Renal Cell Carcinoma (Hypernephroma): Therapy

General measures

  • Nicotine restriction (refraining from tobacco use).
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Aim for or maintain normal weight! Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis.
    • BMI ≥ 25 → participation in a medically supervised weight loss program.
    • Falling below the BMI lower limit (from the age of 45: 22; from the age of 55: 23; from the age of 65: 24) → Participation in a medically supervised program for the underweight.
  • Avoidance of environmental stress:
    • Heavy metal pollution, especially lead or cadmium are discussed

Conventional non-surgical therapy methods

Cryoablation and radiofrequency ablation (RFA) may be offered to patients with small renal tumors and high comorbidity (concomitant diseases) and/or limited life expectancy (level of evidence: 2). Percutaneous renal tumor biopsy should precede the use of ablative procedures.

  • Cryotherapy: cryotherapy refers to the administration of cold to the tumor. For this purpose, a cold probe is inserted into the tumor percutaneously or under direct visual control with the kidney exposed (laparoscopically).One can use the procedure laparoscopically (by laparoscopy) or percutaneously (through the skin). Possible complications: perirenal hematoma (bruise around the kidney), nerve lesions, hypothermia, respiratory insufficiency (respiratory weakness), hematuria (blood in the urine, bleeding, urinoma formation, postoperative ileus (intestinal obstruction due to intestinal paralysis), secondary ureteral outlet stenosis (ureteral outlet stenosis), pneumonia (pneumonia), death.
  • Radiofrequency ablation (RFA): radiofrequency ablation is a local (topical) procedure in which the tumor is destroyed by termonecrosis (heat destruction). The heat is generated by a probe that has previously been inserted into the tumor using sonographic imaging (under ultrasound vision).Possible complications: Flank pain, perirenal hematoma, ileus, urinary retention (urinary retention), hematuria, urinoma formation (accumulation of urine in the body outside the urinary tract), pneumonia, hemorrhage, neuropathic pain, hydronephrosis (aqueous sac kidney), urinary fistulae, death.
  • Note: Although these are minimally invasive procedures, the complication rate is reported in the literature to be approximately to 19%.

All of the procedures mentioned here, as well as the method of high-focus ultrasound, are not among the standard procedures for renal cell carcinoma. Among their advantages is the minimal invasiveness. Furthermore, they are repeatable to use.

Vaccinations

The following vaccinations are advised:

  • Flu vaccination
  • Pneumococcal vaccination

Regular checkups

  • Regular follow-up examinations for five years for early detection of recurrence (recurrence of the disease) [Note “Additional Notes”]

Definition of risk groups in follow-up after local surgery for renal cell carcinoma.

Risk group Characteristics
low risk pT1a/b, cNO, cMO; G1-2
intermediate risk pT1a/b, cNO, cMO, G3; pT2, c/pNO, cMO, G1-2apparative therapy or R1 situation of an otherwise low-risk carcinoma.
high risk pT2, c/pNO, cMO, G3, pT3-4 and/or pN+.

For more details, see the literature given below. Further notes

  • After surgical therapy for locally circumscribed renal cell carcinoma, recurrence (recurrence of disease) was observed in 2% of all patients after more than 60 months, representing one third of all recurrences. This particularly affected patients with G1 and pT1a tumors.

Nutritional Medicine

  • Nutritional counseling based on nutritional analysis
  • Nutritional recommendations according to a mixed diet, taking into account the general knowledge of nutrition in a tumor disease. This means:
    • Consume only limited energy-rich foods.
    • Moderate total fat intake
    • Little red meat (pork, beef, lamb, veal) and sausages.
    • once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
    • High-fiber diet (whole grains, vegetables).
    • Daily total of 5 servings of fresh vegetables and fruits (≥ 400 g; 3 servings of vegetables and 2 servings of fruit).
    • Reduce consumption of smoked and cured foods, because they contain nitrate or nitrite as a component of curing salt. Their preparation produces compounds (nitrosamines), which are risk factors for various tumor diseases.
    • Refrain from polluted foods such as offal and wild mushrooms.
    • Do not eat moldy food
  • Observe the following special dietary recommendations:
  • Selection of appropriate food based on the nutritional analysis
  • See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
  • Detailed information on nutritional medicine you will receive from us.

Sports Medicine

  • Endurance training (cardio training) and strength training (muscle training).
    • In general, endurance training on a bicycle ergometer can be recommended, which is performed according to the principle of interval training. This means that load phases lasting 1 to 3 minutes alternate with rest phases also lasting 1 to 3 minutes. The training should be performed at about 80% of the maximum heart rate for a total of 30 minutes.
  • Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
  • Detailed information on sports medicine you will receive from us.

Psychotherapy