What are the different types of renal cancer?
Renal cell carcinoma (RCC) is the most common type of renal cancer accounting
for over 90% of renal malignancies. Subtypes of RCC (from most to least
common) include: clear cell, papillary, chromophobe, oncocytic, and collecting
duct. The subtype and nuclear grading of the cancer is performed by a
pathologist when tissue from biopsy or tumor removal is available.
What is the stage of my cancer?
The staging of a renal cancer diagnosis is most commonly determined by
the TNM staging system, which was developed by the American Joint Committee
on Cancer (AJCC). The letters within the acronym “TNM” stand for:
T - The size of the main
tumor and whether it has grown into areas nearby.
N - The extent to which the tumor has spread to adjacent lymph
nodes.
M - An indication of whether the tumor has
metastasized, or spread, to other areas of the body.
Numbers or letters generally appear after the T, N and M to indicate details
about the severity or whether it is possible to assess the severity in
each case.
What are my treatment options?
Surgery - Kidney tumors that are located primarily in the kidney or surrounding
areas are most often treated with surgery. There are various methods of
surgical treatment, which are tailored to the individual. They include
the following:
Radical nephrectomy involves removing the whole kidney, including adjacent fatty tissue, and
sometimes the adrenal gland and nearby lymph nodes as well.
At Hoag, surgeons opt to perform laparoscopic or robot-assisted radical
nephrectomy, as compared to standard surgery, whenever possible given
the circumstances. Minimally invasive surgery enables the surgeon to make
a smaller incision, resulting in less blood loss, shorter hospital stays
and a quicker recovery time.
When laparoscopic methods are not possible, the surgeon will perform the
surgery via an “open” approach which involves a much larger incision.
With a
partial nephrectomy (also called kidney-sparing surgery), the cancerous section of the kidney
is removed, along with a margin of the healthy surrounding tissue, rather
than the entire kidney.
Prior to surgery, imaging is done to determine the precise portion to be
removed. Surgeons may opt for partial nephrectomy in cases where the tumor
is in a location that is more easily accessible, co-existing health conditions
that could affect outcomes, as well as patient preference. This procedure
is most commonly chosen for patients whose tumors are 4 centimeters or
less in size.
At Hoag, partial nephrectomy is performed mainly with a robot-assisted
approach when feasable to reduce hospital stays and recovery time. Larger
or more complex tumors may require an open approach.
Energy ablative techniques - Ablative treatment utilizes extreme cold or
heat to treat tumors, without removing the tumor or surrounding kidney.
In general, these methods are best suited for patients who are at high
risk for surgery and/or have small, favorably located tumors.
Examples of ablative therapies include cryo-ablation (freezing) and radiofrequency
ablation (RFA) which destroys the tumor through extreme heat. At Hoag
hospital, our physicians have extensive experience with cryoablation of
small renal tumors.
Targeted therapy - Contemporary research on kidney cancer has identified
specific molecular and genetic changes in tumors. These changes can be
“targeted” with novel drugs which are different from traditional
chemotherapy agents. These drugs are now used as first line agents in
treating advanced stage cancers. Many of the early targeted therapies
focused on inhibiting angiogenesis (formation of blood vessels by the
cancer). Newer agents have been discovered which target specific components
of one’s immune system (immunotherapy) to fight the cancer.
Chemotherapy and Radiation therapy - In general, traditional radiation
therapy and chemotherapy have been relatively ineffective in treating
kidney tumors.
How can I get a second opinion?
A renal cancer diagnosis can be overwhelming. It is important that you
have all of the information you need and an expert medical team to assist
you in this journey.
If you would like a second opinion, Hoag can assist in connecting you with
the proper resources. Call us at 949-7-CANCER (722-6237).