The 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.

Brady Urological Institute experts are committed to developing treatments and therapies that can have a profound impact on human health.

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.

Surgery 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 -185^o C., creating an iceball around it that cuts off blood supply, killing the cancer cells within.

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.