Advanced kidney cancer is commonly termed metastatic kidney cancer. The term metastatic indicates kidney cancer that has spread from the site of origin (kidney) to the nearby organs, tissues, and lymph nodes and also to distant organs like lungs and bones. It is the most advanced form of cancer that treatment regimens cannot cure. It can often only be managed to get relief from the symptoms and stop the spread of malignancy to various other organs.

What are the symptoms of Advanced renal cancer?

1. Prolonged and persistent pain: You may experience a sharp pain in the lower back that progresses. 
2. Hematuria: You may see a passage of blood in the Urine, which is a dangerous sign and indicative of kidney cancer. Over time, Urine may become more visibly stained or appear pink due to an increase in blood content.
3. Significant weight loss: you may undergo an unexplained weight loss and feel tired and weak most of the time. 
4. Swelling in the abdomen: In the advanced stages, where the tumor spreads to the abdomen, it may cause swelling and increased mass.
5. Swelling of the legs: The spread of cancer to lymph nodes can affect the body's fluid balance and cause fluid buildup in the feet and ankles. 
6. Fever
7. Night sweats

What is the best treatment for advanced kidney cancer?

Let us find out about the best treatment for metastatic kidney cancer that includes anti cancer medicines.

1. Targeted therapy: 

It is often the first line treatment preferred for metastatic cancer where the cancer has spread beyond. They can usually decrease or slow the growth of cancer for a while, but none of these treatments appear to be able to cure kidney cancer. This targeted therapy exerts its mechanism of action by preventing the formation and development of new blood vessels, which are the cause of blood supply and nourishment to malignant tumors. They also act by blocking the vital protein molecules that are essentially important for the growth and repair of cancer cells. Medications of this class include Vascular endothelial growth factor and mammalian target of rapamycin inhibitors.

2. Immunotherapy:

The effective use of the human immune system to fight against the underlying tumor cells has increasingly gained popularity and is also effective. The human body contains immune cells called checkpoint proteins that bind with the partner proteins and prevent an immune response. Cancer cells sometimes mimic this action, deceive the immune system, and avoid destruction. This is where the checkpoint inhibitors come into play. They prevent cancer cell proteins from binding with T cell proteins, which triggers the immune system to destroy the cancer cells.

3. Surgery: 

In some cases, surgery can also be an effective option. It involves the process of removal of tumor tissue that has spread to nearby organs or lymph nodes. It can only be considered if the spread is operable and the patient is fit enough for surgery. Last hope for the patients is kidney transplant surgery. 

For advanced metastatic renal cancer, combinational therapy is inevitably an essential treatment option. The combination of various tyrosine kinase inhibitors of targeted therapy along with immune checkpoint inhibitors is the first line of treatment started. These treatments work together to affect many targets and pathways that are involved in the growth of tumors. Combination medicines are considered more significant in treating patients, as evidenced by the encouraging outcomes of recent clinical trials.

Some of the effectively used combination therapy approach consists of;

• VEGFR Inhibitors + mTOR Inhibitors
• VEGFR Inhibitors + Immune Checkpoint Inhibitors
• Dual VEGFR and PD-1/PD-L1 Inhibition

Example: Medications like sunitinib along with everolimus or nivolumab are employed. Avastin injection contains the active compound bevacizumab, which is the first effective antiangiogenic agent, prevents the formation of new blood vessels, and improves the quality of life of patients suffering from metastatic renal cancer. 

Conclusion

Before starting the combinational therapy for metastatic kidney cancer various patient factors must be taken into consideration like cancer stage, identifying secondary cancers caused, extent of spread of tumor, involvement of organs and survivability rate are evaluated by the physician. A multidisciplinary team of oncologist, radiologist and urologist are vital in providing therapy and improving quality of life in patients.