Kidney Cancer

Kidney cancer remains in the top 10 most common cancers that occur in the U.S. According to the most recent reports, there are more than 80,000 women and men diagnosed each year. This number has been on the rise over the past several years. More than half of kidney cancer diagnoses occur between the ages of 55-65.  

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. This is 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 in people who have inherited a genetic disease or have family members who have had kidney cancer. There are several genetic and hereditary conditions that can increase the risk because of a gene mutation. Some examples are: 

• von Hippel-Lindau syndrome
• hereditary papillary renal carcinoma
• hereditary leiomyomatosis and renal cell cancer
• Birt-hogg-dube syndrome

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 (those with advanced kidney disease)
• smoking
• having a job that exposes you to asbestos and cadmium and certain other chemicals
• being assigned male at birth 

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

Depending on these test results, you may have a biopsy done to remove a small piece of your kidney tumor to check for cancer cells. If you have cancer, you may need to have surgery to remove the tumor along with part or all of that kidney. 

Benign Kidney Tumors

Angiomyolipoma (AML): This is the most common benign (non-cancerous) tumor of the kidneys. If the tumor becomes large, it may lead to fever, kidney pain, bleeding, or anemia. This is different from a cancerous tumor. There are three types:

• Classic AMLs
• Monophasic AMLs
• Epithelioid AMLs 

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. If your cancer has spread to other parts of your body, you will be told you have “metastases,” “metastatic cancer,” or “stage 4 (IV)” cancer. The word “advanced” is also used to describe these cancers.

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

Second Opinions

At any point throughout your care, you can ask for a second opinion. Many people may seek a second or third opinion to confirm their diagnosis and review all available treatment options.  

Getting a second opinion does not mean you do not trust your doctor. It means you want to be certain you know all your options. Timely cancer treatment is key. You are entitled to decide what is best for you and your goals.  

Types of Treatment

There are a number of treatments available for kidney cancer. The treatment options for your exact diagnosis will depend on your age, the size and stage of your cancer, and your overall health. This list includes the current, approved treatment types. It is important to talk with your care team about all the options available to you.  

Active Surveillance or Observation

Your care team may suggest watching the cancer instead of performing an invasive procedure to treat it. 

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.

Surgery

To remove the tumor, your surgeon will need to remove some or all of your kidney. This is called a nephrectomy (nuh-FREK-tuh-me). The procedure will be either: 

1. Partial nephrectomy (kidney-sparing or nephron-sparing surgery) - This surgery only removes the part of the kidney that has the tumor. The rest of the kidney is kept in place. A partial nephrectomy is often used for stage I (1) or II (2) kidney cancer.  
2. Radical nephrectomy - This is a surgery done that removes the entire kidney, that would include the tumor itself. 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.

A nephrectomy can be done as an open surgery or a minimally invasive surgery:

Open surgery

This is the traditional type of surgery that is done by making one cut either under your ribs or in your back. This surgery type is recommended if the tumor is larger. Other factors may also affect the decision to perform this surgery. 

Minimally invasive surgery

This surgery type is called “minimally invasive” because there is not a large cut done as in open surgery. This may be a recommended surgery if the tumor is smaller. There are two types:

• Laparoscopic nephrectomy - This is when a laparoscope is used to remove all or part of the kidney. This is a special, thin and long tube with a camera attached. The surgeon inserts this into the cut to remove the kidney.
• Robotic-assisted laparoscopic nephrectomy - This is when the surgeon uses a robot to assist with making the incision and removing the cancerous part of the kidney. Robotic arms allow the surgeon to navigate the tools more easily and with more precision.  

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

Radiation Therapy

Radiation therapy is typically not the first option treating kidney cancer. It 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.  

In radiation therapy, a machine is centered over the area to deliver beams of radiation to kill the tumor. The process is like getting an x-ray done, but with a stronger radiation dose.  

Other Local Treatment Options

If you have other severe health problems, you may not be healthy enough to have surgery. In this case, your healthcare team may recommend other procedures to treat your type of kidney cancer. These procedures are typically used to destroy tumors that are smaller in size. These procedures include 

• Cryoablation or cryotherapy - This procedure uses very cold gas to freeze and kill the tumor cells.  
• Radiofrequency ablation, or RFA - 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 cannot be removed.

Chemotherapy

Traditional chemotherapy uses drugs to kill cancer cells. Chemotherapy is not commonly used to treat kidney cancer.  

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. Targeted therapy works differently than chemotherapy and may often lead to less severe side effects. Some are pills you take by mouth. Others are infusions that go into your vein (IV). Targeted therapy is a common first line of treatment for kidney cancer in advanced stages.

Learn About Targeted Therapy 

Immunotherapy 

Immunotherapy drugs work by getting your immune system to kill cancer cells. Immunotherapy is used to treat almost all types of kidney cancer. This is done as an infusion. Immunotherapy is also often combined with targeted therapy. 

Get More Details About Immunotherapy 

Clinical Trials

Your treatment options may also include clinical trials. These are research studies that test new treatments or learn how to use existing treatments better. They find new and better ways to prevent or treat cancer. The U.S. Food and Drug Administration (FDA) oversees all clinical trials to keep all patients safe.  

If you are interested in seeing the available clinical trials, ask your doctor if there are clinical trials that are right for you. 

Understand Cancer Clinical Trials 

Managing Side Effects 

Every treatment may result in different side effects. It is important to know what the side effects could be so that you are prepared. It is still important to talk to your care team about all the side effects that you experience, even if it seems insignificant. Your care team may have solutions to help alleviate the side effects.

Some of the common physical side effects from kidney cancer treatment are:  

• diarrhea, stomach pain, cramping, nausea/vomiting
• mouth sores
• pain and swelling in the hands and feet
• high blood pressure
• loss of kidney function
• fatigue (feeling tired)
• skin problems like rashes, redness or itching
• General pain, muscle or joint pain
• Hand-foot syndrome  

It is not uncommon for treatment to impact your mental health. Speaking to your care team about any changes in your emotions is also very important. A social worker may recommend ways to cope with these emotions or find other support resources. Some examples of emotional side effects from treatment are:

• Anxiety - A feeling of uneasiness, worry, or fear that usually occurs because of stress.
• Depression - A diagnosed condition. It can cause a persistent feeling of sadness or loss of interest in things you once enjoyed.  
• Overall distress - An unpleasant state that can affect how you think, feel, and act. This may include emotions such as fear, sadness, anger, or worry.  
• Fear of recurrence - A focused fear on cancer returning (recurring) or progressing (become worse). It may cause anxiety or worry about any new or change in symptoms.  

A helpful resource for alleviating side effects is the palliative care team. This group of healthcare professionals help patients with symptoms such as pain. Seeing a palliative care specialist can help address side effects that occur during or after treatment. The goal of palliative care is to help you maintain your best possible quality of life. It is available to you at any point throughout your care.  

 Coping with Kidney Cancer

As you go through treatment, you are likely to have many questions and concerns. You will have different types of questions and concerns.  

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.

After your kidney cancer diagnosis, you may consider the following to help you throughout your care:  

• Be prepared: Keep copies of all medical records and insurance payments. Learn more about managing the cost of cancer treatment.
• Know about the short- and long-term side effects that you may experience following treatment.
• Learn what symptoms 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. 

Your loved one or caregiver may be involved in your care and can be a great help with various tasks. Depending on your treatment, they may assist with managing medications, monitor side effects, or other daily life responsibilities. A caregiver plays a vital role in cancer care. Although they may focus more on caring for their loved one, it is important that caregivers feel supported as well. Your care team can provide support and recommend ways to manage the responsibilities of caregiving.

Life may feel very different after your diagnosis for both you and your loved one(s). You may need to adjust your lifestyle and establish a “new normal.” Seek assistance from your care team, family, friends, and other loved ones for support. Navigating a cancer diagnosis is challenging and stressful. This is normal. Remember, there are multiple resources available to help you every step of the way during treatment and throughout survivorship.