kidney cancer program at Johns Hopkins offers the most modern treatment
options. Our urologists, who are among the leading laparoscopic
surgeons in the world, specialize in the latest minimally invasive
techniques to treat kidney tumors, offering patients comprehensive
and diverse therapy options.
Kidney cancers either start within the kidney
(primary) or have spread to the kidney from another organ. Renal
cell carcinoma (RCC), the most common kidney cancer (accounting
for approximately 85% of all kidney tumors), occurs twice as often
in men as in women.
is the most effective and proven treatment for kidney cancer. RCC
treatment comprises the majority of renal surgeries for the Brady
Urological Institute experts. Historically, the traditional surgery,
the radical nephrectomy, was performed through a large incision
in the flank. The entire kidney was removed along with the tumor.
Today, except in rare instances, open surgery is no longer necessary.
In the search for renal surgical procedures that
were less invasive, most of the pioneering work in laparoscopic
kidney surgery was begun at Johns Hopkins in the 1990s. Johns Hopkins
specialists were among the first to perform the laparoscopic radical
nephrectomy for treating RCC, using miniature tools attached to
long rods that were manipulated through very small "keyhole" incisions
to perform the excision and tumor removal. These smaller incisions
(each about the size of a dime) result in shorter hospitalization
(two days, on average, as opposed to four to seven days for the
open procedure), less postoperative pain, and a shorter convalescence.
The procedures also offer cosmetic advantages (the wounds heal with
almost no visible scar), and patients are able to return more quickly
to normal activities of daily living.
More recently, our experts have been performing
partial laparoscopic nephrectomies-removing the tumor without sacrificing
the entire kidney-a procedure that offers the same long-term disease-free
results that were previously achieved by complete removal of the
diseased kidney. Laparoscopic partial nephrectomy requires laparoscopic
expertise with extensive experience and training. This latest technique
is rapidly becoming the standard of care for kidney cancer; it is
reserved for tumors in the peripheral portion of the kidney, or
for tumors less than 3 cm in size.
The latest kidney cancer therapy advance offered
by Johns Hopkins specialists is percutaneous renal cryoablation.
The procedure begins with one to four needle probes inserted directly
into the tumor under CT guidance. The extreme cold that is the hallmark
of cryosurgery is created by argon gas in the probe. Rapid expansion
of the gas drops the temperature in the tumor to -185o C., creating
an iceball around it that cuts off blood supply, killing the cancer
Percutaneous cryoablation is performed in a minimally
invasive fashion under intravenous sedation, without the need for
general anesthesia. Since a large flank or laparoscopic incision
is not required, there is minimal patient discomfort, a low incidence
of complications, and a significantly reduced recovery time. Most
procedures are performed on an outpatient basis. Currently, kidney
cryoablation is reserved primarily for patients who are at too high
a risk for surgery due to comorbidities. We first started performing
renal cryosurgery in 1997, and since then well over 100 patients
have been treated, with a success rate of approximately 90%. We
recently expanded our renal cryosurgery practice and now expect
to perform many more kidney cryotherapy procedures per year. As
technology improves, cryoablation may eventually prove to be the
preferred therapy for small, incidentally detected renal masses.
Discovery is important in the kidney cancer battle.
RCC often becomes metastatic or recurs after treatment. Our researchers
are now looking at the underlying biology of the cancer and trying
to discover what it does to the immune system, and what we can do
to counteract that activity with drug therapy. We have currently
developed a therapy for metastatic renal cell carcinoma that looks
effective in animal models. By freezing the tumor and providing
a special chemotherapy that stimulates the immune system, we can
have a marked impact on metastatic disease, in many cases curing
the animals of kidney cancer. We expect to initiate clinical trials
with this new treatment approach in late 2006.
New strategies that cause the immune system to
fight the disease are now being studied; these offer new hope for
patients whose tumors cannot be surgically cured. There are now
two new drugs (Sutent and Nexavar) approved for advanced kidney
cancer, and both show promising activity by slowing disease progression.
Working with medical oncologists Michael A. Carducci, M.D., and
Roberto Pili, M.D., we are offering these medications to our advanced
kidney cancer patients, as well as enrolling patients into a variety
of clinical trials combining chemotherapy with these compounds.