Kidney Cancer Treatment at Fox Chase

• If you or your loved one has been diagnosed with a kidney tumor/mass, reliable information regarding this condition is often difficult to obtain.  It is important that you have a good understanding of the diagnostic and treatment options available in order to make an educated choice on how to best proceed with your treatment. The kidney cancer team at Fox Chase strongly believes that an engaged and educated patient is an empowered patient and is dedicated to working with you to make the best possible decisions regarding your care.

  In addition to empowering yourself with information, you should also take into account the experience of your physicians. The multi-disciplinary Fox Chase team is the region’s leader in kidney cancer care. Our physicians are not just clinical experts; they are also researchers and opinion leaders as well. The results of innovations and advances led by Fox Chase physicians have been presented to the international medical community and have been pivotal in advancing the state of knowledge in kidney cancer diagnosis and treatment.

  Our care philosophy is rooted in putting the patient first. We carefully examine each case to tailor a personalized treatment plan for the patient. Patients who have been told elsewhere that their kidneys must be removed have found alternative treatment options at Fox Chase that don’t always involve surgery – and often allow preservation of their kidney. Our multidisciplinary team of medical oncologists, radiologists, pathologists and urologic surgical oncologists work together to coordinate your care and to deliver the best possible clinical outcome.

  Guide to Care

  Generally, when patients are diagnosed with a kidney mass, it is apparent on imaging studies whether the tumor is localized to the kidney or if it has spread beyond the kidney to other parts of the body. For patients with localized disease, surgical resection remains the gold standard, and is superior to therapies such as cryotherapy or radiofrequency ablation.  For patients whose tumor has left the kidney (metastatic disease), Fox Chase offers unparalleled treatment options.  With the development of what is known as “targeted therapy,” metastatic kidney cancer can now be controlled better than ever.  In fact Fox Chase led the effort to bring leading targeted therapy agents into clinical practice. In addition to latest cutting edge treatments for advanced kidney cancer, Fox Chase is developing and evaluating a number of new therapies often before they are available anywhere else.

  For patients whose tumor appears localized several key points are important to remember:

  1. Understand that not All Kidney Tumors are Malignant. 
     • Approximately 15-20 percent of newly diagnosed localized kidney masses are benign.  Such lesions, largely complex cysts, oncocytomas, and angiomyolipomas, are often indistinguishable from kidney cancer with modern imaging.  However, at times, expert radiologists are able to review a patient’s imaging study and make a diagnosis of a benign lesion, saving an individual from unnecessary treatment.  In fact, the kidney cancer team at Fox Chase is fortunate to work with some of the best radiologists in the region.
     • A percutaneous biopsy performed under expert radiographic guidance and interpreted by experience genitourinary pathologists can sometimes provide valuable information to guide treatment decisions in select cases.
     • Fox Chase physicians are performing cutting edge research to develop tools that are able to separate high risk cancers from tumors that do not pose an immediate risk to patients.
  2. Understand Goals of Treatment: 

  • Primary treatment goal: Oncologic cure – cancer control must never be compromised and surgical resection is the gold standard treatment for patients with kidney tumors.  Yet, for some patients “active surveillance” is often an ideal initial option of choice.  Fox Chase physicians are thought leaders and international experts in the field of active surveillance for small kidney tumors.
  • Secondary treatment goal: Kidney preservation — years of experience with kidney (aka: nephron) preserving surgery (partial nephrectomy) demonstrates that this approach is oncologically safe and is associated with long-term benefits to overall health.  Fox Chase physicians are undisputed national and international leaders in kidney preservation surgery, having performed the most partial nephrectomies in the Philadelphia region over the last 5 years. In fact, a standardized system to classify features of kidney tumors as they relate to ability to safely perform partial nephrectomy was developed at Fox Chase in 2009 and is currently used by kidney surgeons all over the globe.  Furthermore, Fox Chase physicians are expert in ablative procedures such as renal cryotherapy or radioablation, which is reserved for select patients.
  • Tertiary treatment goal: Utilization of minimally-invasive surgical  approaches. Fox Chase physicians are leaders in minimally-invasive surgical techniques with one of the largest robotic kidney surgery experiences in the world.  Many tumors that surgeons at other institutions resect through a large incision, Fox Chase surgeons can resect using robotic techniques.

  3. Be Prepared During Your Visit.Here are some questions to pose to your treating physician whether or not you choose to seek an opinion at Fox Chase:
     • Understand characteristics of your mass: size of tumor, clinical stage of tumor, RENAL nephrometry score. If your tumor has been resected, be sure to obtain information regarding pathologic stage, grade and histology.  Pathology review by expert genitourinary pathologists at a high kidney cancer volume academic institution, such as Fox Chase, at times can make a critical difference in guiding further treatments.
     • Why or why not do a biopsy?
     • Treatment Options:
       a. Active Surveillance – am I a candidate?
       b. Medical Therapy (generally reserved for tumors that have spread)
       c. Renal mass ablation (generally reserved for frail patients whose surgical risks are prohibitive).
       d. Surgery – partial nephrectomy is your surgeon familiar and experienced with kidney preservation techniques? Is he/she comfortable performing partial nephrectomy minimally-invasively, thus accelerating your recovery and minimizing pain?; or radical nephrectomy if radical nephrectomy is offered, be sure to establish that partial nephrectomy is not possible at a more experienced center.  If kidney preservation is not possible, can radical nephrectomy be performed with minimally-invasive techniques?
     • Risks of treatment: be sure to understand risks associated with each option.

  In summary, kidney cancer is a rare disease and its treatment is rapidly evolving. Fox Chase is not only on the cutting edge of both medical and surgical treatment for kidney cancer, but is an undisputed international leader in treatment of this condition. At Fox Chase, we take enormous pride in providing world-class care for patients with renal mass.