What Is Kidney Cancer? Symptoms, Causes, Diagnosis, Treatment, and Prevention

“There have been significant advances in kidney cancer over the past decade, and the field is rapidly changing,” says Chung-Han Lee, MD, PhD, a medical oncologist at Memorial Sloan Kettering Cancer Center in New York City.

Types of Kidney Cancer

Many types of kidney cancer can develop. Each requires a range of treatments and may have different effects on kidney function.

Renal Cell Carcinoma

This type of cancer usually develops as a single mass, although sometimes one kidney will contain multiple tumors. In other cases, tumors might affect both kidneys at the same time. Several subtypes of renal cell carcinoma may develop. These are divided into two main categories: clear cell RCC and non-clear cell RCC.

Clear cell RCC is the most common type of renal cell carcinoma, making up about 70 percent of cases. With clear cell RCC, cancer cells appear very pale or clear under a microscope.

• Papillary Renal Cell Carcinoma These cancer cells create fingerlike projections, known as papillae, in the tumor. This is the second most common subtype of renal cell carcinoma, making up about 10 percent of cases.
• Chromophobe Renal Cell Carcinoma Cancer cells in this type appear pale, like clear cells, but are much larger and have other distinct features. This subtype accounts for about 5 percent of renal cell carcinomas.
• Rarer Types Infrequently seen types of renal cell carcinoma include medullary carcinoma, collecting duct RCC, multilocular cystic RCC, mucinous tubular and spindle cell carcinoma, and neuroblastoma-associated RCC.

In addition, some renal cell carcinomas are unclassified, either because they include more than one type of cancer cell or because they don’t fit into any of the existing groupings.

Other Types of Kidney Cancer

• Transitional Cell Carcinoma Instead of starting in the kidney itself, these cancers start in the lining of the renal pelvis, which is the area where the tiny tubes that carry urine to the bladder (ureters) meet the kidneys.
• Wilms Tumor (Nephroblastoma) This type of kidney cancer primarily affects children.
• Renal Sarcoma This cancer begins in the blood vessels or connective tissue of the kidneys. It is rare, making up less than 1 percent of all kidney cancers.

Signs and Symptoms of Kidney Cancer

Some people may notice symptoms of kidney cancer, but others don’t experience any warning signs.

“The kidneys are located in the back of the abdomen, and tumors there can grow quite large without any symptoms at all,” says Andrew J. Armstrong, MD, a professor of medicine, surgery, pharmacology, and cancer biology at Duke University School of Medicine in Durham, North Carolina.

• Blood in the urine, which may look pink, red, or cola-colored
• Persistent pain in the back or side
• Unwanted or unexplained weight loss
• Reduced appetite
• Fatigue
• Fever

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Causes and Risk Factors of Kidney Cancer

• Age Older people are more likely to develop kidney cancer, with the highest incidence between ages 55 and 84.
• Smoking Smokers have double the risk of kidney cancer than nonsmokers.

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• Sex Men are about twice as likely as women to have kidney cancer.
• Race Black people have a higher risk of kidney cancer than white people.
• High Blood Pressure People with high blood pressure are more likely to have kidney cancer. Taking medication to control blood pressure may not be associated with a lower risk of kidney cancer.

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• Obesity Research has shown a significant association between excess weight and kidney cancer.
• Family History People with a family history of kidney cancer are more likely to develop the cancer themselves. Many of the genes associated with an increased risk of kidney cancer are linked to inherited disorders. These disorders include von Hippel-Lindau disease, tuberous sclerosis complex, Birt-Hogg-Dube syndrome, hereditary papillary renal cell carcinoma, and familial renal cancer. When kidney cancer runs in families, it can lead to early onset in people under age 50. “Genetic testing is recommended in younger patients who are diagnosed with kidney cancer,” says Dr. Armstrong.

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• Kidney Failure Treatment Receiving long-term dialysis treatment for chronic kidney failure may increase a person’s risk for kidney cancer. This has more to do with the advanced stage of the disease than the treatment itself.

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• Occupational Exposures Some studies have shown a link between exposure to cadmium or asbestos and kidney cancer.

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How Is Kidney Cancer Diagnosed?

“Kidney cancer is often silent when present, and thus challenging to diagnose early. In fact, many cancers are picked up during CT or MRI scans being performed for other reasons,” says Armstrong. “Unfortunately, there are no recommended screening tests for asymptomatic patients, and this is needed.”

Tests

• Physical Exam This includes an exam to check for any unusual issues, as well as a review of the patient’s medical history.
• Urine Tests Your doctor may request urine samples to see if they contain blood.
• Blood Tests These can help doctors determine if a person’s blood cell count and kidney function are normal.
• Imaging Tests Computed tomography (CT), magnetic resonance imaging (MRI), X-ray, and ultrasound may help identify kidney tumors or abnormalities.
• Biopsy A cancer specialist may remove a small sample of tissue from a tumor to check for the presence of cancer cells. However, doctors often remove kidneys without first taking a biopsy to diagnose and treat the cancer at the same time.

Staging Kidney Cancer

• The size and location of the tumor
• Whether and how much the cancer has spread to other tissues and organs
• Whether and how much the cancer affects lymph nodes (immune system structures that contain white blood cells)

Treatment and Medication Options for Kidney Cancer

• Urologist A doctor with special training in treating diseases of the urinary system
• Nephrologist A doctor who specializes in treating kidney conditions

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• Oncologist A doctor who treats cancer
• Radiation Oncologist A doctor who treats cancer with radiation therapy
• Urologic Oncologist A doctor who specializes in diagnosing and treating cancers of the urinary system

Dr. Lee suggests finding a doctor with extensive experience treating kidney cancer.

“Even though kidney cancer is among the top 10 malignancies in terms of incidence, it is important to see a urologist and medical oncologist who has specific expertise with management of the disease and can help you determine whether standard treatments or a clinical trial would make the most sense for you,” says Lee.

Treatments include surgery, medications, and active observation.

Surgery

• Nephrectomy Doctors remove the entire kidney, a healthy tissue margin, and sometimes nearby tissues, such as lymph nodes. Some surgeons can perform nephrectomies using a single incision. Surgeons may instead make small incisions in the abdomen in a procedure called laparoscopic or robotic-assisted laparoscopic nephrectomy. After the removal of one kidney, the remaining kidney can usually perform the work of both kidneys.

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• Partial Nephrectomy If the tumor is small, or if the patient has just one kidney already, surgeons may recommend removing only the cancerous areas and a small margin of healthy tissue instead of the entire kidney. A surgeon can perform a partial nephrectomy as a traditional surgery requiring one incision, as a minimally invasive laparoscopic procedure, or as a robotic-assisted laparoscopic procedure.

• Cryoablation A surgeon inserts a hollow needle through the skin and into the kidney to deliver cold gas that freezes and destroys cancer cells.
• Radiofrequency Ablation A probe is inserted through the skin and into the kidney to deliver an electrical current that heats and destroy cancer cells.
• Radiation Therapy Radiation technicians use high-energy beams that kill cancer cells to manage kidney cancer that has spread to other areas of the body.

Medication Options

“In patients who are at a high risk of recurrence of their disease, their urologist or oncologist can discuss whether adjuvant treatment or treatment with medications will decrease their risk of the disease coming back,” Lee says.

“Chemotherapy is generally ineffective for kidney cancer,” Armstrong says.

• Targeted Therapies These drugs focus on blocking specific abnormalities in cancer cells. For kidney cancer, targeted therapies typically home in on tumor blood vessel growth through medications like sunitinib (Sutent), pazopanib (Votrient), and cabozantinib (Cabometyx), as well as the kidney-cancer-linked mTOR protein through drugs like temsirolimus (Torisel) and Everolimus (Afinitor).

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• Immunotherapy Some medications trigger a person’s own immune system to fight cancer with medicines called immune checkpoint inhibitors; these include pembrolizumab (Keytruda), nivolumab (Opdivo), and avelumab (Bavencio). Occasionally, cytokines like interleukin-2 (IL-2) are used.

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Active Observation

Newer Treatments and Clinical Trials

Researchers continue to research new methods for targeting and treating kidney cancer.

“We are working on developing new biomarkers that will help oncologists decide which treatment approach will provide the best outcome for their patients,” says Lee. “We are interested in developing novel pathways to attack the cancer. We are doing a lot of work to better understand how the genetics of the kidney cancer and the genetics of the patient impact the response to provide more personalized therapies, and we hope that in the future we will be able to develop more personalized approaches for patients.”

Disparities and Inequities in Kidney Cancer

Lifestyle Changes for Kidney Cancer

Avoid Smoking

Learn Whether You’ve Had Exposure to Certain Toxins

Ask your workplace whether its premises contain or have contained toxins such as asbestos, cadmium, or trichloroethylene. Get information on the steps taken to resolve this, and seek professional advice on how to reduce your exposure and protect yourself moving forward.

Maintain a Healthy Weight

Take Steps to Control Blood Pressure

• Exercise
• Weight loss
• Diet changes

In some instances, they may prescribe medications to control your blood pressure. Lee says that maintaining healthy blood pressure can help guide kidney cancer medication decisions later on.

“Because a lot of the medications that we use for kidney cancer can affect people’s heart or their sugars, it's important to reduce your risk of cardiovascular disease or diabetes, because these are risk factors that we need to consider when recommending treatment down the line,” says Lee.

Kidney Cancer Prognosis

A patient’s prognosis will depend on how advanced the cancer is, the treatments they receive, their overall health, and other factors. The treatments and the stage of disease can help define the possible duration of kidney cancer.

Complications of Kidney Cancer

• High blood pressure
• High red blood cell counts, known as erythrocytosis
• Elevated calcium in the blood
• Liver or spleen issues

The cancer’s spread to other areas of the body can result in associated symptoms, such as fluid buildup in the lungs or bone pain. Regular monitoring can help your doctor catch and manage many complications as they arise.

Support for Kidney Disease

Kidney Cancer Association

This patient-centered organization is dedicated to helping individuals impacted by kidney cancer. Its website is full of information on navigating kidney cancer treatment, and the group provides peer-led virtual support groups for survivors. The Kidney Cancer Association also offers online support communities through a private Facebook group and an online platform where caregivers and family members can connect and share resources.

Judy Nicholson Kidney Cancer Foundation

The Judy Nicholson Kidney Cancer Foundation enables renal cell carcinoma survivors to connect through its online forums. You can share your story, ask questions, and participate in virtual open forums. The foundation also offers dedicated online support groups for caregivers looking to connect with others, discuss their experiences, and find self-care tips.