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What is Kidney Cancer?

Each person has two kidneys. They are located below the ribs on either side of the long bone that runs down the back called the spine. They kidneys are responsible for sorting the body’s waste to make urine.

The most common type of kidney cancer is renal cell carcinoma, which starts in the cells lining the small tubes of the kidneys. Children are more likely to develop another type of kidney cancer called Wilms’ tumor. Kidney cancer occurs most often in people over the age of 40. Kidney cancer makes up about 4% of cancer in American adults.

Risk Factors

Research is improving our understanding of kidney cancer and its causes. The following are risk factors for the disease.

  • Advanced Kidney Disease - People whose kidneys need medical assistance to work are at higher risk. This is described as being “on dialysis.”
  • Gender and Race - This cancer is found about twice as often in men as in women. African Americans have a slightly higher rate of renal cell cancer.
  • Genetics - People who have certain rare, inherited conditions are at high risk. These include: von Hippel-Lindau disease, hereditary papillary renal cell carcinoma, hereditary leiomyomatosis and renal cell carcinoma, birt-hogg-dube syndrome and renal oncocytoma. Having a family member who has kidney cancer also increases risk.
  • High Blood Pressure - People with high blood pressure may have a higher risk of kidney cancer.
  • Medicines - Phenacetin, a formerly popular pain killer, has been linked to kidney cancer.
  • Smoking - People who smoke have a higher risk. The risk increases with more cigarettes smoked.
  • Weight - People who are overweight have a higher risk of developing kidney cancer.
  • Work Environment - Studies suggest that exposure to certain chemicals, such as asbestos, cadmium, herbicides, benzene and organic solvents increases the risk of kidney cancer.

Signs and Symptoms

Early kidney cancer usually does not have symptoms. As cancer develops, people start to have symptoms, including the following:

  • Blood in the urine
  • Lower back pain on one side that is not caused from an injury
  • A mass or lump on the side or lower back
  • Tiredness
  • Weight loss
  • A fever that doesn't go away after a few weeks
  • Swelling of the ankles and/or legs

Diagnosis

In order to diagnose kidney cancer, a doctor will do a complete physical exam and feel the side of the body and abdomen for lumps. Once you learn the results of the tests or procedures, you will be able to work with your health care team to make thoughtful decisions.

You also will likely have one or more of the following tests:

  • Urine Test - Urine is checked for blood and other signs of disease.
  • Blood Test - Blood is checked for levels of several substances, including creatinine, to make sure the kidneys are doing their job.
  • Intravenous Pyelogram (IVP) - Dye injected into the vein travels through the body to the kidneys and shows up on x-rays. Dye can then be tracked and x-rays can show tumors or other kidney problems.
  • CT Scan - An x-ray machine takes detailed pictures of the kidneys and can show kidney tumors.
  • Ultrasound - Sound waves and a computer are used to create a picture of the kidneys, which can show a solid tumor or cyst.
  • Biopsy - A thin needle is inserted into the kidney to remove a small amount of tissue. A pathologist looks at the sample of tissue under a microscope to check for cancer cells.
  • Surgery - Occasionally, all or part of a kidney is removed and examined by a pathologist for final diagnosis.

Stages of Renal Cancer

If kidney cancer is diagnosed, the doctor needs to know the , or extent, of the disease to plan the best treatment. Staging is used to find out whether the cancer has spread, and if so, to which parts of the body.

Stage I is an early stage of kidney cancer. The tumor measures up to 2 3/4 inches (7 centimeters). It is no bigger than a tennis ball. The cancer cells are found only in the kidney.

Stage II is also an early stage of kidney cancer, but the tumor measures more than 2 3/4 inches. The cancer cells are found only in the kidney.

Stage III is one of the following:

  • The tumor does not extend beyond the kidney but cancer cells have spread to a nearby lymph node or the tumor has invaded the adrenal gland or the layers of fat and fibrous tissue that surround the kidney, but cancer cells have not spread beyond the fibrous tissue.
  • Cancer cells may be found in one nearby lymph node or the cancer cells have spread to a nearby large blood vessel.

Stage IV is one of the following:

  • The tumor extends beyond the fibrous tissue that surrounds the kidney or cancer cells are found in more than one nearby lymph node. 
  • The cancer has spread to other parts of the body such as the lungs.

Treatment and Side Effects

Your treatment options depend on the stage of cancer, your overall health and your preferences about treatment. In metastatic disease, when the cancer has spread, the location and extent of the cancer are also important considerations.

Standard treatments for kidney (renal) cancer include:

Surgery: Most kidney cancer treatment starts with surgery. An operation to remove the kidney is called a nephrectomy. Your doctor might do a radical nephrectomy, removing the entire kidney, adrenal gland and tissue around the kidney. Other options are a simple nephrecotomy (removal of just the kidney) or a partial nephrectomy (removal of the part of the kidney that contains the tumor).

Arterial Embolization: This therapy aims to shrink the tumor by cutting off blood flow and oxygen to the kidney. This is done by injecting a substance into a blood vessel. This therapy is used either before an operation to make surgery easier or instead of surgery to reduce pain and symptoms.

Cryoablation: When tumors cannot be removed surgically, doctors use this procedure to freeze the cancer tissue until the cells die.

Radiation Therapy: A large machine directs uses high-energy rays directed at the body to kill cancer cells. Some people with kidney cancer have radiation before surgery to shrink the tumor, and some have it after to kill any remaining cancer cells. Radiation also can be used to relieve pain and other symptoms.

Biological Therapy: Also called immunotherapy, this approach uses the body’s immune system to fight the cancer. Biological therapy is sometimes used alone, and sometimes after surgery.

Chemotherapy: This treatment uses drugs to kill cancer cells. Chemotherapy has not been as effective in treating kidney cancer as it has been in treating other cancers. Doctors are studying new drugs and combinations that may be more beneficial.

Keep these tips in mind as you discuss treatment:

  • Take your time. Consider your treatment options carefully. Seek a second opinion if needed.
  • Ask questions. Ask your doctor to say something again or explain a medical term. Research shows that people of all educational levels and backgrounds can have a hard time communicating with their health care team.
  • Ask about clinical trials. Clinical trials can offer the opportunity to benefit from the latest treatments or combinations of treatments while helping advance knowledge of the disease and its treatment options.
  • Prepare for visits. Improve communication by writing down questions in advance. Plan to take notes. Consider bringing a friend or family member to take notes for you.
  • Make a treatment plan. Focus on both the short- and long term goals of managing your cancer. Talk through the options and develop a treatment plan that best fits your needs.

Side Effects Management

It helps to learn more about the side effects of your treatment(s) before you begin, so you will know what to expect. When you know more, you can work with your health care team to manage your quality of life during and after treatment.

There are effective medications to address traditional side effects of cancer treatment such as nausea, diarrhea, constipation and mouth sores. Keep in mind that everyone reacts differently to treatment and experiences side effects differently.

Side Effects from Renal Cancer Treatments

Arterial Embolization: Temporary side effects may include vomiting, nausea or pain.

Cryoablation: This procedure can be painful. Rare side effects include bleeding, infection and damage to tissue near the tumor.

Radiation Therapy: Side effects of external radiation therapy may include skin changes, nausea, vomiting, diarrhea, fatigue, painful sores in the mouth and throat, dry mouth or thick saliva. Most side effects of radiation are temporary, but some rare serious side effects can be permanent. In some cases, radiation to the chest can also cause lung damage, which may lead to breathing problems or shortness of breath.

Biological Therapy or Immunotherapy: This treatment can have serious side effects including fever, nausea, chills, vomiting and loss of appetite.

Chemotherapy: The side effects of chemotherapy depend on the specific drug(s) given, and the dose and the length of time they are taken. Side effects can include hair loss, mouth sores, loss of appetite, nausea, vomiting, diarrhea, increased chance of infections (due to low white blood cell counts), easy bruising or bleeding (due to low blood platelet counts) and fatigue (due to low red blood cell counts).