Kidney Cancer Treatment Options By Stages [I to IV]

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kidney-cancer

Once the kidney cancer has been diagnosed through various investigations, TNM staging helps to determine the disease prognosis and to select an appropriate treatment strategy. 

The kidney cancer treatment options mainly depends on the stage, location of the tumor, whether unilateral/bilateral, performance status of the patient, along with other factors. But the final decision is taken by the oncologist after complete clinical assessment.

Treatment of Localised and Locally Advanced Kidney Cancer explained with Images and Video

Video Transcript:

Now, lets come to the treatment of non-metastatic kidney cancer.

It is called as T1 when the tumor is 7 cm or less in greatest dimension and is limited to the kidney.

T1, tumor is 7 cm or less

Surgical resection of the tumor in the form of partial or radical nephrectomy is the mainstay of treatment for T1 disease.

It is called as T2 when the tumor is more than 7 cm in greatest dimension and is limited to the kidney.

T2, tumor is more than 7 cm

T3 includes cases in which the tumor extends into the renal vein or its segmental branches, or into the renal sinus fat.

T3, tumor extends to renal vein or renal sinus fat

It also includes cases in which the tumor extends into the perirenal fat but not beyond gerota’s fascia, as you can see in this figure.

T3, tumor extends into the perirenal fat

Extension of the tumor into inferior vena cava is also T3.

T3, extends to inferior vena cava

And when the tumor extends beyond the Gerota’s fascia, it is called as T4.

T4, extends beyond Gerota’s fascia

Infiltration of the ipsilateral adrenal gland is also T4.

T4, ipsilateral adrenal gland involvement

Involvement of regional lymph nodes of the kidney as you can see in this figure is called as N1.

N staging - extends to regional nodes

Surgical resection of the tumor in the form of radical nephrectomy is the mainstay of treatment for T2, T3, T4 or node-positive disease.

The decision to do surgery and the type of surgery is taken by oncologist after assessing the exact content of the tumor along with the performance status and the comorbidities of the patient.

Non Metastatic Kidney cancer treatment infographic

Treatment of Metastatic Kidney Cancer explained with Images and Video

Video Transcript:

And lastly, we come to the M staging or metastatic staging for kidney cancer.

This figure shows multiple metastatic deposits in the liver.

metastasis to liver

And here cancer has spread to the lungs in form of multiple nodular deposits.

metastasis to lungs

It may also spread to the peritoneum in form of peritoneal deposits as you can see in the figure.

metastasis to peritoneum

Metastatic deposits in the adrenal gland without direct extension of the tumor may also be seen.

Metastatic deposits in the adrenal gland

Sometimes, it may also spread to the brain or bones.

Chemotherapy is the mainstay of treatment for patients with metastatic disease.

Nowadays, a lot of oral medications are available for treatment of kidney cancer.

In a patient with metastatic disease anytime after starting chemotherapy, if the surgeon feels that the disease can be surgically resected, then surgical resection may be was done in metastatic disease also.

And rarely, upfront surgical resection may be done in metastatic disease, with or without chemotherapy later.

metastatic disease treatment

But the final decision whether to start chemotherapy or to do surgery is taken by oncologists on an individual patient basis, after assessing the exact conditions of the patient, comorbidities, performance status, along with other factors.

Treatment options for different stages of kidney cancer:

Stage I

T1 N0 M0 

Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment approach.
In case of patients who cannot have surgery, arterial embolization or ablation may be employed in selected cases.

Stage II

T2 N0 M0

Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment.

Stage III

T1-2 N1 M0
T3 N0-1 M0

Surgery (radical nephrectomy or partial nephrectomy) is considered the preferred treatment.

Stage IV

T4 Any N M0
Any T Any N M1

Systemic therapy with targeted drug and/or immunotherapy is the mainstay of treatment in most cases.
Surgical removal of the kidney with/without removal of metastasis may be done in selected cases.
Palliative therapy to relieve symptoms and improve the quality of life may be employed.

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