Treatment for kidney cancer depends on the type and stage of the disease. Surgery is the most common treatment as kidney cancer does not often respond to chemotherapy and radiation therapy. Surgical complexity can be estimated by the
RENAL Nephrometry Scoring System. If the cancer has not spread it will usually be removed by surgery. In some cases this involves
removing the whole kidney however most tumors are amenable to
partial removal to eradicate the tumor and preserve the remaining normal portion of the kidney. Surgery is not always possible – for example, the patient may have other medical conditions that prevent it, or the cancer may have spread around the body and doctors may not be able to remove it. If the cancer cannot be treated with surgery, other techniques such as
freezing the tumour or
treating it with high temperatures may be used. However, these are not yet used as standard treatments for kidney cancer. Recently, evidence stemming from the KEYNOTE-564 study has shed light on the potential use of systemic therapy in the adjuvant setting, with promising results. Patients exhibiting specific clear cell RCC tumor characteristics and having undergone treatment with
Pembrolizumab for 17 cycles (around 1 year) had significant improvement in disease-free survival. However, the study has yet to yield conclusive findings in relation to overall survival. Other treatment options include biological therapies such as
everolimus,
torisel,
nexavar,
sutent, and
axitinib, the use of
immunotherapy including
interferon and
interleukin-2. Immunotherapy is successful in 10 to 15% of people.
Sunitinib is the current standard of care in the adjuvant setting along with
pazopanib; these treatments are often followed by everolimus, axitinib, and
sorafenib.
Immune checkpoint inhibitors are also in trials for kidney cancer, and some have gained approval for medical use. In the second line setting,
nivolumab demonstrated an overall survival advantage in advanced clear renal cell carcinoma over everolimus in 2015 and was approved by the
FDA.
Cabozantinib also demonstrated an overall survival benefit over everolimus and was approved by the FDA as a second-line treatment in 2016.
Lenvatinib in combination with everolimus was approved in 2016 for patients who have had exactly one prior line of angiogenic therapy. In Wilms' tumor, chemotherapy, radiotherapy and surgery are the accepted treatments, depending on the stage of the disease when it is diagnosed.
Children The majority of kidney cancers reported in children are Wilms' tumors. These tumors can begin to grow when a fetus is still developing in the uterus, and may not cause problems until the child is a few years old. Wilms' tumor is most common in children under the age of 5, but can rarely be diagnosed in older children or in adults. It is still not clear what causes most Wilms' tumors. The most common symptoms are swelling of the abdomen and blood in the urine. ==Epidemiology==