• Chemotherapy
• Clinical Trials
• Future Treatments
• Immunotherapy
• Nephrectomy
• Radiation Therapy
• Surgical Treatments
• Treatment Choices by Stage

Surgery is the main treatment for RCC. The chances of surviving a large RCC without having surgery are poor. Depending on the type and stage, surgery may be used to remove the RCC together with some of the surrounding kidney tissue or the entire kidney. Sometimes it is necessary to remove the adrenal gland (small gland found attached above the each kidney), depending on the location of the tumor.

• Radical nephrectomy: The most commonly performed surgery to treat RCC is called a radical nephrectomy. Radical nephrectomy removes the whole kidney (along with its cancer), occasionally the adrenal gland if it is in proximity or involved with the tumor, and the fatty tissue immediately around the kidney. Regional lymphadenectomy (taking the lymph nodes around the kidney) is not usually indicated in most cases. Several studies showed no benefits after lymph node dissection. This procedure removes nearby lymph nodes and may help in staging the cancer. However, there is no therapeutic benefits.

• Partial nephrectomy: This procedure does not remove the entire kidney. Instead, only part of the kidney containing cancer is removed, leaving the rest of the organ behind. Partial nephrectomies are often done in patients with impaired kidney function, RCC in both kidneys, or in patients with only one kidney who develop RCC. More and more partial nephrectomies are being done in patients without any kidney dysfunction or having multiple tumors. RCC (smaller than 4 cm (about 1 _ inch) can be considered for partial nephrectomies. The results, so far, have been very promising. The obvious benefit is that the patient is left with 1 1/2 kidneys instead of just one. There is a very small risk that some cancer may be left behind, however. Current data suggest that recurrence rate is very similar to radical surgery over 5 year period.

• Removal of metastases: About one-third of patients diagnosed with RCC already have metastatic spread of their cancer. Sometimes surgical removal of the metastases will temporarily relieve the pain and some other symptoms of metastatic disease. But this usually does not help patients survive longer. In general, if many metastases are present, surgery to remove all or some of these is not recommended. But surgery may be recommended if only a few easily accessible ones are present and can be completely removed without causing serious side effects.

• Arterial embolization: Arterial embolization is a technique that blocks the artery that feeds the tumor-containing kidney. A very small catheter (tube) is placed in an artery in the groin and advanced through the vessel until it reaches the kidney's artery. Material is then injected into the artery to block it. This procedure, while rarely performed, is sometimes done before nephrectomy to kill some of the cancer cells and to reduce bleeding during the operation.
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• Laparoscopic nephrectomy: This is a new surgical treatment modality for removing RCC. As compared to open surgery, it uses multiple small "keyhole" incisions to introduce telescopes and surgery is done by using these telescopes. After separating the kidney from its blood supply, the kidney is removed through a smaller incision in the lower belly or shredded in an inpermeable bag and removed through a telescope port. Claimed benefits are less pain and shorter convalescent period as compared to the open surgery. High learning curve and technical difficulties are some of limitations of this technique. Recently developed "Hand-assisted Laparoscopic Technique" uses one hand in the abdomen and the other hand a telescope thereby providing a textile sensation for surgeon. This theoretically may decrease the learning curve and surgical time of the laparoscopic procedure. In addition, intact specimen can be extracted whereas the entire kidney and tumor are shredded for extraction in a pure laparoscopic procedure. Laparoscopic surgery for RCC is still in infancy and long-term data and follow-ups are needed to evaluate its efficacy.

• Cryoablation: Currently, this procedure is still in the experimental stages for treating RCC. A cryo (freezing) probe is inserted into the kidney tumor either through a laparoscopic approach or open surgery. Liquid nitrogen is run through the probe to freeze and kill the tumors. An ice ball is thereby created around the probe which can be seen and followed by simultaneous ultrasound examination. There is no known data regarding safety, effectiveness, or follow-up after cryoablation of the renal tumors yet. Cryoablation is most commonly performed by laparoscopy.

Risks of surgery
Risks associated with surgery include intraoperative (during surgery) or postoperative (after surgery) bleeding which may require blood transfusions, wound infection, damage to internal organs and blood vessels (such as the spleen, pancreas, aorta, vena cava, large or small bowel) during surgery, pneumothorax (unwanted air in the chest cavity), incisional hernia (bulging of internal organs underneath the surgical incision due to problems with wound healing), and renal failure (if the remaining kidney fails to function well).

Some people can't tolerate surgery because of poor health (heart or lung problems, for example). For them, radiation therapy, arterial embolization of the cancer, or experimental chemotherapy or immunotherapy may be their only choices for kidney cancer treatment.