Treatment
Many people with kidney cancer want to take an active part in making decisions about their medical care. They want to learn all they can about their disease and their treatment choices. However, shock and stress after the diagnosis can make it hard to think of everything they want to ask the doctor. It often helps to make a list of questions before an appointment. To help remember what the doctor says, people may take notes or ask whether they may use a tape recorder. Some also want to have a family member or friend with them when they talk to the doctorto take part in the discussion, to take notes, or just to listen.
The doctor may refer the patient to a specialist, or the patient may ask for a referral. Specialists who treat kidney cancer include doctors who specialize in diseases of the urinary system
(urologists)
and doctors who specialize in cancer
(medical oncologists and
radiation oncologists).
Before starting treatment, a person with kidney cancer might want a second opinion about the diagnosis and the treatment plan. Some insurance companies require a second opinion; others may cover a second opinion if the patient or doctor requests it.
There are a number of ways to find a doctor for a second opinion:
- The patient's doctor may refer the patient to one or more specialists. At cancer centers, several specialists often work together as a team.
- The Cancer Information Service, at 1-800-4-CANCER, can tell callers about nearby treatment centers.
- A local or state medical society, a nearby hospital, or a medical school can usually provide the names of specialists.
- The American Board of Medical Specialties (ABMS)
offers a list of doctors who have met specific
education and training requirements and have
passed a specialty examination. Their
directorythe
Official ABMS Directory of Board Certified Medical Specialistslists doctors' names along with their specialty and their educational background. The directory is available in most public libraries. Also, ABMS offers this information by telephone and on the Internet. The toll-free telephone number is 1-866-ASK-ABMS (1-866-275-2267). The Internet address is
http://www.abms.org.
- The NCI provides a helpful fact sheet on how to find a doctor called
"How To Find a Doctor or Treatment Facility If You Have Cancer." It is available on the Internet at
http://www.cancer.gov/publications.
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Treatment depends mainly on the stage of disease and the patient's general health and age. The doctor can describe treatment choices and discuss the expected results. The doctor and patient can work together to develop a treatment plan that fits the patient's needs.
People may want to ask the doctor these questions before treatment begins:
- What is the stage of the disease? Has the cancer spread? If so, where?
- What are my treatment choices? Which do you recommend for me? Will I have more than one kind of treatment?
- What are the expected benefits of each kind of treatment? Will it cure or control the disease?
- What are the risks and possible
side effects
of each treatment? Will I be given anything to control side effects?
- How long will treatment last?
- Will I have to stay in the hospital?
- What is the treatment likely to cost? Is this treatment covered by my insurance plan?
- How will treatment affect my normal activities?
- How often should I have checkups?
- Would a
clinical trial (research study) be appropriate for me?
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People do not need to ask all their questions or understand all the answers at once. They will have other chances to ask the doctor to explain things that are not clear and to ask for more information.
People with kidney cancer may have
surgery,
arterial embolization,
radiation therapy,
biological therapy, or
chemotherapy. Some may have a combination of treatments.
At any stage of disease, people with kidney cancer may have treatment to control
pain and other symptoms, to relieve the side effects of
therapy, and to ease emotional and practical problems.
This kind of treatment is called
supportive care,
symptom management, or
palliative care.
Information about supportive care is available on NCI's Web site at
http://www.cancer.gov and from NCI's Cancer Information Service at 1-800-4-CANCER.
A patient may want to talk to the doctor about taking part in a clinical trial, a research study of new treatment methods. The section on
"The Promise of Cancer Research" has more information about clinical trials.
Surgery is the most common treatment for kidney cancer. It is a type of
local therapy. It treats cancer in the kidney and the area close to the tumor.
An operation to remove the kidney is called a
nephrectomy. There are several types of nephrectomies. The type depends mainly on the stage of the tumor. The doctor can explain each operation and discuss which is most suitable for the patient:
-
Radical nephrectomy: Kidney cancer is usually treated with radical nephrectomy. The
surgeon
removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area also may be removed.
-
Simple nephrectomy: The surgeon removes only the kidney. Some people with Stage I kidney cancer may have a simple nephrectomy.
-
Partial nephrectomy: The surgeon removes only the part of the kidney that contains the tumor. This type of surgery may be used when the person has only one kidney, or when the cancer affects both kidneys. Also, a person with a small kidney tumor (less than 4 centimeters or three-quarters of an inch) may have this type of surgery.
People may want to ask the doctor these questions before having surgery:
- What kind of operation do you recommend for me?
- Do I need any lymph nodes removed? Why?
- What are the risks of surgery? Will I have any long-term effects? Will I need dialysis?
- Should I store some of my own blood in case I need a
transfusion?
- How will I feel after the operation?
- How long will I need to stay in the hospital?
- When can I get back to my normal activities?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
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Arterial embolization is a type of local therapy that shrinks the tumor. Sometimes it is done before an operation to make surgery easier. When surgery is not possible, embolization may be used to help relieve the symptoms of kidney cancer.
The doctor inserts a narrow tube
(catheter)
into a blood vessel in the leg. The tube is passed up to the main blood vessel
(renal artery)
that supplies blood to the kidney. The doctor injects a substance into the blood vessel to block the flow of blood into the kidney. The blockage prevents the tumor from getting oxygen and other substances it needs to grow.
People may want to ask the doctor these questions before having arterial embolization:
- Why do I need this procedure?
- Will I have to stay in the hospital? How long?
- What are the risks and side effects?
- Would a clinical trial be appropriate for me?
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Radiation therapy (also called
radiotherapy) is another type of local therapy. It uses high-energy rays to kill cancer cells. It affects cancer cells only in the treated area. A large machine directs radiation at the body. The patient has treatment at the hospital or clinic, 5 days a week for several weeks.
A small number of patients have radiation therapy before surgery to shrink the tumor. Some have it after surgery to kill cancer cells that may remain in the area. People who cannot have surgery may have radiation therapy to relieve pain and other problems caused by the cancer.
People may want to ask the doctor these questions before having radiation therapy:
- Why do I need this treatment?
- What are the risks and side effects of this treatment?
- Are there any long-term effects?
- When will the treatments begin? When will they end?
- How will I feel during therapy?
- What can I do to take care of myself during therapy?
- Can I continue my normal activities?
- How often will I need checkups?
- Would a clinical trial be appropriate for me?
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Biological therapy is a type of
systemic therapy.
It uses substances that travel through the bloodstream,
reaching and affecting cells all over the body.
Biological therapy uses the body's natural ability
(immune system)
to fight cancer.
For patients with metastatic kidney cancer, the doctor may suggest interferon alpha or interleukin-2 (also called IL-2 or aldesleukin). The body normally produces these substances in small amounts in response to infections and other diseases. For cancer treatment, they are made in the laboratory in large amounts.
Chemotherapy is also a type of systemic therapy. Anticancer drugs enter the bloodstream and travel throughout the body. Although useful for many other cancers, anticancer drugs have shown limited use against kidney cancer. However, many doctors are studying new drugs and new combinations that may prove more helpful. The section on
"The Promise of Cancer Research" has more information about these studies.
People may want to ask the doctor these questions before having biological therapy or chemotherapy:
- Why do I need this treatment?
- How does it work?
- What are the expected benefits of the treatment?
- What are the risks and possible side effects of treatment? What can I do about them?
- When will treatment start? When will it end?
- Will I need to stay in the hospital? How long?
- How will treatment affect my normal activities?
- Would a clinical trial be appropriate for me?
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