Speisekarte
Kidney cancer is a disease of the kidneys occurring among smokers. In 2013, an estimated 65,000 new cases were diagnosed in the United States along with 13,700 deaths. Early stages of kidney cancer usually do not exhibit symptoms; in addition, early detection tests for the disease have not been proven. Today, standard-of-care kidney cancer treatment options include but are not limited to checkmate, axitinib, pembrolizumab, lenvatinib plus everolimus, and sunitinib. According to the overall health, kidney cancer treatment options will be inclusive of the signs and symptoms management of kidney cancer that the patients will have upon going to the doctor or clinic with either blood or imaging tests. Like any other dangerous disease, kidney cancer requires immediate doctors’ care. Hence, researchers find it difficult to comprehend the complex features of the subject involved and their implications.
Kidney cancer is taken to be a very common type of malignancy that takes place in a large number of people, particularly adults. For this reason, adults have a very high risk of acquiring such cancer; hence, immediate medical help is necessary to take care of themselves. In the case of several patients, the disease may become very non-treatable in a speedy and effective way. This may be the main reason for a detailed examination along with the broad treatment approach, which may be required in most cases. This discussion mainly focuses on the interpretation and analysis of recent advances in kidney cancer treatment. Though several past studies explained in detail the features and characteristics of renal cancer, many other factors remain to be discovered soon. For the patient, kidney carcinogens should be avoided in order for kidney cancer to be prevented. Although renal cancer is a very rare disease affecting both kidneys, due to huge emotional distress caused by the disease, it is worth taking all necessary precautions against the disease. Prevention can be done in various ways, and the individual must contemplate certain measures before the beginning of kidney cancer symptoms.
Kidney cancer ranks among the top 10 most frequently diagnosed malignancies in the world. While there are several types of kidney cancer, the most common is renal cell carcinoma, which accounts for at least 90 percent of cases. Among the heterogeneous group of renal cell carcinomas, clear cell renal cell carcinoma is the most prevalent, affecting approximately 70% of patients. At the same time, the percentage of cases of kidney disease has decreased, kidney tumor de novo has been increasing.
According to the literature, the classification of kidney cancer subtypes has been refined in the subclassification of metanephric neoplasm, adenoma oncocytoma, and chromophobe carcinoma, as well as papillary RCC, of which subtype 3 has the worst prognosis. Furthermore, subtype 2 papillary RCC also presents in children carrying alterations in the MET, FH and FN1 genes. Meanwhile, further subclassification of clear-cell RCC is on the horizon. Frequent genetic alterations in kidney cancer have also made it possible to develop pathway inhibitors. For example, sunitinib has been reported to be a tyrosine kinase inhibitor targeting VEGF, PDGFR, KIT, etc., and has been found to be effective in first-line treatment of clear cell RCC in a clinical trial. The recent development of the International Metastatic RCC Database Consortium (IMDC) and the Memorial Sloan Kettering Cancer Center Criteria (MKCC) has led to the provision of a prognosis based on underlying systemic inflammation and conditions. At the same time, achieving an understanding of genes and molecular mechanisms is an important aspect of elucidating the pathology of individual cancers. In addition to the crucial roles of VHL and PBRM, FH and Sdh have emerged as genes related to hypoxia.
The broad treatment approach for renal cell carcinoma is surgery, as radical nephrectomy continues to be the cornerstone of the treatment. The surgical technique of limited or partial nephron-sparing surgery has been aided by a number of technological advancements. Though open kidney cancer surgery remains the standard approach to remove renal cell carcinomas, the popular interest in minimally invasive procedures has led to the development of laparoscopic, robotic, and retroperitoneal approaches. These modalities carry a similar safety profile and complication rate, demonstrate equivalent oncological outcomes, and have equivalent overall or disease-specific survival when compared to open procedures.
An entirely different specialized form of surgery, yet a cornerstone of the treatment of localized kidney cancer, is effective at debulking tumors involving regionally metastatic disease. Traditional management for metastatic disease has included various chemotherapies, hormonotherapies, and radiation treatments, but none have been very successful. It has not been until recent years when the first compounds specifically targeting VEGF and mTOR pathways have been introduced, leading to greatly improved overall survival for patients with metastatic disease. Targeted molecular therapies took over from kidney cancer chemotherapy in the last decade; systemic therapeutics, most in the form of an oral VEGFR TKI, were shown to have a superior, longer, objective response rate compared to the previous class of systemic agents (cytokines). Palliative care for patients with kidney cancer, whether they have radical cancer at diagnosis, as well as primary patients with gross cavernous tumor invasion, has also been improved and expanded.
Kidney cancer surgery has always been considered as the primary treatment for renal cell carcinoma (RCC). However, the past few decades have demonstrated pathology stage migration from localized RCC to more cases being diagnosed at an advanced stage. Unlike localized cases, systemic treatments have always been the first and only decision for the metastasis population. Classical types of kidney cancer surgery include partial and complete removal of the affected kidney. As such, as a tissue-specific cancer, surgical approaches in the form of radical or partial nephrectomy have remained to be the standard-of-care option for treatment.
The nephron-sparing approach, particularly robot-assisted partial nephrectomy, was first promoted in the new millennium due to being able to feature the same oncological control like radical approaches but with a lower risk of kidney carcinoma recurrence. In addition, it provides excellent kidney function preservation. In the new era of evidence-based medicine, therapies targeted at proteins involved in various mechanisms of cancer development have been developed, providing significant results in controlling tumor growth and survival in these cases. Since erosion in renal function following nephrectomy is inevitable, partial over total nephrectomy is considered as a beneficial approach. It was the first randomized trial to compare the systemic treatment with sunitinib, an anti-angiogenetic tyrosine kinase (TK) inhibitor over the standard of care cytokine-based therapy. It demonstrated that sunitinib targeted therapy achieved a significantly prolonged progression-free survival and improved tumor response rate compared with the traditional cytokine-based systemic treatment.
In the present day, we can detect early-stage kidney cancer, and when many tumors are confined inside of the kidney, the gold standard kidney cancer treatment is surgery, usually done by partial nephrectomy. Besides, when it is already spread to other sites or if the surgical option is not the best approach, there is another option that includes biologic and immunochemotherapy. Beyond this, there is no chemotherapeutic medicine to standard care for kidney cancer.
Now, we will firmly focus on cutting-edge therapy for kidney cancer. In the last decade, the tumor’s characterization through molecular genomics made it possible to directly attack an intrinsic mechanism of the tumor without damaging healthy tissue, which is one of the greatest stoics in cancer research. Several studies comparing a new combination of free drugs versus the current standard of care showed no difference in expanding survival time but showed fewer side effects, which is good. In this particular trial, researchers evaluated if receiving a combination of a medication called atezolizumab and a VEGF pathway inhibitor – either bevacizumab or sunitinib, was more effective in comparison with a ‘standard of care regimen’ of sunitinib. This trial is currently covered. Since VEGF and mTOR regulate angiogenesis, the potential is that these drugs work as well, and VEGF will shut down as well. So, what should we expect for new demons in the upcoming years? First antibody-drug has available in the market as a new alternative for patients.
It has often been said that kidney cancer is a third important genitourinary malignancy. While therapeutic measures such as surgery, radiation therapy, chemotherapy, and targeted therapy have been the cornerstone, this manuscript tries to concentrate essentially on immunotherapy and analyzes the various developments that have been successful in treating a host of malignancies, especially renal carcinoma. Indeed, since the late 1980s, patients with metastatic renal cell carcinoma have been successfully treated with cytokines such as interferon and interleukin-2. As the roles that PD-1 and CTLA-4 have been brought to light within the immune system, extensive studies in using these proteins as a target for treatment have resulted in therapeutic development of PD-1 and PD-L1 monoclonal antibodies, hence improving patient outcomes.
Kidney cancer or renal cell carcinoma ranks within the top 10 most common cancers diagnosed for both males and females globally, though being higher in countries that are more developed. In 2022 alone, it is expected that a total of 76,080 new cases would be diagnosed, the majority of which are likely predicted to die from the disease in the United States. However, the era of immune checkpoint therapy has brought much-awaited results for patients suffering from mRCC or localized and advanced disease. Based on the overall patient outcomes recorded in various trials, risk categories have been defined and therapeutic implication drawn, which is used in real-world clinical practice. It is further confirmed that the current gold standard of treatment in mRCC is a combination of TKI and PD-1 therapy, which will further strengthen the immune therapy role in treating renal cancer.
An ongoing challenge when treating advanced or metastatic clear cell renal cell carcinoma (RCC) mainly resides in the tumor microenvironment, affected by intra-tumor and inter-tumor heterogeneity that leads to recurrent resistance. Precision medicine therefore appears to be a promising strategy that involves adopting a patient stratification based on histological findings, the clinical features of patients, and more recently, the molecular features of the tumors. In particular, next-generation sequencing has contributed to the identification of driver alterations that have been developed as candidate predictive biomarkers of response to treatment incorporated in clusters of agents able to specifically target signaling pathways that are abnormally deregulated. Apart from this, other breakthroughs have disrupted the history of oncology including pathways of immune tolerance, directly affecting the immune system, and permitting the reversal of a suppressive tumor microenvironment, as immunotherapy is emerging as another key player. Allowing the effective and durable activity of both the innate and adaptive immune systems has begun to play a fundamental role in cancer treatment, revolutionizing the context of oncology via upfront combination with conventional systemic treatments.
Progress has highlighted objective overall response rates independently of mutational status, implicating a marginal cross-talk between the antiangiogenic treatment and T-cell immunity. Finally, the first-in-class anti-Hippo pathway agent has emerged. In short, advances in multimodal precision medicine in the management of RCC based upon their molecular landscape, metastatic sites, and histology are profoundly revolutionizing how renal cell carcinomas are best treated. Thus, hope can finally be given to patients who are resistant to standard-of-care treatment.
Genomic profiling of clear cell renal cell carcinoma (ccRCC) has enhanced the understanding of the mutational landscape as well as epigenetic dysregulation associated with kidney cancer. Several novel targeted therapies that address specific genetic characteristics of these lesions, such as mutations in the von Hippel-Lindau (VHL) gene and mutations and amplification of the proto-oncogene mesenchymal-epithelial transition (MET) receptor, have been developed. These targeted therapies work on the basis of disrupting each molecular pathway. With the development of next-generation sequencing (NGS) genomic profile tests, many more specific attributes relating to tumor biology are elucidated, offering a valuable resource to match patients with advanced or metastatic kidney cancer to targeted therapies. A further fine-tuning of these strategies has been to develop combination therapies to counteract immune-evasion pathways.
Combinations of therapies that work well with each other expand the range of effective treatments. This enables patients with advanced disease, previously thought to be untreatable, to undergo neoadjuvant treatments before surgical removal. It also leads to overall longer periods without disease progression, higher percentages of shrinkage of metastases on imaging, and very rare complete, durable shrinkage.
The background materials present an overall schematic of the general treatment contours. The subsequent papers fill in details of the components of the corresponding panel, including Surgical Removal, Systemic Therapy for Metastatic Disease, Adjuvant Trials after Complete Surgical Removal of Kidney Cancer, and Systemic Therapy.
The primary goal of modern molecular oncology is to develop intervention strategies that act selectively on tumors, stopping cancer growth while causing less harm to the body. Tremendous progress in this direction has been made, due not only to research targeted directly at kidney cancer, but general progress in understanding molecular genetics and cellular physiology.
An estimated 1274 kidney cancer research studies are currently ongoing. Of these, 1106 (86.9%) are actively recruiting, with trials being done everywhere in the world, including in Europe (562; 44.2%), the United States and Canada (335; 26.3%), and Asia (201; 15.8%). The majority of ongoing clinical trials use new molecularly targeted agents (n = 860; 67.5%), increasingly combined to exploit synergies (406; 31.9%). There are ongoing trials that evaluate different targeted tool compounds, starting from tyrosine kinase inhibitors (n = 293; 23.0%) to immune therapy agents (n = 158; 12.4%). Also, many new compounds are specifically designed to target specific tumor targets such as molecular/cellular alterations, including hormone receptors, chromatin regulation enzymes, receptor tyrosine kinase ligands, and lymphocyte accumulation regulators.
Regarding the strategies used in undergoing trials, a great proportion of trials compare new treatments with the current standard treatment (i.e., they are carried out in a neoadjuvant setting or in patients with disease progression or relapse), or with an alternative experimental treatment (i.e., in second- or third-line setting), with the hope of improving efficacy and reducing toxicity. Meta-analysis summaries of such trials can provide comprehensive summary overviews of any differences in efficacy and safety between treatments. Smaller proportions of trials are devoted to validating new techniques or to exploring the most effective forms and schedules of current treatment.
For all these reasons, there is hope for the achievement of further significant breakthroughs in the treatment of advanced and metastatic RCC in the coming years. This will involve, among other things, a continuing search for effective treatments in the implementation of targeted therapies in combination, and for investigation of plant-based treatment with variously mature views. There is also renewed research interest in developing porter-target monoclonal antibodies, for the use of new pathway combinations, and in strategies using virological immunotherapies and targeted therapies.
Advancements in kidney cancer treatment: A comprehensive analysis. This comprehensive analysis analyzes and explains recent changes and developments in the treatment methods used in kidney cancer therapy, from drugs that fight the disease to non-drug options.
The diagnosis of kidney cancer and the associated therapies can result in physical and emotional stress. The modern approach to kidney care is holistic. In this context, palliative care is an important part of enhancing the quality of life. A multidisciplinary staff may be able to help people feel more at ease. This team will include a doctor, a nurse, and a social worker working together to handle the kidney care. Pain relief is important to have a good quality of life. This may include a variety of techniques and treatments.
Disease symptoms of side effects depend on the treatments. Learn about some of the most common kidney cancer care side effects. The side effects of kidney cancer drugs might be serious. Kidney cancer care should not stop without a consultation. Tell the nurse or doctor whether there are any medications that cause problems. After injection, most symptoms are already bearable. Give your healthcare provider a list of all treatments as well as physical and emotional worries. The emotional effects of cancer care are addressed in this chapter. They can lead to common feelings of anxiety when faced with pain and immune system issues, stress, and other difficulties. Emotional healthcare can help address these risks.
Because of the often complex nature of kidney cancer, especially for those with metastatic renal cell carcinoma, and the constant advancements in treatments and drug options, it is especially important for patients to have access to educational resources. Patient education has shown to contribute positively to patient experience and outcomes. Many in-depth support programs are available to patients of varying language and background. Many times, nurses, social workers, and other healthcare professionals are available to answer any questions that patients may have about risks, managing side effects, diet, and symptom management. These resources also assist in alerting patients to the risks of not following proposed treatment plans, either through misinformation or disinformation, or by ignoring treatment altogether. Furthermore, patients are coached on how to effectively communicate with their care team to check progress and provide informed consent.
One support program allows patients to reach out to oncologists, case managers, and peer mentors if they need help in managing the community support and financial services. This network employs doctors, social workers, financial advisors, public and private organizations, and individuals to seek to help low-income patients attain necessary transportation, food access, housing, insurance, and family support that enables patients to undergo cancer treatment without financial hardship. Other financial counseling and support services are offered at most oncology care offices. Many insurance companies also have in-house case managers. The specific types of support available to patients are unique to any particular institution. The burden of insuring patient well-being is shared among oncologists, their staff, the patients’ families, and the patient themselves. Providing comprehensive educational and support resources serves dual purposes in the fighting of the disease: providing patients with necessary tools of disease management, and assisting them in finding secondary support to undergo treatments.
Today, with the additional novel agents that are available – cabozantinib, lenvatinib with everolimus, lenvatinib with pembrolizumab, etc. – the problem of kidney cancer treatment cost, continues to increase. Currently, for the United Kingdom (UK) patient, the introduction of tyrosine kinase inhibitors (TKIs), nivolumab, and pembrolizumab provides a “cost” of approximately £30,000 per annum for the hope of survival of 12 months compared to the use of standard interferon and dacarbazine. The price “suggests” a kidney cancer treatment cost per Quality Adjusted Life Year (QALY) that exceeds the National Institute of Clinical Excellence (NICE) threshold, and with about 25% of these patients responding, a further 75% do not obtain this benefit. From an economic point of view, truly answering whether the cost-effectiveness of these treatments is appropriate and in whom they should be administered more robustly impacted by their extent of efficacy is probably the most important unanswered question.
Every country appears to have access issues based on the economics of care. The U.S. has the problem of health insurance and high out of pocket expenses. More importantly, the U.S. has the highest overall healthcare dollar spend per capita, and the cancer spend is the second major use of the dollar in that economic context, exceeded only by cardiac care. Approximately, 20-25% of cancer spend is for those expected to die within 6 months, which has long been a challenge regarding the absolute magnitude of care confronting modest survival options. Other economic considerations of an advanced disease can include the need for caregiver support, co-morbidities and their kidney cancer treatment cost, the use and effects of opioids, and the total costs of care. The range of treatments from £15,000 to £41,000, though QALY estimation, does not limit UK NHS Resource Allocation Committee acceptance and a growing annual treatment bill, which can provide a glimpse into how much additional care is utilized.
Since it was first approved in 1992, many other therapeutics have appeared, altering the treatment landscape for metastatic kidney cancer. Additional progress is necessary in order to eliminate advanced disease and enhance the likelihood of clinical healing or long-term survival. Concentrating on well-defined, high-level research concerns will be vital as it is continued to explore optimal treatment strategies for non-metastatic renal cell cancer. Several ongoing and near-term studies in the CKCS, Urothelial, and other contexts are looking at investigating the revitalized combination portfolio in the adjuvant and neoadjuvant environments, as well as examining effect sequencing concerns. In patient subgroups with micrometastatic renal cancer, Detroit site investigators are also leading trials to observe the combination of ICI and VEGF inhibitors, as well as one of nivolumab in the metastatic kidney cancer concept. In order to obtain broader applicability across the entire community, these trials emphasize enriched populations with the highest promise of benefiting from treatment.
Advancement in the management of kidney cancer has been swift over the previous two decades, with investigations into combination strategies, identification of new aims for directed drug treatment, modulation of tumor microenvironment with immunotherapy (IO), and personalized patient selection and dosing, amongst other areas of development. Nevertheless, one of the most exciting fresh concepts is developing how the human host can aid in his or her own fight against cancer, with a focus on further improving IO effectiveness and appreciating how the consequences of a therapeutic may differ when combined with various arenas of personalized therapy or therapy combinations.
Kidney cancer may be treated with nephrectomy or partial nephrectomy. In a radical nephrectomy, the whole kidney is removed. An entire kidney could also be removed, as well as some tissue from the circumference. Another term useful for describing the carcinoma is invading the surrounding tissues. Secondly, partial nephrectomy is carried out when the total removal of a wrapped neoplasm is not considered the most viable treatment option. The inner and surrounding margins of the neoplasm are removed via this method.
Non-invasive treatments are important for kidney cancer. As a result, radiotherapy, kidney cancer chemotherapy, and biologic therapy (immunotherapy) may all be positive options. Many people with kidney cancer will have one or more of the above. Individuals who meet all the following requirements may be eligible for radiation therapy as a prioritized treatment: First, the individual is unable to undergo an operation to extract the tumor due to underlying medical circumstances. Second, the individual is unwilling to undergo surgery. Third, the neoplasm is still contained inside the kidney. Finally, the individual’s renal function is 60ml/minute or greater. In theory, almost all medications can be given first or possibly after radiation therapy. A partial nephrectomy is more likely to be given as a first choice for a small (<4 cm) peripheral neoplasm. A small neoplasm does not undergo therapy for grade 1 cancer. Combining medication following radiation or medication alone is more likely to be done first in a peripheral neoplasm that measures greater than 4 cm or individuals who have larger pelvic tumors. Immunotherapy and targeted therapies can be used to decide on the best therapy. Furthermore, second-line therapy alternatives. Whether medication if a second operation is needed should also be considered in assuming.
The most common side effects of surgery are pain and fatigue. Enucleations have a lower risk for long-term kidney damage. Side effects of targeted therapy and immunotherapy include, but are not limited to tiredness, diarrhea and colitis, skin changes, high blood pressure, low magnesium level, thyroid changes, pneumonitis, liver changes, heart changes, and many more. Immunotherapy can stimulate inflammation throughout the body known as an immune-related response. This can present as new or worsening symptoms that can affect every system in the body. This usually is not known to be related to an infection. Please inform your provider about any new or worsening symptoms.
The side effects can be split into two main sections: the physical. These include how patients feel in themselves and how their bodies are working. For example, patients might feel tired, have indigestion, a rash, or an immunotherapy side effect that affects their skin or thyroid. The emotional side effects are those where patients feel anxiety, depression, or anger. Managing possible side effects ties into both the treatment options and precautions on how to prevent or cope with side effects. Here, practical tips for managing aspiration, diarrhea, fatigue, lack of appetite, nausea, and vomiting are emphasized. Patients are also consoled with the fact that while treatment for kidney cancer can be challenging, completion is rewarding. Lastly, it is important to tell your doctor or healthcare team about any side effects you might be experiencing. This includes new symptoms or changes in any of the symptoms you currently have. You could need to be seen or have your treatment altered, stopped, or temporarily held until improvement of a symptom.
It is strongly believed that advancement in the treatment of kidney cancer is made through clinical research and innovative therapeutic trials. The development and eventual approval by the U.S. Food and Drug Administration, or by other regulatory agencies around the world, of any new therapeutic agents for the diagnosis or the treatment or cure of any human diseases ought to make a strong scientific merit, with plenty of preclinical laboratory experiments, and with clear demonstration of an improved safety or an improved efficacy when compared with the existing therapeutic interventions. When this scientific evidence is clear and established, using a mechanism of proper informed consent, it is ethical to propose and write protocols for human clinical applications to reach drug approval. Progress in kidney cancer management, such as the current outstanding patient survival duration under the use of recent therapeutic agents, would have not been feasible without patients, physicians, researchers, and pharmaceutical companies showing interest and willingness to participate in therapeutic clinical trials and in innovative studies.
There are a lot of outstanding trials testing brand new treatment modalities which are promising in all different levels of the treatment of kidney cancer. There are multiple different immune stimulants showing activity in early stage clinical trials in combination with immunotherapy and/or chemotherapy. In addition to immune stimulants there are novel therapies that promote selective apoptosis or natural cell death in kidney cancer. There are also trials evaluating new vaccine therapies to better engage a patient’s immune response to eliminate the cancer. In addition, there are trials that offer early surgery, stereotactic ablative radiations, and some with bladder preservation surgeries that look very intriguing.
The importance of supportive care alongside more traditional cancer treatments, such as kidney cancer chemotherapy, has become increasingly apparent. In fact, it’s been shown to significantly lengthen survival time. Active symptom control and palliative care, however, has traditionally been associated with end-of-life care, but it has great value in helping you retain a sense of wellbeing in the intermediate stages, when you’re having ongoing treatment.
Kidney cancer and the treatment of the disease often means you’ll have a great team supporting you, including a dietitian. And possibly, this sort of input may not fall under the realm of your surgeon or medical oncologist.
Supportive care and lifestyle recommendations may encompass areas such as symptom management in advance disease, dietary advice, activity advice, pain management, mentally managing this part of your pathway. It’s well-proven that making specific lifestyle changes can augment your treatment, reduce your kidney cancer surgery recovery time, and help with general health and happiness.
Eating well, keeping as active as your body lets you, especially when you’re quite sedentary during treatment and feeling terrible, increasing your exercise marginally (remembering you’re needing rest and kidney cancer surgery recovery too), resting well, and surrounding yourself with love and laughter will provide you with resilience that translates into better treatment tolerance and curative outcomes.
While ‘prehabilitation’ and preparedness approaches for kidney cancer surgery are well-documented, supportive care, specifically with a diet and lifestyle focus, may not be standard in your hospital. These are areas you can request specific help for. Your multidisciplinary team can offer detailed, practical advice for dealing with the muscular and emotional burden of ongoing treatment and side effects to ensure you are at your strongest physically and psychologically to fight kidney cancer.
English 
Türkçe 
Deutsch 
Русский 
Italiano 
Español 
Français 
Português 
Română 
Українська 
Bosanski 
Српски језик 
العربية 
简体中文