Kidney cancer arises due to malignant proliferation of the parenchymal tissue of the kidney. Localized early-stage kidney cancer treatment is graded as stage I in the absence of locally advanced disease or lymph node involvement. Metastasis at diagnosis or locally advanced disease is at least stage III or IV. Staging can be done both clinically and radiologically. The clinical T stage is sometimes insufficient and should be radiologically confirmed, for which CECT or MRI can be performed. Today, different options for kidney cancer stages and treatment are available depending on the stage of the disease; stage I usually undergo surgery, while active surveillance or ablation is an option for very small and low-risk patients. Stage II commonly undergoes surgery, while certain cases of stage III undergo surgery and targeted therapies if neoadjuvant treatment is necessary. The treatment for advanced kidney cancer for stage IV is to start the patient on systemic therapy immediately.
Kidney cancer can often grow quite large without causing symptoms, and thus it is quite common for patients to present with treatment for advanced kidney cancer and early-stage kidney cancer treatment at the time of their original diagnosis. In recent years, with the early detection of more kidney tumors, this scenario is gradually changed in some countries.
Previously, cancer was staged as non-metastatic and metastatic. However, doctors re-evaluated their approach to cancer stages. Each type of kidney cancer stage 1 to 4 and specific treatments matching that stage. Appropriate cancer treatments have been shown to be more effective than actual systematic treatment. The best approach to treatment for advanced kidney cancer is given to patients at each stage. Beginning with stage I and II, let us see the appropriate treatment for each type of stages of kidney cancer.
The main treatment for early-stage kidney cancer treatment is surgery. Your treatment may be a combination of surgery plus one or more types of adjuvant injection. It is also the standard of care. The effectiveness of most of the treatments in early-stage kidney, stages I and II, has been studied to have proven that the treatment is beneficial. The main purpose, as a minimal goal, is for the patient to realize that this important treatment is not necessary.
Ordinarily, kidney cancer stage 1 to 4 has treatment strategies need to be added to those previously discussed for “early stage” in stages of kidney cancer. However, many people will either have macroscopic invasion of surrounding uninvolved structures or a collection of metastatic lymph nodes and classically only have a prompt total nephrectomy (with or without removal of involved tissue), reserving systemic therapy for recurrence. Experience has taught us that eventually some people will derive benefit from a multimodal approach. This could include systemic therapy or sometimes adding radiation therapy. We no longer think that adding systemic therapy is effective. The therapies seemed to be promising, but they are now approved for this aggressive behavior.
However, the emotional impact of knowing one has “stage IV” disease is significant; counseling patients and their families is a key part of the evaluation. Most studies analyzing the natural history in those who have had resection of all visible tumors suggest the average time to progression is under a year, with a median survival of 2-3 years. Only some people are even candidates to consider removal of the kidney. If the kidney is crushed by tumor, there appears to be very little benefit in doing so, but otherwise the decision is nuanced to consider the tumor (number of spots, “bulk”, spread outside the kidney window capsule, molecular testing) as well as the patient’s overall health. Systemic therapy with either targeted therapy or immunotherapy is very well tolerated and quite helpful in dealing with systemic symptoms. In some cases, these therapies are also very helpful in limiting the size and number of tumors, improving tumor biology, and increasing the chances of incomplete surgery.
Many different systemic treatments have been shown to work for these patients, including a group called immunotherapy drugs. Similar to adjuvant therapy, these drugs are used in patients with metastatic kidney cancer stages and treatment at high risk for recurrence or in patients with non-clear-cell renal cell carcinoma who cannot have tyrosine kinase inhibitors. Patients with metastatic renal cell carcinoma and low risk will generally live for years, even when they do not receive treatment. That means that in general, providers will recommend treatment when you have symptoms, and survival may be improved with therapy. People who have intermediate or poor prognoses are generally treated with immune combinations – typically ipilimumab plus nivolumab or pembrolizumab with axitinib if they are not already receiving non-cancer drugs that disrupt blood vessels. Patients who are already on an immune combination and whose treatment for advanced kidney cancer has not gotten worse will often continue with the combination. Healthcare providers are also conducting clinical trials of chemo-immunotherapy combinations. Recent trials demonstrate possible survival improvement and toxicity concerns in a high-risk group. Talk to your healthcare provider to understand the risks as well as the potential benefits of these new approaches. In situations where your healthcare provider may prefer non-immunotherapy drugs, they will consider your age, your ability to tolerate your cancer, and the specific details of your cancer when offering treatment advice. Your healthcare team may refer to supportive care, which involves managing symptoms of advancing cancer to improve your quality of life while you are receiving anticancer therapy. Although most patients prefer to receive cancer treatments that offer a benefit in terms of their kidney cancer stages and treatment, some treatments are also considered based on how one will generally feel. This is known as giving treatment for comfort, and it often involves using medications to improve symptoms without treating cancer itself. This is something to mind as your healthcare provider, as most patients would prefer both reduced suffering and anticancer intervention. The majority of the time, your healthcare provider will discuss systemic therapy with a broad array of plan options from a group of experts who understand the latest results of clinical trial research. Multidisciplinary treatment is comprehensive care from a team of urologists, kidney cancer doctors, medical cancer doctors, patient staff, nurses, nutrition experts, social workers, and pain experts who work together to address your health requirements. Ongoing clinical trials are examining many new and established drugs to better define treatment responses and minimize side effects. In some instances, patients must travel to specialized centers to receive experimental combinations that are only available in a research setting.
