There are three types of open nepherectomies: 1. Radical nephrectomy. During this type of surgery, the surgeon removes the entire kidney together with the adrenal gland, the tissue around the kidney, and sometimes lymph nodes (regional lymphadenectomy). 2. Partial nephrectomy. During this type of surgery, the surgeon removes only part of the kidney where the tumor is located. This type of surgery is performed in patients that (1) have only one kidney, (2) the cancer is present in both kidneys, or (3) the tumor is small. 3. Simple nephrectomy. During this type of surgery, the surgeon removes only the kidney without other additional tissues or structures.

The most common side effects of nepherectomy are:

• Bleeding during and after surgery
• Wound infections
• Pneumothorax (unwanted air in the chest cavity)
• Damages caused to nearby organs or blood vessels during surgery (such as the spleen, pancreas, aorta, vena cava, large or small bowel)
• Kidney failure

II. Laparoscopic nephrectomy, also known as “keyhole” surgery, is a type of surgery where part of the kidneys or the entire kidney is removed through small incisions. The advantages offered by this surgery are: a fast recovery, less postoperative pain, and less blood loss. The surgery, where the incisions are made in the cavity that surrounds the kidneys, is called retroperitoneoscopic nephrectomy. A laparoscopic nephrectomy can be performed in patients that developed small tumors confined to the kidney.

III. Metastases Removal: Sometimes, renal cell carcinoma patients need another type of surgery, where only the metastases are removed. During this surgery, the doctor removes tissues or structures where the cancer has spread to relieve symptoms that cause a high level of discomfort for the patient.

The medical decision for one of these types of surgery is based on the following two factors: (1) the cancer type, (2) the cancer stage, and (3) the tumor location.

Arterial Embolization

This is a treatment option available for those patients that cannot be treated with surgery. This is a local type of therapy that shrinks the tumor by blocking the artery that carries the blood to the kidney. During this procedure, the doctor inserts a catheter into a peripheral artery (usually in the patient’s leg) and then into the renal artery, and administrates a drug that when it comes into contact with the blood blocks its flow. This blockage stops the blood rich in oxygen and nutrients to feed the tumor, which stops growing, and the tumor shrinks.

The most common side effects of the arterial embolization include:

• Pack pain
• Fever
• Nausea and vomiting

Chemotherapy

Chemotherapy is a systemic treatment (affects cells throughout the entire body) that uses drugs either to stop the abnormal growth and dividing process of the cancerous cells, or to kill them. This type of treatment involves either a single drug, or a combination of several drugs, and it is usually administrated in cycles where a treatment period is followed by a recovery period. This type of treatment can be administrated as a pill, intravenous, or as injection into the muscle. Unfortunately, chemotherapy has shown a limited effect on treating kidney cancer.

Chemotherapy’s side effects include:

• Increased vulnerability to infections
• Easy bruising and bleeding
• Lack of energy
• Temporary hair loss
• Mouth sores
• Nausea and vomiting
• Loss of appetite
• Changes in the women's period cycle
• Permanent or temporary infertility in women and men

Radiotherapy or radiation therapy is a local type of therapy that uses high-energy rays or particles to destroy cancerous cells. Usually, renal cell carcinoma patients receive external beam therapy, where the radiation beam is generated by an external device (linear accelerator). Radiation therapy can be administrated (1) before surgery, as a neoadjuvant treatment - to reduce the size of the tumor (in a small number of patient), (2) after surgery, as an adjuvant treatment - to enhance the results of the surgery by destroying possible cancerous cells that could have been left behind, and reducing the risk of cancer relapse, or (3) as a palliative treatment - to relieve symptoms that cause a high discomfort for the patient. Unfortunately, radiation therapy is not as effective in treating kidney cancer as it is for other types of cancer. Its most common side effects include:

• Discomforting skin sensations (skin pain, red skin, itching and burning skin sensations, desquamation - the exterior layer of the skin sheds, and even atrophies - the skin tissues die)
• Breathing difficulties (because the radiation beam affects the lungs)
• Diarrhea
• Fatigue
• Loss of appetite

Hormone Therapy

This type of treatment uses hormones, administrated as pills or injected, to stop the cancer from growing. Hormone therapy, used as treatment for renal cell carcinoma, involves certain substances that either interfere with the activity of hormones, or stop the production of hormones. This type of therapy is used in a small number of patients with advanced stages of renal cell carcinoma.

Targeted therapy is a new treatment approach that targets only the cancer. In renal cell carcinoma patients, this type of therapy uses drugs that stop the new blood vessels from growing, and targets certain factors that cause the cells to grow. There are only two types of drugs used in patients with renal cell carcinoma approved by the FDA.

1). Sorafenib (Nexavar). This is a drug which blocks the new blood vessel from growing and the growth-stimulating molecules within the cancerous cell. It has proven to be effective in advanced stages renal cell carcinoma patients by slowing down the cancer progression. Sorafenib is administrated as a pill. The most common side effects of this drug are:

• Rashes
• Diarrhea
• High blood pressure
• Red, painful, swelling, or blistered skin on the palms or soles of the feet.

2). Sunitinib (Sutent). This drugs blocks new blood vessel from forming and targets other factors that stimulates the cell’s growth. Sunitinib is administrated as a pill. The most common side effects include:

• Diarrhea
• Skin color changes
• Mouth irritation
• Weakness and tiredness
• An altered taste
• High blood pressure
• Bleeding
• Hypothyroidism

Biological Therapy or immunotherapy is a systemic type of treatment (affects cells throughout the entire body) used to improve the body’s natural defenses. This treatment uses the body’s immune system either to fight against cancer, or to decrease the side effects caused by the cancer treatment, by administrating substances made by the body or created artificially in the laboratory.

There are several types of biological therapy available for renal cell carcinoma patients:

1). Interferon is a natural protein produced by the immune system cells to fight against foreign agents including cancerous cells. For renal cell carcinoma patients, the interferon boosts the immune system and slows down the cancer growth.

2). Interleukin is a substance normally produced by the body in small amounts to fight against infections or different diseases. This drug is used in patients with advanced stages of renal cell carcinoma by boosting their immune system and slowing down the cancer growth.

The biological therapy side effects are:

• Flu-like symptoms (fever, chills, and headache)
• Fatigue
• Low blood pressure
• Kidney damage
• Breathing difficulties
• Heart attacks
• Fluid accumulation in the lungs
• Intestinal bleeding
• Abdominal pain
• Diarrhea