DR. VIVEK VENKAT

Metastatic kidney cancer refers to cancer that has spread to other organs like bones, lungs, liver or non-regional lymph nodes. It is also referred to as stage 4 disease.

Symptoms depend on the organ involved.

• Progressive loss of weight and appetite are common.
• Bone pain and anemia from bone involvement are common.
• Weakness or paralysis can occur if the spine is involved and needs urgent treatment.
• Jaundice from liver involvement.
• Cough from lung involvement.
• Local symptoms related to the kidney like severe pain, a lump, blood in the urine, etc. may be seen.

Multiple treatments are available presently. A lot of research is being performed leading to discoveries of new treatments regularly.

• Targeted therapy – these new medicines target specific mutations in cancer cells to reduce their growth and revolutionized the treatment of advanced kidney cancer
• Immunotherapy – Newer class of medicines which enhance the defense against cancer cells by stimulating the body’s own immune system. They have shown excellent results and can be used in combination with targeted therapy
• Cytoreductive nephrectomy - In selected cases it may be necessary to remove the kidney. This is needed when the patient has severe symptoms like pain or bleeding, or to improve the response to the immunotherapy the patient will receive. This procedure is similar to radical nephrectomy.
• Chemotherapy – It is not very effective and used only in certain types of kidney cancer.
• Radiation – This is used for symptomatic treatment especially for bone pain.

Each drug has specific side-effects and in a small percentage of people these can be severe needing stoppage of the medicine. Side-effects of include


• Skin reactions
• Flu-like symptoms of fever and tiredness
• Muscle aches
• Breathlessness due to pneumonitis
• Diarrhea
• Fluid retention and swelling of legs
• Damage to the thyroid
• Problems with blood clotting
• High blood pressure

How can you prepare for treatment?

• First your diagnosis and staging will be completed. If you have metastatic disease need to discuss the options with your uro-oncologist.
• If the kidney or tumor has not been removed you may need a biopsy to determine the type of kidney cancer. This is usually done by CT scan-guidance.
• The uro-oncologist may ask for further details and tests to assess your baseline fitness.
• Continue your normal exercise and increase walking and weight bearing exercise.
• Healthy diet rich in fruits and vegetables with reduced salt, sugar, fats and processed meats is recommended.
• A thorough discussion on various options described above and their side-effects will allow the doctor and you to choose the optimal treatment in your case.

What is the follow-up involved?

• Follow-up involves examination and assessment of your symptoms usually every 2-3 months.
• Basic blood tests like CBC, kidney and liver function are monitored to check for progression of disease and side-effects of medicines.
• If there are any signs of worsening then scans may need to be repeated.

What is the success rate and survival?

Don’t lose hope - advanced kidney cancer can be controlled for a long time and it is important to keep a positive mindset.
With current treatments patients are able to survive for many months to years and newer treatments are being discovered each year.