Kidney Helpline
Kidney Health Australia
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Overview
When kidney cancer has spread to the main kidney veins or nearby lymph nodes (stage 3), you may still be able to have surgery to remove the tumour. If the cancer is growing very slowly, the doctors might suggest monitoring it but not treating it (active surveillance).
If the cancer has spread to other parts of the body, targeted therapy, immunotherapy or radiation therapy may be used to control it.
What's on this page
When kidney cancer has spread
When kidney cancer has invaded the major kidney veins or spread to nearby lymph nodes (stage 3 or locally advanced), you may still be able to have surgery to remove the tumour.
If kidney cancer has spread outside the kidney to other parts of the body (stage 4 or metastatic), treatment usually aims to slow the spread of the cancer and to manage any symptoms.
A combination of different treatments may be recommended. Which combination is suitable for you will depend on several things, including how soon after diagnosis you start drug therapies, as well as your blood counts, blood calcium levels and general health.
Active surveillance
In some cases, kidney cancer grows so slowly that it won’t cause any problems for a long time. Because of this, especially if the advanced kidney cancer has been found unexpectedly, your doctor may suggest looking at the cancer regularly, usually with CT scans. This approach is known as active surveillance.
If the cancer starts to grow quickly or cause symptoms, your doctor may recommend active treatment.
Speaking to a counsellor about your feelings and individual situation can be helpful. You can also call Cancer Connect on 13 11 20 to talk to a health professional about your concerns.
Having drug therapies
Drugs can reach cancer cells throughout the body. This is called systemic treatment.
Controlling kidney cancer
Targeted therapy and immunotherapy are the main types of drug therapies used to control advanced kidney cancer. Chemotherapy is rarely used for kidney cancer these days. The types of drugs and combinations used are rapidly changing as clinical trials show better responses and improved survival with newer drugs.
Accessing new drugs
Talk with your doctor about the latest developments and whether you are a suitable candidate for any new drug treatments. You may also be able to get other drugs through clinical trials.
Cost of drugs
The Pharmaceutical Benefits Scheme (PBS) subsidises the cost of some targeted therapy or immunotherapy drugs as long as certain criteria are met. Medicines or treatments that are not on the PBS are usually very expensive unless given as part of a clinical trial.
Reporting side effects
Your doctors will explain the possible side effects of the different drugs. It is important to tell your treatment team about any side effects you have from drug therapies. Side effects can be better managed when they are reported early. If left untreated, some can become life-threatening.
Managing side effects of drug therapies
Your doctor may be able to prescribe medicine to prevent or reduce side effects of targeted therapy and immunotherapy drugs. In some cases, your doctor may delay treatment or reduce the dose to lessen side effects. For more information, see Targeted therapy and Immunotherapy. You may also find Cancer Council's podcast episode New Cancer Treatments – Immunotherapy and Targeted Therapy helpful.
Treatment options
Targeted therapy
Targeted therapy is a type of drug treatment that attacks specific features of cancer cells to stop the cancer growing and spreading.
Targeted therapy
Targeted therapy drugs are used as the first treatment for advanced kidney cancer (first-line treatment), often in combination with immunotherapy drugs.
These drugs are usually taken daily as tablets. They may be taken for many months and sometimes even years. There are different drugs available and your medical oncologist will discuss which combination of drugs is best for your situation.
Cancer cells often stop responding to targeted therapy drugs over time. If the first-line treatment stops working, your oncologist may suggest trying another targeted therapy or an immunotherapy drug.
Side effects of targeted therapy
The side effects of targeted therapy will vary depending on the drug used. Common side effects include fatigue, skin rash, mouth sores, nausea, diarrhoea, joint pain and high blood pressure.
Immunotherapy
There have been many advances in treating advanced kidney cancer with immunotherapy drugs known as checkpoint inhibitors. These use the body’s own immune system to fight cancer.
Immunotherapy
Checkpoint inhibitors may be used at different stages of advanced kidney cancer:
- as the first-line treatment for advanced kidney cancer, either on their own or in combination with targeted therapy drugs
- as a second-line treatment when targeted therapy has stopped working
- as long-term treatment to try to control the cancer’s growth (maintenance treatment).
The drugs are usually given into a vein through a drip (intravenously) and the treatment is repeated every 2–6 weeks. How many infusions you have depends on how you respond to the drug and whether you have any side effects. You may keep having the drugs for many months and sometimes even years.
The drugs used for kidney cancer are rapidly changing as clinical trials test newer drugs. Your medical oncologist will discuss which combination of drugs is best for your situation.
Side effects of immunotherapy
The side effects of immunotherapy can vary – not everyone will react in the same way. Immunotherapy can cause inflammation in any of the organs of the body. This can cause side effects such as fatigue, skin rash, joint pain and diarrhoea.
The inflammation can lead to more serious side effects in some people, but this will be monitored closely and managed quickly.
Radiation therapy
Also known as radiotherapy, radiation therapy uses a controlled dose of radiation to kill or damage cancer cells.
Radiation therapy
Conventional external beam radiation therapy may be used if you are not able to have surgery. It may also be used in advanced kidney cancer to shrink a tumour and relieve symptoms such as pain and bleeding (palliative treatment).
Some people may have stereotactic body radiation therapy (SBRT) to treat tumours that have spread. This may be offered when the cancer has spread to only a few places outside the kidney.
If you have radiation therapy, you will lie on a treatment table under a machine called a linear accelerator. The machine directs radiation beams from outside the body to the kidney. The treatment is painless and takes only a few minutes.
The total number of treatment sessions depends on your situation. Each session usually lasts for 10–20 minutes. You will be able to go home once the session is over, and in most cases you can drive afterwards.
Side effects of radiation therapy
You might have some temporary side effects, such as fatigue, nausea, loss of appetite, diarrhoea, tiredness and skin irritation. The radiation oncologist can talk to you about possible side effects and ways to manage them.
Surgery
Surgery to remove kidney cancer that has spread is known as cytoreductive surgery. Generally, surgery is not recommended if you are unwell or if the cancer has spread to many places in the body.
Surgery
Two types of cytoreductive surgery may be possible in some situations:
- nephrectomy – to remove the primary cancer in the kidney. This may be offered when the kidney cancer is causing symptoms or when there is very little cancer spread outside the kidney. It can also be used in some people who have responded well to systemic treatment
- metastasectomy – to remove some or all of the tumours that have spread. This may be offered when the cancer has spread to only a few places outside the kidney.
Palliative treatment
In some cases of advanced kidney cancer, the medical team may talk to you about palliative treatment. This is treatment that aims to slow the spread of cancer and relieve symptoms without trying to cure the disease.
Palliative treatment
You might think that palliative treatment is only for people at the end of their life, but it may help at any stage of advanced cancer. It is about living for as long as possible in the most satisfying way you can.
Treatments given palliatively for advanced kidney cancer may include radiation therapy, arterial embolisation (a procedure that can reduce blood in the urine by blocking the blood supply to the tumour), targeted therapy or immunotherapy.
Palliative treatment is one aspect of palliative care, in which a team of health professionals aims to meet your physical, emotional, practical, cultural, social and spiritual needs. The team also provides support to families and carers.
See Living with advanced cancer and Palliative care for more information.
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