Kidney Cancer

Kidney cancer is among the 10 most common cancers that occur in the U.S. About 63,000 women and men are diagnosed with the disease each year. Your risk of developing kidney cancer increases as you get older. The average age at diagnosis is 64.

Most people are born with two kidneys. If you picture a kidney bean as large as your fist, you will have a good idea of what each kidney looks like. Your kidneys are located above your waist. One is on the right side of your spine, the other is on the left.

The kidneys take water, salt and waste out of your blood and turn them into urine. They also produce hormones that help control your blood pressure and that tell your bone marrow when to make more red blood cells. Your body will work fine with just one healthy kidney. That’s why a healthy person can choose to donate a kidney to someone whose kidneys are no longer working properly.

There are a number of known risk factors for kidney cancer.

The highest risk is seen in women and men who have inherited a disease that increases the risk of kidney cancer or who have parents or siblings who have had kidney cancer. These diseases include:

• von Hippel-Lindau syndrome which stems from a genetic mutation that causes kidney tumors
• Hereditary papillary renal cell carcinoma which stems from a genetic mutation in the MET gene that causes kidney tumors
• Birt-hogg-dube syndrome a skin disease that also causes kidney tumors

However, most people diagnosed with kidney cancer do not have an inherited disease.

Other known risk factors for kidney cancer are:

• being overweight
• having high blood pressure
• being on dialysis 
• smoking
• having a job that exposes you to asbestos and cadmium and certain other chemicals

Keep in mind: More than half of the people who are diagnosed with kidney cancer don’t have any symptoms.

If your cancer spreads to the bone, you will be told you have “metastases,” “metastatic cancer,” or “stage 4 (IV)” cancer. The word “advanced” is also used to describe these cancers.

Some people learn they have kidney cancer after seeing a doctor because they have had health concerns such as:

• blood in urine
• pain or pressure in the side or back
• swelling in the ankles and legs
• high blood pressure
• a low red blood cell count (anemia)
• a high red blood cell count (erythrocytosis)
• feeling very tired
• loss of appetite
• unexplained weight loss
• recurring fever
• a rapid enlargement in the veins around a testicle

If you have these symptoms, it does not mean you have kidney cancer. They are more commonly seen in people who have other health problems. But, your doctor may recommend additional tests.

Testing for Kidney Cancer

If you have health concerns that could be a sign of kidney cancer, your doctor will ask you to have some tests done. These could include:

• urine tests
• blood tests
• imaging tests to get pictures of your kidneys

After these tests results come back, you may need to have a biopsy to remove a small piece of your kidney tumor to check for cancer cells. If you have cancer, you will likely need to have surgery to remove the tumor along with part or all of that kidney.

Staging

Treatment options for kidney cancer are based largely on your cancer’s stage. 

•  Stage I (1): The tumor is no more than 7 centimeters (or 2 ¾ inches) in diameter, is inside the kidney and has not spread to the lymph nodes
•  Stage II (2): The tumor is 7 centimeters or larger and inside the kidney
• Stage III (3): The tumor has spread outside of the kidney to surrounding tissue or veins, or is inside the kidney but has spread to nearby lymph nodes
• Stage IV (4): The tumor has spread—or metastasized—from the kidney to nearby organs or to other parts of the body, such as the bones, liver or lungs

Your age, the size and stage of your cancer, and your overall health will determine your treatment options.

Choosing Your Healthcare Team

Kidney cancer is usually treated by a team of experts. Your team can include:

• your primary care provider
• a urologist, who treats health problems that develop in the urinary tract and male reproductive organs
• a urological oncologist, a urologist with additional training in treating cancer
• a medical oncologist, with special training in the use of chemotherapy, targeted therapy and immunotherapy
• an interventional radiologist, who uses imaging to biopsy a tumor or radiation to kill cancer cells
• a nephrologist, who manages patients with poor kidney function, including those on dialysis

Second Opinions

It is widely recommended that people diagnosed with kidney cancer get a second opinion from another urologist, urological oncologist or medical oncologist about their diagnosis and treatment.

Getting a second opinion doesn’t mean you don’t trust your doctor. It means you want to be certain you know all of your options.

Types of Treatment

There are a number of treatments available for kidney cancer depending on your age, the size and stage of your cancer, and your overall health which will determine your treatment options. There are two types of treatment: localized and systemic treatments. Surgery and radiation are localized treatments. They remove or kill the cancer cells in or near the kidney. Systemic treatments involve immunotherapy and targeted therapy.

Active Surveillance or Observation

If you:

• are older
• have a very small cancer
• have a serious medical condition like heart disease

your doctor may suggest watching the cancer instead of performing an invasive procedure to treat it. This is called active surveillance or observation.

Localized Treatment

There are two types of cancer treatments: localized and systemic. Surgery and radiation are localized treatments. They remove or kill the cancer cells in or near the kidney.

Surgery

To remove the tumor, your surgeon will need to remove some or all of your kidney. The procedure will be either:

Partial nephrectomy (kidney-sparing or nephron-sparing surgery)

• Often used for stage I (1), II (2), or III (3) kidney cancer.
• The tumor and part of the kidney are removed.

Nephrectomy (radical nephrectomy)

• Used for a large tumor.
• The whole kidney is removed.
• Nearby lymph nodes and fatty tissue around the kidney may also be removed.
• The adrenal gland, which sits on top of the kidney, may also be removed.

It will be done as an:

Open surgery

• The traditional type of surgery done with a scalpel.
• Recommended if the tumor is 4 inches (10cm) across or larger.

OR

Minimally-invasive Surgery

• The surgeon uses special tools that are about ½ inch in diameter and a small camera.
• The tools are inserted through small cuts in the abdomen.
• When done with a laparoscope, it is called laparoscopic surgery.
• May be done with the surgeon controlling robotic arms.
• May be an option if the tumor is smaller than 4 inches.

For any surgery, surgeon skill and expertise is critical. Ask your surgeon how many surgeries of the type they have done or how many they do in a given month or year.

Radiation and Other Local Treatment Options

If you have other severe health problems, you may not be healthy enough to have surgery. In this case, your health care team may recommend:

• Cryoablation or cryotherapy - This procedure uses very cold gas to freeze and kill the tumor cells. It is usually performed by an interventional radiologist or urologist.
• Radiofrequency ablation - During this procedure the doctor puts a probe that uses heat to kill cancer cells directly into the tumor.
• Arterial Embolization - Your doctor will insert a special material into the artery to keep the tumor from getting the blood it needs to grow. This procedure is also sometimes used to shrink the tumor before surgery or to reduce pain when the tumor can’t be removed.
• Radiation therapy - This may be used to treat the primary tumor if surgery is not an option. Typically, radiation is only used to relieve pain or bleeding that might develop when the cancer spreads to other parts of the body.

Systemic Treatment: Stage III (3)

Traditional chemotherapy is not used to treat kidney cancer. These cancers respond better to other types of anti-cancer drugs, like targeted therapies and immunotherapies.

Targeted therapy or immunotherapy is sometimes used before surgery to shrink a large tumor. It may also be used after surgery in patients who are at a high risk for recurrence. You can learn more about targeted therapy and immunotherapy in the next section below titled Systemic Treatment: Stage IV (4) or Metastatic Kidney Cancer. A risk assessment tool can help you and your doctor assess how likely you are to have a recurrence within five years of surgery and the benefits and risks of additional treatment.

Systemic Treatment: Stage IV (4) or Metastatic Kidney Cancer

If you have stage IV (4) kidney cancer, it means your cancer has spread, or metastasized, to other parts of your body. Some people (about 16 out of 100) will have an initial diagnosis of stage IV kidney cancer. In other cases, the cancer recurs, or comes back, as metastatic after initial treatment.

If you have not previously had surgery, your doctor may recommend that you have the kidney removed along with any tumors (metastases) that are near the kidney. Your doctor is also likely to recommend a systemic treatment. This could be a targeted therapy or an immunotherapy, or both.

Targeted Therapy

Different types of targeted therapies are used to treat kidney cancer. Some work by blocking the growth of the new blood vessels tumors need to survive. Others target specific proteins that help tumors grow. Some are pills you take by mouth. Others are infusions that go into your vein (IV). The most common side effects of targeted therapies are:

• skin rashes
• tiredness
• nausea
• diarrhea
• mouth sores
• pain and swelling in the hands and feet
• high blood pressure

Immunotherapy for Advanced Kidney Cancer ​

Immunotherapy drugs work by getting your immune system to kill cancer cells. These treatments are given as infusions.  The most common side effects are minor. These include:

• fatigue (feeling tired)
• skin problems like rashes, redness or itching
• muscle or joint pain

Less often, the side effects may be severe or even life-threatening. Tell your health care team immediately if you have:

• diarrhea
• problems breathing
• eye problems
• stomach pain, cramping, nausea/vomiting
• fever
• sudden changes in energy or severe weakness
• headaches
• chest pain
• decreased urination (peeing less)
• problems thinking or remembering things

Risk Stratification for Stage IV (4) Metastatic Kidney Cancer

A tool has been developed to help doctors decide whether a patient is healthy enough to be treated with a targeted therapy or immunotherapy.

One widely used tool, called the IMDC, looks at whether or not you have these six risk factors:

1. A low red blood cell count (anemia)
2. A high white blood cell count (neutrophilia)
3. An elevated platelet count (thrombocytosis)
4. High calcium levels or hypercalcemia
5. Difficulty taking part in daily activities
6. It’s been less than a year since your kidney cancer diagnosis or your initial diagnosis was stage IV(4)

The IMDC is scored like this:

• 0 factors: good-risk category
• 1 or 2 factors: intermediate-risk category
• 3 or more factors: poor-risk category. 

The score helps your doctor determine if the risk of symptoms and side effects outweighs possible benefits from treatment.

Clinical Trials

Your treatment options may also include clinical trials.

There are currently about 200 clinical trials taking place in the U.S. that are enrolling kidney cancer patients. You can:

• Ask your doctor if there are clinical trials that are right for you.
• Look for clinical trials on Cancer.gov/ClinicalTrials.
• Learn more about cancer clinical trials.

Looking Forward

As you go through treatment, you are likely to have many questions and concerns. You will have different types of questions and concerns after you have completed treatment, if your cancer recurs (comes back), or you have stage IV(4) or metastatic kidney cancer.

The more information you have about your diagnosis and treatments, the easier it will be for any healthcare providers you see to answer your questions.

A Survivorship Care Plan is a document that includes information about the treatments you have had and the follow-up care you need. Your doctor may provide you with one. Or, you may have to ask a member of your healthcare team to help you complete one.

Be Prepared

As someone who has been or is being treated for kidney cancer you will want to:

• Be prepared: Keep copies of all medical records and insurance payments.
• Know about the short- and long-term side effects that you may experience following treatment.
• Learn what symptoms to be aware of that may suggest your kidney cancer has returned.
• Learn what symptoms to be aware of that suggest your kidney function has been impaired.
• Know if or how often you should see a nephrologist, an expert in diagnosing and managing diseases that affect how the kidneys function.

Know About Other Cancers

Having kidney cancer puts you at higher risk of getting certain other types of cancer, especially if you were diagnosed with kidney cancer before age 50. These include:

• bladder cancer
• melanoma (skin cancer)
• prostate cancer
• thyroid cancer and
• a second cancer in the other kidney

Improve Your Overall Health

After a cancer diagnosis, it is important to take steps to improve your overall health.

You will want to:

• Eat a healthy diet
• Get regular exercise
• Stop smoking
• Maintain or try to get to a healthy weight
• Limit how much alcohol you drink
• Have access to resources for emotional support. Learn more about finding support in this section of our website