Kidney Cancer

Symptoms, diagnosis & treatment of Kidney Cancer

Risk Factors for Kidney Cancer

When you receive a diagnosis of kidney cancer, it’s natural to wonder what may have caused the disease. We do know that people with certain risk factors may be more likely than others to develop kidney cancer. A risk factor is something that may increase the chance of getting a disease.

Studies have found the following risk factors for kidney cancer:

Smoking: Smoking tobacco is an important risk factor for kidney cancer. People who smoke have a higher risk than nonsmokers. The risk is higher for those who smoke more cigarettes or for a long time.

Obesity: Being obese increases the risk of kidney cancer.

High blood pressure: Having high blood pressure may increase the risk of kidney cancer.

Family history of kidney cancer: People with a family member who had kidney cancer have a slightly increased risk of the disease. Also, certain familial propensities that run in families can significantly increase the risk of kidney cancer such as:

Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It’s caused by changes in the VHL gene. People with a changed VHL gene have an increased risk of kidney cancer. They may also have cysts or tumors in the eyes, brain, or other parts of the body. Family members of those with VHL can have a test to check for a changed VHL gene.

Many people who develop kidney cancer have none of these risk factors, and many people who have known risk factors don’t develop the disease. The most common kidney cancer currently is that which is found incidentally by imaging for a variety of complaints. These “incidentalomas” have greatly increased the incidence of kidney cancer.

Symptoms

  • Most kidney cancers today occur in patients who have no symptoms
    However, common symptoms of kidney cancer include:

    • Blood in your urine (which may make urine look rusty or darker red)
    • Pain in your side that doesn’t go away
    • A lump or mass in your side or abdomen
    • Weight loss for no known reason
    • Fever
    • Feeling very tired

These symptoms may be caused by kidney cancer or by other health problems, such as an infection or a complex kidney cyst.

DIAGNOSIS

Urine tests: The lab checks your urine for blood and other signs of disease.

Blood tests: The lab checks your blood for several substances, such as creatinine. A high level of creatinine may mean the kidneys aren’t doing their job.

Ultrasound: An ultrasound device uses sound waves that can’t be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside your abdomen. The echoes create a picture of your kidney and nearby tissues.

CT scan: A radiographic machine linked to a computer takes a series of detailed pictures of your abdomen. You may receive an injection of contrast material so your urinary tract and show up clearly in the images. The CT scan may show a mass (cancer) in the kidneys, lymph nodes, or elsewhere in the abdomen.

MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your urinary tract and lymph nodes. You may receive an injection of contrast material. MRI can also show masses in your kidneys, lymph nodes, or other tissues in the abdomen.

IVP: You’ll receive an injection of dye into a vein in your arm. The dye travels through the body and concentrates in your kidneys. A series of x-rays then tracks the dye as it moves through your kidneys to your ureters and bladder. The x-rays can show a kidney tumor or other problems. (IVP is not used as commonly as CT or MRI for the detection of kidney cancer.)

Biopsy: The removal of tissue to look for cancer cells is a biopsy. In some cases, your doctor will do a biopsy to diagnose kidney cancer. Your doctor inserts a thin needle through your skin into the kidney to remove a small sample of tissue. Your doctor may use ultrasound or a CT scan to guide the needle. This can also be performed through a laparoscopic or open surgical approach. A pathologist will then utilize a microscope to check for cancer cells in the tissue.

Surgery: If surgery is indicated to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer cells.

Staging

If kidney cancer is suspected, your doctor needs to learn the extent (stage) of the disease to guide  the best treatment. The stage is based on the size of the kidney tumor and whether the cancer has invaded nearby tissues or spread to other parts of the body.

Blood tests: Your doctor can check for substances in your blood. Some people with kidney cancer have high levels of calcium and C-reactive protein.

Chest x-ray: An x-ray of the chest can show if your lungs are clear or if there is kidney cancer that may have spread to the lungs.

CT scan: CT scans of your chest (like x-ray above but more sensitive) and abdomen can show relatively small cancer volumes in your lymph nodes, lungs, or elsewhere.

MRI: MRI can often show suspicious areas in your blood vessels, lymph nodes, or other tissues in the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It’s treated as kidney cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.

These are the clinical stages of kidney cancer:

Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters). Cancer cells are found only in the kidney.

Stage II: The tumor is bigger than a tennis ball and may have spread into the surrounding fat.

Stage III: The tumor can be any size. It has spread to at least one nearby lymph node. Or it has grown through the kidney to reach nearby blood vessels.

Stage IV: The tumor has grown through the layer of fatty tissue and the outer layer of fibrous tissue that surrounds the kidney. Or cancer cells have spread to nearby lymph nodes or to the lungs, liver, bones, or other tissues.

Treatment

Common treatment options for people with kidney cancer are surgery, cryotherapy (freezing), targeted therapy, and biological therapy. You may receive more than one type of treatment.

The treatment that’s right for you depends mainly on the following:

  • The size of the tumor
  • Whether the tumor has invaded tissues outside the kidney
  • Whether the tumor has spread to other parts of the body
  • Your age and general health

You may wish to see a urologist who is a surgeon who specializes in treating problems of the urinary tract. Other specialists who treat kidney cancer include medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.

Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because systemic cancer therapy may damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on the National Cancer Institute’s (NCI) web site at https://www.cancer.gov/cancertopics/coping”.

You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of kidney cancer. See the Taking Part in Cancer Research section.

You may want to ask your doctor these questions before you begin treatment:

  • How large is the tumor? What is the stage of the disease? Has the tumor grown outside the kidney or spread to other organs?
  • What are my treatment choices? Which do you suggest for me? Why?
  • What are the expected benefits of each kind of treatment?
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long?
  • What are the risks and possible side effects of each treatment? How can side effects be managed?
  • What is the treatment likely to cost? Will my insurance cover it?
  • How will treatment affect my normal activities?
  • Would a research study (clinical trial) be a good choice for me?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for people with kidney cancer. The type of surgery depends on the size and stage of the cancer, whether you have two kidneys, and whether cancer was found in both kidneys.

You and your surgeon should discuss the different types of surgery and which may be right for you:

Removing the entire kidney (radical nephrectomy): The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area may also be removed.

Removing part of the kidney (partial nephrectomy): The surgeon removes only the part of the kidney that contains the tumor. People with a kidney tumor that is smaller than a tennis ball may choose this type of surgery.

There are two approaches for removing the kidney. The surgeon may remove the tumor by making a incision into your body (open surgery). Or the surgeon may remove the tumor by making small incisions (laparoscopic surgery). The surgeon looks inside your abdomen with a thin, lighted tube (a laparoscope) placed inside a small incision. Sometimes a robot is used with the surgeon using handles below a computer display to control the robot’s arms.

The surgeon may use other methods of destroying the cancer in the kidney. For people who have a tumor smaller than 4 centimeters and who can’t have surgery to remove part of the kidney because of other health problems, the surgeon may suggest:

Cryosurgery: The physician inserts a tool through a small incision or directly through the skin into the tumor. The tool freezes and kills the kidney tumor.

Radiofrequency ablation: The surgeon inserts a special probe directly through the skin or through a small incision into the tumor. The probe contains tiny electrodes that kill the kidney cancer cells with heat.

After Surgery:

It takes time to heal after surgery, and the time needed to recover is different for each person.

Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.

If one kidney is removed, the remaining kidney is usually able to do the work of both kidneys. However, if your remaining kidney isn’t clearing your body satisfactorily of waste products, you may need dialysis. Some people may ultimately need a transplant with a healthy kidney from a donor.

You may want to ask your doctor these questions before having surgery:

  • What type of surgery do you suggest for me? Do you recommend surgery that is through an incision? Or through  small incisions with a laparoscope? Do you recommend surgery with a robot?
  • Will lymph nodes and other tissues be removed? Why?
  • How will I feel after surgery? If I have pain, how can it be controlled?
  • How long will I be in the hospital?
  • When will I be able to return to normal activities?
  • What are the long-term effects of the surgery? Will I need dialysis?

Targeted Therapy

People with kidney cancer that has spread may receive a type of drug called targeted therapy. Many kinds of targeted therapy are used for kidney cancer. This treatment may shrink a kidney tumor or slow its growth.

Usually, the targeted therapy is taken by mouth. You may feel very tired while taking targeted therapy for kidney cancer. Other side effects may include diarrhea, nausea, vomiting, sores on the lips or in the mouth, and high blood pressure. You may want to read the NCI fact sheet Targeted Cancer Therapies.

Biological Therapy

People with kidney cancer that has spread may receive biological therapy. Biological therapy for kidney cancer is a treatment that may improve the body’s natural defense (the immune system response) against cancer. The treatments used for kidney cancer can slow the growth of tumors or shrink them. The biological therapy is injected intravenously or under the skin. The treatment may be given at the hospital or a doctor’s office.

Other drugs may be given at the same time to prevent side effects. The side effects differ with the biological therapy used, and from person to person. Biological therapy commonly causes a rash or swelling. You may feel very tired during treatment. The treatment may also cause a headache, muscle aches, a fever, or weakness.

You may find it helpful to read the NCI booklet Biological Therapy. You may also wish to read the NCI fact sheet Biological Therapies for Cancer.

You may want to ask your doctor these questions about targeted therapy or biological therapy:

  • Why do I need this treatment?
  • Which drug or drugs will I receive?
  • How do the drugs work?
  • When will treatment start? When will it end?
  • How will I feel during treatment? What are the side effects? Are there any lasting side effects? What can I do about them?