels is one of the hallmarks of cancers. This happens because of upregulation of molecules that drive formation of new blood vessels in cancer cells. An example of such a molecule is Vascular Endothelial Growth Factor (VEGF). Drugs which bind to the active site of VEGF can block the supply of blood vessels and starve the cancer cells to death – leading to shrinkage of tumour. An example of such a VEGF inhibitor that has been proven effective in the targeted killing of kidney cancer cells is Bevacizumab.
• mTOR inhibitors: Drugs that target mTOR protein that helps kidney cells growth can slow cancer cell growth in kidney. E.g. Everolimus, Temsirolimus

iii. Immunotherapy

During Immunotherapy, the body’s defense mechanism is boosted to fight against the cancer. Some examples of immunotherapeutic drugs are Interleukin-2 (IL-2), α-interferon, immune checkpoint inhibitors (Nivolumab & Ipilimumab).

V. Radiation therapy

High energy radiation is used to kill cancer cells in radiation therapy. Radiotherapy is however not an effective primary treatment mode for kidney cancer.

What lifestyle changes could one take to adjust with the disease and treatment conditions?

Coping with the disease

Discomfort, pain and side-effects are an unavoidable part of the disease and its treatment. Hence, for a better quality of life for the patient, it is best to be well-aware of what to expect and to be equipped with appropriate measures. One must never hesitate to talk to the doctor understand what measures will help him/her to ease the pain and side-effects.

• If you are experiencing acute side-effects such as excessive nausea, vomiting, itchiness, constipation or drowsiness, talk to your doctor. He/she may change the dosage of medication.
• Sit together and talk to your doctor and palliative care helper which can help relieve symptoms.
• Eat healthy and adopt and a positive lifestyle.
• Whatever the situation, it is important that you decide to make yourself feel as best as you can. Take rest, if you must, but do not quit hope.