Advanced kidney cancer

Your kidney cancer is called advanced if it has spread from where it first appeared in the kidney. Your cancer may be advanced when you are first diagnosed. The cancer can spread

• Locally, which means to tissues next to the affected kidney
• To other parts of the body

Local spread means the cancer has spread

• Within the kidney OR
• To the renal vein (the large vein leading out of the kidney) OR
• To the vena cava (the large vein taking blood back to the heart)
• To the adrenal gland above the kidney
• To other body tissues very close by, for example the bowel

If you have a cancer that has spread locally, you may still be able to have surgery to remove the cancer. It is also possible sometimes to operate to remove cancer spread. This type of treatment won't be suitable for everyone. You have to be fit enough to make a good recovery and some people with advanced cancer are not well enough.

Cancer that has spread to another part of the body is called a secondary cancer or metastasis. Not every kidney cancer will spread. And not all kidney cancers will spread to the same places. But if a kidney cancer is going to spread, it is most likely to go to the

• Lungs
• Bones
• Brain
• Liver
• Other kidney

It is not possible to say for sure where a cancer will spread because the same type of cancer can behave in completely different ways in different people.

Remember - if you get aches and pains they may not be related to the cancer but may have another cause. Do check with your doctor about any symptom that is worrying you.

If you have advanced kidney cancer, the aim of your treatment is to try to slow down the growth of the cancer or to destroy some of the tumour. And to reduce or get rid of any symptoms that you have.

Which treatment you have depends on

• How much your cancer has spread
• Where the cancer has spread to in the body
• The treatment you have already had

Your treatment will also depend on how fit and well you are. Your fitness is an important indicator of how you will respond to treatment.

If your cancer has spread to only one other site in your body, such as the lungs or liver, your doctor may suggest surgery to remove either

• Your kidney alone OR
• Your kidney and the secondary cancer

Generally, this treatment will only be possible if you have only one secondary cancer (or a very small number). Even if it is only possible to remove your kidney, this is worth doing if you are well enough. If you are fit enough for the surgery, it may slow down the progress of the cancer and keep you in reasonable health for longer. If possible, your affected kidney and the secondary may be removed in one operation. For example, if the secondary is in the liver, close to the affected kidney. But in most cases, it will be necessary for you to have 2 operations. Generally, the kidney will be removed first. Then, after you have recovered from that operation, you will have more scans, followed by surgery to remove the secondary cancer.

When deciding if this type of treatment is right for you, your doctor will take into account how healthy and fit you are. You will need to be in good general condition. This is very important for predicting how well you will respond to treatment. Depending on where your cancer has spread, your cancer specialist will refer you to a specialist surgeon to do your surgery. There is more about surgery for secondary kidney cancer in this section of CancerHelp UK.

Doctors and researchers have been working for years on ways of destroying kidney tumours without having a major operation. They have tried freezing (cryotherapy), using radio waves to make heat (radio frequency ablation) and high intensity focused ultrasound (HIFU), also to produce heat. One main advantage of these techniques is that they are done from outside your body (by putting probes through the skin or by using a laparoscope) rather than having open surgery. Radio frequency ablation is already used for tumours that have spread to the liver. But all these techniques are still under development and none of them can be regarded as standard treatment just yet. There is information about cryotherapy, high intensity focussed ultrasound (HIFU) and radio frequency ablation (RFA) in our kidney research page.

If you are not well enough to have surgery, your doctor may suggest embolisation. This is a procedure where the doctor injects a substance into the artery leading to the area of the cancer. The substance blocks the artery and cuts off the blood supply to the tumour, which makes it shrink. But your doctor is only likely to suggest this if you are being troubled by symptoms that could be relieved by this treatment. This treatment can be used to treat cancer that has spread outside the kidney (for example to the liver) as well as the cancer in the kidney.

Embolisation is explained in detail on the page about treating early kidney cancer in this section of CancerHelp UK. The process is basically the same when it is used to treat a secondary cancer.

Embolisation can also be used before or during surgery to reduce the risk of bleeding during the operation. For example, it may be used before surgery to secondary cancer in the spine.

If your cancer has spread to the brain, then your doctor may suggest having radiotherapy to the brain. There is detailed information about this treatment in the section on radiotherapy for kidney cancer.

If the cancer is advanced when you are diagnosed or comes back after surgery your doctor may suggest treatment with biological therapy. Biological therapies are treatments that use natural substances from the body, or drugs made from these substances. There are several different types of biological therapy used for advanced kidney cancer, including sunitinib, interferon and interleukin (IL-2).

Other biological treatments are being researched. Bevacizumab (Avastin), sorafenib (Nexavar) and temsirolimus (Torisel) have been shown to stop or slow the growth of advanced kidney cancer but the National Institute for Health and Clinical Excellence (NICE) have given guidance that they are currently too expensive for the amount of benefit they give. So they are not widely available on the NHS. You may have them as part of clinical trials.

There is detailed information about biological therapies for kidney cancer in this section of CancerHelp UK. And there is information about research into some new biological therapies in the kidney cancer research section. If you have advanced kidney cancer you might be offered one of these newer therapies as part of a clinical trial.

So far, chemotherapy has had very little effect in patients with kidney cancer. So it is not often used to treat the disease. You may be offered chemotherapy as part of a clinical trial of new drugs, or in combination with biological therapy.

You will need to discuss with your doctor which of these different treatments, or combinations of treatments is best for you. There is information about chemotherapy in this section of CancerHelp UK.