Kidney cancer

The kidneys are part of the body’s urinary system. They filter waste products out of the blood and remove them as urine. Kidney cancer starts when cells of the kidney change and grow out of control.

Kidney cancer is about twice as common in men as in women, and is one of the more frequently diagnosed cancers in men. The risk increases with age, and most cases occur in people over the age of 50.

Signs and symptoms#

Most people with kidney cancer have no symptoms, and doctors find most kidney cancers while checking for something else. When signs and symptoms do occur, they can include:

• blood in your urine, which may be obvious or may make the urine look dark, rusty or brown
• pain in your lower back or side
• a lump in your abdomen
• constant tiredness
• unexplained weight loss
• fever that is not caused by a cold or flu

Not everyone with these symptoms has kidney cancer. If you have any of them, or you are worried, always see your doctor.

Risk factors#

Some things make kidney cancer more likely. These are called risk factors and they include:

• smoking
• obesity, as excess body fat may change certain hormones in ways that can lead to kidney cancer
• high blood pressure
• kidney failure, particularly end-stage kidney disease
• a family history of kidney cancer, especially in a parent, sister or brother
• certain inherited conditions, including von Hippel-Lindau disease, hereditary papillary renal cell carcinoma, Birt-Hogg-Dubé syndrome, hereditary leiomyomatosis renal cell carcinoma, tuberous sclerosis and Lynch syndrome

Having these risk factors does not mean you will develop kidney cancer, and often there is no clear reason why it occurs. If you are worried about your risk, ask your doctor for advice.

Tests for kidney cancer#

You will probably have urine and blood tests to check your general health and look for signs of a problem in the kidneys. These tests do not diagnose kidney cancer on their own, but they may include a full blood count of red blood cells, white blood cells and platelets, tests to check how well your kidneys are working, and blood chemistry tests.

Your doctor may then ask you to have further tests, such as:

• Ultrasound – a scan on the outside of your abdomen to check for cancer.
• CT scan – takes detailed pictures of the inside of the body.
• MRI scan – uses magnetism and radio waves to take pictures of the inside of the body.
• Bone scan – uses a dye to show changes in the bones.
• PET scan – a specialised imaging test that uses a small amount of radioactive solution to make cancer cells show up more brightly.
• Cystoscopy – if you have had blood in your urine, the doctor passes a small camera into your bladder to look inside.
• Biopsy – removal of a tissue sample to examine under a microscope. This is a common way to diagnose many cancers, but it is not often needed for kidney cancer before treatment, because imaging scans are good at showing whether a kidney tumour is cancer.

Types of kidney cancer#

Most kidney cancers are renal cell carcinoma (RCC), sometimes called renal cell adenocarcinoma. Usually only one kidney is affected, but in rare cases both can be. As the cancer grows it can spread to nearby areas, and it may also spread to other parts of the body, such as the lungs or bones.

RCC is the most common type, but there are less common types too:

• Urothelial carcinoma, sometimes called transitional cell carcinoma, behaves and is treated like bladder cancer rather than like RCC.
• Wilms tumour, also called nephroblastoma, is the most common kidney cancer in younger children, though it is still rare.
• Very rarely, cancer can spread to the kidney from a primary cancer elsewhere in the body, known as secondary cancer.

Stages and grades#

Stages and grades describe how far a cancer has spread and how quickly it is growing.

The stage tells you how large the cancer is, where it is, and whether it has spread beyond the kidney. Your doctor uses your test results to assign a stage. Stages 1 and 2 are considered early kidney cancer, where only the kidney is affected. Stages 3 and 4 are advanced kidney cancer, where it has spread beyond the kidney. Ask your doctor or nurse to explain the stage of the cancer.

The grade describes how quickly a cancer might grow, and helps your doctor plan the best treatment. Both the Fuhrman system and the newer International Society of Urological Pathology (ISUP) system may be used to grade kidney cancer. Both grade it from 1 to 4, with grade 1 the slowest growing and grade 4 the fastest.

Prognosis#

When someone is diagnosed with kidney cancer, their doctor will give a prognosis, an opinion of how likely the cancer is to spread and the chances of recovery. A prognosis depends on the type and stage of the cancer, as well as the person’s age and general health. In most cases, the earlier kidney cancer is diagnosed, the better the chance of successful treatment.

Your doctor will talk with you about your individual situation. Every person’s experience is different, and support is available to you.

Treatment#

Treatment for kidney cancer depends on how quickly the cancer is growing, and differs for early and advanced disease. You might feel confused or unsure about your options, it is fine to ask your treatment team to explain things more than once, and it is often fine to take some time over your decisions. If you are a current smoker, your team will advise you to stop before treatment starts, and your doctor or a quit-smoking service can help you make a plan.

Treatment for early kidney cancer#

Active surveillance. When small tumours are found, they are less likely to be aggressive and may not grow during a person’s lifetime. In this case your doctor might recommend active surveillance (also called observation), with regular ultrasounds or CT scans. If these suggest the tumour has grown, you will be offered treatment.

Surgery is the main treatment for kidney cancer that has not spread outside the kidney. Depending on the type, grade and stage, and your general health, you might have:

• A partial nephrectomy – removal of the cancer and a small part of the kidney. This is the most common option for small tumours within the kidney.
• A radical nephrectomy – removal of the whole affected kidney, a small part of the ureter and the surrounding fatty tissue. The adrenal gland and nearby lymph nodes might also be removed. This is the most common operation for large tumours.

Other treatments. If you are not well enough for surgery and the tumour is small, your doctor may recommend thermal ablation (using heat from a needle to kill the cancer cells), cryotherapy (using probes to freeze them) or stereotactic body radiation therapy (using highly targeted radiation to destroy them).

Treatment for advanced kidney cancer#

Sometimes kidney cancer that has spread grows so slowly that it causes no problems for a long time. Your doctor may then suggest active surveillance with regular ultrasounds or CT scans, moving to active treatment if the cancer starts to grow quickly or causes symptoms.

Surgery to remove kidney cancer that has spread is called cytoreductive surgery. This can mean removing the primary cancer in the kidney (nephrectomy) or removing some or all of the tumours that have grown elsewhere (metastasectomy). Surgery is generally not recommended if you are unwell or if the cancer has spread to many places.

Targeted therapy attacks specific parts of cancer cells with medicines to stop the cancer growing and spreading.

Immunotherapy. There have been many advances using immunotherapy drugs known as checkpoint inhibitors, which use the body’s own immune system to fight cancer. Targeted therapy and immunotherapy are the main systemic treatments (drugs that reach cancer cells throughout the body) used to control advanced kidney cancer. Since these more effective treatments were developed, chemotherapy is rarely used for kidney cancer. Ask your doctor for more information.

Radiation therapy, also known as radiotherapy, uses a controlled dose of radiation, such as focused x-ray beams, to kill or damage cancer cells. In advanced kidney cancer it may be used to shrink a tumour and relieve symptoms.

Side effects and wellbeing#

All cancer treatments can have side effects. Your treatment team will discuss these before you start, so talk to your doctor or nurse about any you experience. Some side effects can be upsetting and difficult, but help is available.

Kidney cancer and its treatment can change how you feel about yourself, other people and sex. These changes can be hard to talk about, but doctors and nurses are understanding and can offer support. You can ask for a referral to a doctor or therapist who specialises in body image, sex and relationships.

Living with advanced cancer#

Advanced cancer usually means cancer that is unlikely to be cured, though some people live for many months or years with it. During this time, palliative care services can help. Most people continue to have treatment for advanced cancer as part of palliative care, because it helps manage the cancer and improve daily life.

Many people think palliative care is only for those who are dying, but it is for any stage of advanced cancer. Doctors, nurses and others specialise in it, and treatment can include chemotherapy, radiation therapy or other approaches. It can help you live more comfortably by managing symptoms such as pain. Treatment depends on several things, including where the cancer started, how far it has spread, your general health, and your own preferences and wishes. Ask your doctor about treatment and palliative care services that may help you.

Support for carers, family and friends#

Caring for someone with cancer can be difficult at times. If you are caring for someone with kidney cancer, cancer support organisations and carer support services can help.

Key points#

• Kidney cancer is about twice as common in men as in women, and is one of the more commonly diagnosed cancers in men.
• The risk increases with age, and most cases occur in people over 50.
• Most people with kidney cancer have no symptoms.
• Not everyone with possible symptoms has kidney cancer.
• If you have any of these symptoms or are worried, always see your doctor.

Where to get help#