Kidney Cancer

What is kidney cancer?

Cancer that starts in kidney cells is called kidney or renal cancer.

A kidney is made up of many layers of cells. Kidney cancer can affect any one or all of these layers. The cancer can stop the kidneys from working normally and spread to other parts of the body. When cancer spreads, it’s called metastasis. The more cancer spreads (metastasizes), the harder it is to treat.

Overview

What are the different types of kidney cancer?

The main type of kidney cancer is called renal cell carcinoma (RCC). About 9 out of 10 kidney cancer tumors are this type. If you have this type of kidney cancer, you may have more than 1 tumor in 1 or both kidneys. These may be large by the time they are diagnosed. But most cases of kidney cancer are found before the cancer has spread to other organs.

There are different types of RCC. A healthcare provider called a pathologist identifies these types by looking at the cancer cells under a microscope. The types of RCC include:

• Clear cell. This is the most common type of RCC. The cancer cells look pale or clear.
• Papillary. This is the second most common type of RCC. This type of tumor has tiny fingerlike growths.
• Chromophobe. This is a rare form of RCC. The cells are larger than other types of RCC.
• Collecting duct. This is also a rare form of RCC. The cancer cells look like irregular tubes.
• Unclassified. This includes tumors that have cells from more than one type of cancer. It also includes tumors with cells that don’t fit into the other categories.

Other types of kidney cancer

Other less-common types of kidney cancers include:

• Transitional cell carcinoma. This is also known as urothelial carcinoma. It starts where the ureter and kidney meet. This area is called the renal pelvis. This type of kidney cancer can act and look like bladder cancer.
• Wilms tumor. This cancer mostly occurs in children. It's very rare in adults.
• Renal sarcoma. This is a very rare type of kidney cancer. It begins in the blood vessels and connective tissue around the kidneys.

Kidney tumors that aren’t cancer

Several types of kidney tumors are not cancer (benign). These include renal cell adenoma, renal oncocytoma and angiomyolipoma. These tumors may still affect kidney function and cause pain and other symptoms. But the cells often do not spread to other organs.

Symptoms

What are the symptoms of kidney cancer?

Kidney cancer often causes no symptoms in its early stages. As the cancer grows, it can cause kidney cancer symptoms, such as:

• Blood in the urine. Blood in the urine (hematuria) is one of the most common signs of kidney cancer
• Pain in the side or lower back
• A lump in the kidney area
• Tiredness
• Fast weight loss. Weight loss that happens quickly without any effort can be a sign of kidney cancer
• Loss of appetite
• Swelling of the legs and ankles
• Fever
• High blood pressure
• Swollen blood vessels around a testicle

Risk Factors

Who is at risk for kidney cancer?

Increased risk of kidney cancer include:

• Age. Most people with kidney cancer are aged 55 and older. The risk increases with age, but this cancer can happen at any age. It can also affect children and young adults.
• Gender. Men are more likely than women to develop kidney cancer.
• Race. Blacks are at a slightly higher risk for kidney cancer.
• Smoking. The longer you've smoked, the greater your chance of having kidney cancer.
• Obesity. People who are very overweight are more likely to get kidney cancer than those at a healthy weight.
• Medicines. Long-term use of certain medications has been linked to kidney cancer. These include water pills (diuretics) and over-the-counter pain medicines, like acetaminophen, aspirin and ibuprofen.
• Contact with chemicals. Contact with certain substances puts you at higher risk for kidney cancer. This includes chemicals and substances like the metal cadmium, herbicides, and organic solvents, especially trichloroethylene.
• High blood pressure, People with high blood pressure have a higher risk for kidney cancer. It's unknown if the risk is because of the condition, the medicines used to treat it, or both.
• Advanced or chronic kidney disease, This puts you at a higher risk for kidney cancer. People getting dialysis are at an even higher risk.
• Certain inherited conditions. Certain syndromes linked to genes passed in families affect your kidney cancer risk. For instance, people with von Hippel-Lindau (VHL) disease are at higher risk for kidney cancer. Other conditions linked to kidney cancer include Birt-Hogg-Dube syndrome, hereditary papillary renal cell carcinoma, Cowden syndrome and hereditary leiomyomatosis.
• Family history of kidney cancer. People with a family history of kidney cancer have a higher chance of developing the disease. This risk is highest in brothers or sisters of those with kidney cancer.

What are your risk factors?

Talk with your health care provider about your risk factors for kidney cancer. Ask about genetic testing and kidney cancer screening if you are at high risk.

Your primary care provider may advise regular screenings if genetic tests show a risk for kidney cancer.

Prevention

How to prevent kidney cancer?

You may be able to lower your risk for kidney cancer by making some lifestyle changes. These include:

• Maintaining a healthy weight
• Not smoking
• Keeping blood pressure in a healthy range

Are there screening tests for kidney cancer?

There are no recommended screening tests for people of average risk for kidney cancer. Screening tests are done to check for disease in people who don’t have symptoms.

If you have a family history of kidney cancer or other disorders linked to the disease, you may want to think about genetic testing and kidney cancer screening.

If genetic tests show a risk for kidney cancer, your health care provider may advise you to get screened often for kidney cancer. There are no standard guidelines for how often you should be screened if you are at increased risk. Your healthcare provider will advise a screening schedule based on your health and risk factors.

Diagnosis

How is kidney cancer diagnosed?

Diagnosing kidney cancer starts with your health care provider asking you questions. They will ask about your health history, symptoms, risk factors and family history of the disease.

Your health care provider will also give you a physical exam. You may be checked for a fever and high blood pressure. The health care provider may feel your belly (abdomen), sides and back for lumps.

What tests might I need?

Symptoms of kidney cancer can be caused by other less serious problems. Because of this, you will likely have some tests. Unlike most types of cancer, kidney cancer can often be diagnosed without a biopsy. A biopsy is when small pieces of tissue are removed and looked at with a microscope. Instead, you may have 1 or more of the following:

• Angiography
• Blood tests
• CT scan
• Fine needle aspiration or biopsy
• Intravenous pyelogram (IVP)
• MRI scan
• Ultrasound
• Urine test

Treatment

How is kidney cancer treated?

There are various treatment choices for kidney cancer. Which may work best for you? It depends on several factors. These include the type, size, location and stage of your cancer. Factors also include your age, overall health and the side effects you’ll find acceptable.

Treatment options include:

• Surgery. Surgery to remove the kidney is called a nephrectomy. Surgery is used to remove the kidney with the tumor and any nearby lymph nodes that contain cancer. You may also have surgery to ease pressure or pain. The remaining kidney is often able to do the work of both kidneys.
• Immunotherapy. This type of systemic therapy helps your immune system find and fight cancer.
• Radiation therapy. This treatment kills cancer cells with high-energy X-rays. Radiation is most often used when the kidney cancer has spread to certain bones or the brain. It may be used to treat symptoms such as cough or pain.
• Chemotherapy (chemo). This treatment uses 1 or more medicines to kill cancer cells or shrink tumors. They work by attacking rapidly growing cells. Regular chemotherapy medicines are not often very effective against kidney cancer.
• Targeted therapy. These are medicines that target specific parts of kidney cancer cells to kill them or slow their growth. These medicines work differently from regular chemo medicines. They’re often used to treat advanced kidney cancer.
• Ablation therapy. There are 2 main types of ablation therapy used to treat kidney cancer. They’re both done by putting a needle into an area of cancer cells. This is a less-invasive treatment that causes less bleeding. It also keeps the side effects to a small area of the body. Radiofrequency ablation (RFA) uses energy waves to kill cancer cells. Cryoablation uses extreme cold to kill cancer cells.
• Supportive care. Your cancer specialist may advise therapies that help ease your symptoms but don’t treat the cancer. They may suggest supportive care if available treatments are more likely to do you more harm than good.

Your cancer specialist may suggest that you have more than one of these types of treatment. This is sometimes called combination therapy.

Newer types of treatment may be available only through a research study. This is called a clinical trial. Talk with your cancer specialist about what clinical trials may be an option for you.

Is kidney cancer curable?

Yes. Survivability largely depends on the stage of kidney cancer. The American Cancer Society reports the five-year survival rate for kidney cancer that hasn’t spread and remained localized at 93%. If the cancer hasn’t spread outside the starting area, the survival rate is 72%.