Focus on renal cell carcinoma

Smaller kidney tumours often do not cause any symptoms, but are sometimes detected by chance during preventive examinations or, for example, during an ultrasound scan. Pain in the flank or back area and blood in the urine (reddish to brown discolouration) can be an indication of kidney disease, but colic, weight loss, anaemia, unclear fever, high or low blood pressure, intestinal problems or constant fatigue can also indicate a disease.

Early detection offers the best chance of a cure. After a detailed medical consultation, the most important examinations for the detection of renal cell carcinoma include a physical examination, laboratory tests (blood), ultrasound examination and further imaging procedures using computer tomography (CT) or magnetic resonance imaging (MRI).

The treatment methods depend on the stage of the tumour. The earlier a renal cell carcinoma is detected, the sooner kidney-preserving operations can be performed and the more favourable the prognosis for the affected patients. The size and location of the tumour, as well as the patient's age and general state of health, are taken into account when selecting the treatment.

We offer the complete surgical and medical spectrum for the treatment of renal cell carcinomas.
Complex issues and major surgical procedures can be discussed in our interdisciplinary tumour board. Here we discuss the best treatment strategy together with radiologists, nuclear medicine specialists, pathologists, oncologists and radiotherapists, particularly in the case of more advanced tumour stages.

Surgical removal of the kidney tumour

Partial kidney removal or complete kidney removal (nephrectomy)
Organ-preserving partial removal of small and medium-sized tumours is now an established standard procedure that enables the affected kidney to retain its function. In some cases, kidney tumour surgery is performed in a minimally invasive and robot-assisted manner (DaVinci® system). Depending on the size and location of the tumour, it may be necessary to remove the entire kidney affected by the tumour.
Alternative forms of therapy include interventional, minimally invasive ablation procedures (e.g. heat treatment/radiofrequency ablation) for some kidney tumours. Sclerotherapy using cold (cryo) or heat probes (radiofrequency) can be used for small tumours if older or sick people have a very high surgical risk but wish to undergo treatment. This procedure is not yet an established standard procedure.
Tumour embolisation can also be performed in exceptional cases in patients who cannot be operated on. In this procedure, the blood vessel supplying the kidney is closed off by a catheter so that the tumour is cut off from the blood supply and can no longer continue to grow or even regress. Unfortunately, this effect is often short-lived as the blood vessels open up new routes.

Advanced or metastatic renal cell carcinoma

Tumour resection or metastasectomy
In around 15-30% of patients with renal cell carcinoma, the tumour has already spread to the lymph nodes or other organs (metastasis) at the time of diagnosis. The aim of therapy is then to prolong life or improve quality of life. There are indications that tumour removal can bring a survival advantage despite existing metastases if this is followed by drug-based tumour therapy. Surgical tumour removal (usually complete removal of the affected kidney) may therefore be advisable even in metastatic stages in patients who are not at significantly increased risk of surgery.
If there are only isolated distant metastases, e.g. in the lungs, surgical removal of these metastases may be advisable. This can reduce symptoms and minimise the risk of the disease progressing.

Drug tumour therapy
If metastases of the tumour occur in several places in the body, various drugs can be used to suppress tumour growth. Conventional chemotherapy is virtually ineffective for renal cell carcinomas and is therefore no longer used. Similarly, renal cell carcinomas do not respond well to radiotherapy. Radiotherapy is therefore only used selectively for pain relief or bone stabilisation.
In recent years, a whole series of modern, molecularly-targeted drugs have been newly authorised. Unlike chemotherapy, which can have a toxic effect on both tumour cells and healthy cells, these new drugs influence molecular signalling pathways in the cancer cells and can therefore, for example, inhibit the formation of blood vessels and thus the blood supply to the tumour. Such therapies are often better tolerated than chemotherapy, but are also not free of side effects.
Other novel targeted therapies influence the body's own immune system (known as "immunotherapy") and help it to recognise and attack degenerated tumour cells. Such so-called immune checkpoint inhibitors can achieve long-term success in some patients with metastasised kidney cancer.
In some cases, we can offer our patients novel drugs or drug combinations as part of clinical trials. This can be examined and discussed in a detailed consultation with a doctor. If you are taking part in a clinical trial, you will be looked after by our trial centre in close consultation with your treating urologist.

The causes of kidney cancer are not yet clearly understood. However, a number of different factors can increase the risk of developing renal cell carcinoma.
The most important preventable risk factors are smoking and passive smoking; obesity and alcohol can also play a role. Exposure to cadmium, lead, petrochemical substances, tar and wood preservatives are also considered possible risk factors. Other factors that can increase the risk of developing renal cell carcinoma are chronic renal insufficiency, cystic kidney disease, a positive family history (occurrence of renal cell carcinoma in one's own relatives) and genetic diseases (e.g. von Hippel-Lindau's disease and tuberous sclerosis).

Due to the generally low incidence of renal cell carcinoma in the population, explicit screening is not recommended for everyone. In the presence of the above-mentioned risk factors, in particular cystic hereditary kidney disease, the occurrence of renal cell carcinoma in one's own relatives and other genetic diseases (von Hippel-Lindau's disease and tuberous sclerosis), regular screening, e.g. using ultrasound, may be useful.
If symptoms occur (flank pain, blood in the urine, possibly palpable hardening in the flank), a doctor should be consulted immediately. Even if in many cases the cause of the symptoms turns out to be relatively harmless, a kidney tumour should still be ruled out.

Surgical removal of renal cell carcinomas is currently the only way to achieve a permanent cure if the disease is limited to the kidney. If the tumour is detected in time, in many cases it is possible to remove the kidney tumour while preserving the kidney, so that the function of the kidney is largely preserved. In some cases, partial kidney removal can also be performed in a minimally invasive manner, for example robot-assisted using the DaVinci® system.
If complete removal of the tumour-infected kidney is necessary, the function is taken over by the remaining healthy kidney.
Surgical removal of the kidney tumour may also be advisable if the cancer has already spread to the lymph nodes or other organs. There are indications from scientific studies that systemic drug tumour therapy in combination with kidney tumour removal can be more effective than drug therapy alone. However, this must be discussed with the attending physician in each individual case. Complex cases can be discussed in the interdisciplinary tumour board with experts from different specialist departments so that the best possible therapy can be found for each individual patient.
Interventional therapies (e.g. heat or cold treatment) or close monitoring of tumour growth can be alternatives for people who no longer have a long life expectancy due to their age or previous illnesses, or who have an increased risk of surgery.