Kidney Cancer

The complete range of advanced treatment options for kidney cancer is offered by USC urologists are the very same physicians who pioneered and refined these procedures. USC urologists continue to define the field of minimally invasive surgery for kidney cancer, with special expertise in kidney-saving techniques.

The combined experience of our urologists with robotic and laparoscopic minimally invasive surgery, in addition to percutaneous and open surgery, exceeds 3,500 clinical cases, which is among the highest in the world. Our kidney cancer specialists have extensive experience and expertise, which results in optimal outcomes for some of the most challenging surgical cases.

Recent advances in immunotherapy and chemotherapy have brought more options for treating kidney cancer. In addition to classic chemotherapy drugs that target cancer cells, some forms of kidney cancer respond to medicines that activate the body’s own natural defenses to kill the cancer cells. At USC, we not only provide these options to our patients based on their needs, but our research has helped advance the field forward to better treat kidney cancer.

Our stem cell and tissue regeneration laboratory is a unique resource. Funded by the National Institutes of Health, it is ranked as one of the top laboratories of its kind in the world. We are focusing on cell therapeutics for tissue regeneration and tissue bioengineering research to repair or grow new organs, such as the kidney and bladder.

Keck Medicine of USC urologists spend time educating our patients and their families so the anxiety that comes with a diagnosis of kidney cancer is reduced by understanding all the treatment options available.

Symptoms

For many people, kidney cancer is found incidentally when they have imaging done for other conditions. For others, kidney cancer presents with some symptoms, including:

• Abdominal pain
• Blood in the urine
• Back pain
• Unintentional weight loss
• Anemia (or low blood count)

Some patients are at increased risk for developing kidney cancer, including those with certain hereditary disorders such as:

• Von Hippel-Lindau (VHL)
• Tuberous Sclerosis
• Birt Hogg Dube Syndrome

Patients with these syndromes should be monitored for any abnormal growths found on their kidneys.

Diagnosis

The main mode of diagnosis of kidney cancer is through imaging. This is usually done through a CT scan or an MRI. Once a mass is confirmed, our doctors may recommend a biopsy to determine the nature of the mass. Smaller masses, usually < 3cm warrant a biopsy, however our doctors will spend ample time with you to determine the need for further testing prior to recommending a treatment. If kidney cancer is found, laboratory tests as well as additional imaging will be done to determine the stage of the cancer.

Treatment

Surgery (including Cryotherapy)
The USC Institute of Urology houses the premiere center for robotic and laparoscopic minimally invasive treatment for kidney cancer. Surgery to remove all of the kidney (radical nephrectomy) or only the tumor and surrounding area (partial nephrectomy) is the recommended treatment for kidney cancer that has not spread beyond the kidney.

In the vast majority of patients, we are able to perform this surgery in a minimally invasive manner. This holds true for even larger-sized organ-confined tumors, up to 10-15 cm in size. When necessary in advanced cases, we offer open surgery as well, in order to provide the best treatment for your specific condition. Generally, smaller tumors can be treated with a partial nephrectomy, while larger tumors and those involving the inferior vena cava (IVC) are treated with complete removal of the kidney and affected areas of the IVC. For some patients with a small renal tumor, cryotherapy, or freezing of the kidney tumor, is a good alternative. In this method, imaging tools are used to locate the tumor within the kidney and freeze the cancer tissue so that it can no longer survive.

Medical Therapy

Recent advances in both immunotherapy and chemotherapy have brought forth more options for treating kidney cancer. In addition to classic chemotherapy drugs that target cancer cells, some forms of kidney cancer respond to medicines which activate the body’s own natural defenses to kill the cancer cells. At Keck Medicine of USC, we not only provide these options to our patients based on their needs, but we also perform research that has helped advance the field forward in helping to fight kidney cancer.

Robotic Surgery

Kidney cancer (also referred to as renal cell cancer) includes renal cell carcinoma and renal pelvis carcinoma. According to the American Cancer Society, the most common type of kidney cancer is renal cell cancer which accounts for 85 percent of all kidney tumors.

Kidney cancer is fairly resistant to radiation and chemotherapy. As a result, the gold standard treatment for localized kidney cancer is removal of the kidney or kidney tumors. Kidney surgery is traditionally performed using an open approach, meaning doctors must make a large incision in the abdomen.

Robotic surgery for kidney cancer incorporates the best techniques of open surgery and applies them to a robotic-assisted, minimally invasive approach. The precision and dexterity of advanced instrumentation facilitates a minimally invasive approach for treating kidney cancer.

Surgeons at the USC Institute of Urology have performed more than 1,000 minimally invasive partial nephrectomies for renal tumors, having by far the most experience in this type of surgery throughout the world. Our surgeons have well established experience in treating some of the most complex tumors such as:

• Hilar tumors
• Tumors in just one kidney
• Cystic lesions
• Multiple tumors

Clinical Trials and Research

Keck Medicine of USC urologists, oncologists and researchers are constantly looking at ways to improve patient care in the entire realm of urology. Specifically, in the field of kidney cancer, here’s a sampling of recent and current studies:

Kidney cancer and EphrinB2 targeting: Kidney cancer is unique in that the genetic predisposition from the loss of a normal gene (VHL) results in very high levels of a blood vessel growth factor called VEGF. Increased levels of this growth factor result in high EphrinB2 and Notch receptors. We have thus developed inhibitors of Notch receptor as well as EphrinB2. The goal of the first trial is to gain insight as to the impact of therapy on the cancer stem cells and potential to achieve tumor eradication.

The dynamics of DNA methylation in human cells. CpG methylation of DNA has been shown to be fundamentally important in genetic imprinting, cancer and mammalian development. Our laboratory developed a genetic system using EBV-based stable episomes to dissect the impact of DNA methylation on gene regulation in human cells. This system has provided us with a unique opportunity to understand the role of methylation in gene regulation and to dissect the control of methylation changes. The understanding of how DNA methylation is controlled and the impact of DNA methylation on gene regulation would provide answers to cancer and developmental processes.

The interplay between chromatin structure, DNA methylation and gene regulation. Chromatin is the packaging of the DNA in the human genome. The genome provides the information for the cell, but the packaging is important in dictating how the information is accessed. DNA methylation is a heritable but adjustable form of genetic information. Deciphering the inter-reliance and interplay between the DNA, DNA methylation and chromatin is fundamental to all aspects of human health and disease, including urologic cancers (bladder cancer, prostate cancer and renal cell carcinoma). We utilized and developed several new methods to dissect the interaction between gene expression, DNA methylation and chromatin modification. The understanding of these inter-relationships will permit us to develop therapeutic intervention of many genetic diseases as well as cancers.