Treatment for Kidney Cancer

There are more treatment options today than ever before to control kidney cancer or help you live a full life with kidney cancer. 

Our kidney cancer specialists work closely with you, your family and each other to get you back to health. At Fred Hutchinson Cancer Center, we provide all standard therapies for kidney cancer and offer you access to the latest innovations through clinical trials.

“My goal is to help you regain your health, independence and wellness following a cancer diagnosis.”
— Sarah Psutka, MD, urologic oncologist

Treatment Plan FAQs

Kidney cancer treatment at Fred Hutch is highly customized for each patient’s needs. 

How Do We Create Your Treatment Plan?

Your physician, supported by a team of kidney cancer experts:

  • Decides on the best direction to take to start therapy
  • Thinks about the standard of care for your subtype
  • Looks into any clinical trials that match your needs, so you can think about joining them

Your doctor will walk you and your caregiver through your treatment plan. You will have a chance to discuss your personal preferences and options, and you will decide together how to move forward.

Why Do Treatment Plans Differ?

The treatment plan we design for you depends on many factors, including:

  • Your kidney cancer subtype, because different subtypes start, grow and respond to treatments differently
  • If your kidney cancer is slow-growing (indolent) or fast-growing (aggressive)
  • The stage of your disease
  • If you have had treatment for kidney cancer in the past
  • Your age and overall health
  • Your needs and preferences, like what type of treatment schedule works in your life and if you want to join a clinical trial

What Is The Standard Therapy For Kidney Cancer?

Because there are different types of kidney cancer, there is no one way to treat everyone. However, many people are treated using surgery, radiation, targeted therapy or immunotherapy. Physicians may use these one at a time or combine them. 

At Fred Hutch, our standard always involves caring for you as a whole person. We help you get relief from side effects and provide many other forms of support, like integrative medicine, nutrition counseling, pain management, palliative care, rehabilitation and physical therapy.

Our patients also have the option to receive promising, new kidney cancer therapies that you can get only through a clinical trial. Many people come to Fred Hutch for access to these trials. Your care team will tell you about trials that might be right for you, so you can think about joining them.

Treatment Process

There are more kidney cancer treatment options than ever before. Although the most common treatment for localized kidney cancer is still surgery, many new immunotherapies and targeted therapies have been approved by the U.S. Food and Drug Administration (FDA) in recent years to treat metastatic kidney cancer. 

We match your treatment plan to you. Learn more about the treatment types offered at Fred Hutch.

Surgery

Surgery is the most common treatment for kidney cancer that has not spread outside of the kidney.

There are several procedures your surgeon may use, depending on:

  • The type, size and location of your tumor
  • The extent of your cancer
  • Your overall health

Whenever possible, we use laparoscopic or robotic surgery techniques, making small keyhole incisions and using telescopic instruments.

Surgery for kidney cancer may require:

  • Radical nephrectomy — surgery to remove your entire kidney, including the tumor and a border (portion) of healthy tissue and nearby lymph nodes
  • Partial nephrectomy — surgery to remove only the part of your kidney that contains the cancer and a small margin (portion) of healthy tissue around it
  • Regional lymphadenectomy — surgery to remove lymph nodes near the tumor to see if they contain cancer
  • Ablation — using extreme cold (cryoablation) or heat (radiofrequency ablation) to kill tumor cells, either by putting a needle through a small puncture in your skin (percutaneously) or through a very small laparoscopic incision
Learn More About Surgery

Targeted Therapy

Targeted therapies are relatively new for treating kidney cancer. They work in a more focused way than chemotherapy. Often used for advanced kidney cancer, these therapies may shrink tumors and control their growth for long periods.

Targeted therapies commonly used for kidney cancer include:

  • Axitinib: Inhibits tyrosine kinases and is used for people who have not responded to other medicines.
  • Cabozantinib: A tyrosine kinase inhibitor (TKI) and anti-angiogenesis (preventing the growth of new blood vessels that tumors need to grow) medicine that blocks MET oncogene signaling.
  • Everolimus: Blocks mTOR and is typically used after other medicines, such as sorafenib or sunitinib, have been tried.
  • Lenvatinib: A TKI and anti-angiogenesis medicine that blocks signaling through FGFR (fibroblast growth factor receptor).
  • Pazopanib: A TKI and anti-angiogenesis medicine.
  • Sunitinib: A TKI that works by preventing the growth of new blood vessels that tumors need to grow (anti-angiogenesis effect) and blocking cells from dividing and multiplying.
  • Tivozanib: A TKI and anti-angiogenesis medicine used for people who have not responded to other medicines.

Your care team will talk with you about the specific drugs we recommend for you, how you will receive them, your treatment schedule and what to expect. We will also explain how to take the best possible care of yourself during treatment and after, and we will connect you with medical and supportive care resources at Fred Hutch.

Learn more about Targeted Therapy

Immunotherapy

Immunotherapies are some of the latest advances in kidney cancer care. They use the power of your immune system to fight your cancer.

The main immunotherapy medicines used in kidney cancer are:

  • Checkpoint inhibitors: These medicines include nivolumab (Opdivo®), ipilimumab (Yervoy®), pembrolizumab (Keytruda®), and avelumab (Bavencio®), which are already FDA-approved for kidney cancer. More options are being tested in research studies. Fred Hutch has clinical trials that use checkpoint inhibitors to treat kidney cancer.
  • Interleukin-2, or IL-2 (Proleukin®): IL-2 is a growth factor for two types of white blood cells that may have strong anti-tumor effects. Some people with clear cell RCC (five to seven percent) can have long-lasting complete remission after IL-2 therapy. However, high dose IL-2 is linked with severe side effects and is not right for everyone. If you are interested in IL-2, look for a cancer center, like Fred Hutch, that is familiar with this type of therapy. 
Learn More About Immunotherapy

Radiation Therapy

Radiation therapy is typically used to treat kidney cancer that has spread to other parts of the body, especially the brain or bones. Radiation therapy is painless and noninvasive, and each treatment takes only minutes.

Radiation may be used:

  • To help with symptoms of advanced kidney cancer, such as pain or bleeding
  • To prevent symptoms from tumors growing in critical areas, such as the brain or spinal cord 

Different types of radiation are used for different situations. Two examples are radiosurgery and intensity-modulated or image-guided radiotherapy (IMRT/IGRT).

Radiosurgery

Radiosurgery is an advanced form of highly focused, high-dose radiation therapy that can kill tumors in fewer treatments than conventional radiation treatment — usually one to five sessions rather than daily sessions for several weeks. It has a greater than 95 percent chance of killing small tumors.

There are many names for this type of treatment, such as:

  • Stereotactic body radiation therapy (SBRT)
  • Stereotactic ablative body radiotherapy (SABR)
  • CyberKnife® or Gamma Knife® (brand names)

Gamma Knife is specifically designed for treating tumors in the brain. It is not an actual knife or scalpel (neither is CyberKnife) — instead, it uses carefully focused beams of radiation. Patients are usually treated in one session. 

IMRT/IGRT

To do IMRT/IGRT, a doctor will use computed tomography (CT) to scan the tumor and create beams of radiation that closely match the tumor's shape. The beams have different shapes and intensities (strengths), so they can deliver a higher dose of radiation to the tumor and lower doses to nearby healthy tissue.

Learn more about Radiation Therapy

Chemotherapy

Renal cell carcinoma (RCC) does not respond well to chemotherapy. But it may be used to treat certain patients with advanced RCC and transitional cell carcinoma as well as patients with uncommon types of kidney cancer, including medullary renal cell carcinoma or sarcomatoid renal cell carcinomas.

Learn More About Chemotherapy

Videos on Kidney Cancer Treatment

Scott S. Tykodi, MD, PhD, talks about the different types of treatment for kidney cancer.

Your goals and priorities play an important role in shaping the treatment plan we create for you. What’s important to you is also important to us.

Scott S. Tykodi, MD, PhD, discusses immunotherapies, including many researched here at Fred Hutch, are changing cancer care. They may play an even bigger role for people with kidney cancer in the years to come.

Monitoring Your Health

While you are in active treatment, your kidney cancer care team sees you regularly for exams and tests to check:

  • How well your treatment is working
  • If there is any reason to change your treatment
  • If you need help with side effects or supportive care services, like nutrition care or mental health counseling

We update your treatment plan based on the best scientific evidence as well as how your disease responds and what you prefer.

Possible Results of Treatment

Throughout treatment, your care team looks for signs of:

  • Remission: Fewer signs and symptoms of cancer. Partial remission means some signs and symptoms remain. Complete remission means there are no signs or symptoms.
  • Stable disease: No change in the extent or seriousness. The disease is not going away, but it’s not getting worse, either.  
  • Disease progression: The disease is getting worse or spreading.
  • Relapse: The disease, signs or symptoms have come back after they had improved.
  • Refractory disease: The disease does not respond to treatment.

What about “cured”? Sometimes physicians use the word “cured” if you have been in complete remission for several years. Although there are no tests that show cancer is 100 percent gone, the longer the remission, the smaller the chance the cancer will come back (recur).

Managing Side Effects

You might be wondering about possible side effects from treatment, like hair loss or nausea from chemotherapy. If you are, it might be helpful to know that many of today’s treatments are more targeted to cancer cells, so they don’t cause as many side effects as standard chemotherapy. 

You are always at the center of everything we do. Kidney cancer physicians, nurses and advanced practice providers are here to help prevent or manage the side effects of treatment.

Get Help with Side Effects

Before you begin treatment, we talk with you about what to expect, based on your treatment plan, and what can help if you do have side effects.

At your appointments, we want you to tell us about any side effects you are having. If you have questions or concerns between appointments, you can call or email us. We will make sure you know how to reach care providers at Fred Hutch after hours, if that is when you need us. 

We have many tools to help you feel better, such as:

  • Antibiotics, vaccines and antiviral drugs to prevent or treat infections
  • Transfusions, steroids and medicines that help the immune system treat low levels of blood cells (low blood counts)
  • Nutrition care and medicines to help with digestive problems
  • Conventional and integrative therapies for pain

Coping with Side Effects

Common Side Effects

Side effects are different depending on which treatment you get. They also depend on other factors, like how strong your immune system is. These are some of the common side effects of kidney cancer treatment:

  • Unusual tiredness (fatigue)
  • Problems in your digestive tract, like nausea, vomiting, constipation or diarrhea
  • Mouth sores
  • Rash or other skin changes, itchiness
  • Arthritis (inflammation) 
  • Thyroid abnormalities
  • Changes in renal function (kidney sensitivity)
  • Blisters on palms of hand or soles of foot
  • High blood pressure

Common changes to lab results because of kidney cancer treatment include:

  • Low blood counts 
  • Elevated (higher) liver enzymes
  • Abnormal thyroid function tests
  • High urine protein

Supportive Care Services

Along with treating your kidney cancer, Fred Hutch provides a range of services to support you and your caregiver before, during and after treatment. This is part of how we take care of you — not just your disease.

From registered dietitians to chaplains, we have experts who specialize in caring for people with cancer. We understand this may be one of the most intense and challenging experiences you and your family ever go through. We are here to provide the care you need. 

Learn more about Supportive Care

Caregiving During Treatment

If your loved one is getting targeted therapy, immunotherapy, radiation therapy or chemotherapy, there are many ways you can help. Caregiving during active treatment for kidney cancer often means doing tasks like these:

  • Keeping track of their appointments and driving them to and from treatment
  • Watching for changes in their condition and telling their care team about any symptoms
  • Providing physical care, like helping them take medicines
  • Spending time with them and encouraging them
  • Taking care of tasks at home that they might not be able to do, like grocery shopping and cleaning

Continuing Care

When your disease is in remission and your active treatment ends, it is still important to get follow-up care on a regular basis. At follow-up visits, you will see the same Fred Hutch team who treated your kidney cancer. They will check your overall health and look for signs that your cancer has come back (signs of recurrence). 

Your team will also help with any long-term side effects (which go on after treatment ends) or late effects (which may start after treatment is over).

Schedule For Follow-up Visits

Just like we personalize your treatment plan for you, we personalize your follow-up schedule, too. Your physician will base your schedule on many factors, including:

  • Your kidney cancer subtype
  • Whether your disease was slow-growing (indolent) or fast-growing (aggressive)
  • Which treatments you had and how your disease responded 
  • How the disease and treatments affected you 
  • How long it has been since your treatment ended

Most patients have follow-up appointments for at least several years if they had a localized tumor or if their advanced disease went into remission. It is common to have visits more often at first and less often as time goes on.

What Happens at Follow-up Visits

Follow-up for kidney cancer usually means seeing your physician for a physical exam and having urine tests or blood tests to check your organ function and blood cell levels.

Your physician will let you know if you need any imaging tests. You might have tests like a computed tomography (CT) scan or magnetic resonance imaging (MRI) scan. These can help check for recurrence (if the cancer has come back), but they also expose you to some radiation. Together, you and your physician will decide on the benefits and risks.

Meet the Kidney Cancer Care Team

Kidney Cancer Team at Fred Hutch