Kidney cancer forms in kidney cells that line the tiny tubes where blood is filtered. If the cancer grows too large, it can prevent the kidneys from removing waste and regulating blood pressure.
Doctors diagnose kidney cancer with a physical exam and lab tests. They may also use computed tomography (CT) scans and magnetic resonance imaging.
Kidney cancer is the presence of a tumor in one or both of your kidneys. These two bean-shaped organs are located on either side of the spine, just below your rib cage. They remove waste and excess water from the blood, creating urine, which the body flushes out through tubes called ureters into the bladder. The kidneys also help regulate blood pressure and maintain a healthy balance of certain minerals, including sodium and potassium.
Over half of all kidney masses are found by chance, often during routine imaging tests for other health problems. The other half are diagnosed when symptoms develop, such as a pain in the back or abdomen; blood in the urine; loss of appetite and weight loss; high blood pressure; fatigue; swollen ankles and legs; fever unrelated to a cold or flu; and low red blood cell counts (anemia).
To make a diagnosis of kidney cancer, your doctor will run several types of tests. A urine test will look for signs of cancer, such as protein or blood cells. A blood test will check your overall blood health and levels of certain hormones, such as erythropoietin, which signals the bone marrow to create red blood cells. Your doctor will also perform an ultrasound of your kidneys and ureters to see if there is a mass. An MRI, which uses magnetic fields and radio waves, may be helpful in diagnosing some types of kidney cancer. Your doctor may also use a computed tomography scan, or CT scan, which creates multiple X-rays of your body and helps your doctor distinguish between solid and fluid-filled masses.
Other tests can show if the cancer has spread inside your kidney or to other parts of your body. Your doctor will use these results to determine the stage of your kidney cancer, which tells how serious it is.
Your doctor will likely prescribe medication to control your symptoms and stop the cancer from spreading. Depending on the stage of your cancer, you may also undergo systemic treatments, such as chemotherapy or radiation therapy, to reach the cancer cells throughout your body and prevent them from growing.
Kidney cancer occurs when healthy kidney cells change and grow out of control, forming a tumor. A tumor may be malignant (cancer) or indolent (not cancer). A malignant tumor can spread to other parts of the body. A benign tumor is unlikely to spread.
Surgery is usually the first treatment for a kidney tumor. At MD Anderson, surgeons use minimally invasive surgical techniques when possible. These include laparoscopy and robotic surgery. These techniques allow the surgeon to insert a tube with a camera and tools through small incisions in the abdomen.
A surgical procedure called partial nephrectomy can be used to remove just the kidney tumor and a small amount of surrounding tissue when it is safe. Candidates for this type of surgery are chosen based on the location and size of the tumor, health problems that could affect your outcome, and whether or not you want to keep your kidneys.
Other types of surgery can be used to treat kidney cancer that has spread. For example, a surgical procedure called nephron-sparing surgery can be used to remove just the kidney, a small part of the surrounding tissue, and the adrenal gland, which sits above each kidney. This is a good option for people who want to preserve their kidneys and have other health conditions that make it unsafe to undergo major surgery.
Your healthcare team will use tests to watch your cancer and symptoms over time. They may also recommend a clinical trial to test new treatments.
Chemotherapy uses medicines to kill cancer cells and stop them from growing. These medicines can be given orally, intravenously, or as a combination. They can also be combined with surgery, radiation, or other therapies.
Targeted therapy uses drugs to block certain characteristics that help cancer cells grow and spread. For example, medications called anti-angiogenic agents can prevent blood vessels from feeding a tumor, causing it to shrink or grow less quickly. Another type of targeted therapy, known as tyrosine kinase inhibitors, blocks a pathway that allows cancer cells to grow.
Ablation therapies can destroy cancer cells using heat or cold in people who can’t have surgery. These techniques can be used for all kinds of kidney cancer.
The kidneys are bean-shaped organs located on both sides of the spine in the upper abdomen. They remove excess water, salt and waste from the blood and filter it into a urine that passes through tubes called ureters to the bladder. Kidney cancer, also known as renal cell carcinoma, begins in the kidney cells and can spread to other parts of the body.
Doctors use a combination of factors, including a person’s age, general health and the stage of the disease, to determine a prognosis. The stage of the cancer is important because it helps doctors decide what treatment option is best.
Surgery offers the best chance of a cure for people with kidney cancer that hasn’t spread. The five-year survival rate for people with tumors that haven’t spread to other organs is about 88 percent.
But survival rates decline as the tumor size and where the cancer has spread in the body increase. UT Southwestern doctors are working to reduce these rates by improving surgical techniques and developing novel radiation approaches and immunotherapy treatments that help the body’s own immune system fight cancer better.
Those treatments are still experimental, but early results suggest that they may improve prognoses for some patients. For example, patients with the most common type of kidney cancer, clear cell carcinoma (RCC), who receive targeted drug therapy and radiation treatment have a good chance of staying alive for more than five years.
Other types of kidney cancer have lower five-year survival rates and less promising outcomes. They include papillary and chromophobe RCC and Wilms’ tumor, a childhood cancer that accounts for 95% of all pediatric kidney cancer cases.
If you are diagnosed with kidney cancer, learn as much as you can about the disease and what treatment options are available. Your doctor will discuss your prognosis with you, taking into account the type and stage of your tumor, your overall health and your personal preferences. You can also ask questions and get answers from other sources, such as support groups or websites.
A vaccine trains the body’s immune system to recognize cancer cells and kill them without harming healthy ones. It can help prevent a cancer from coming back, eliminate any remaining cancer cells after other types of treatment or stop the growth of new tumors. At this time, only some types of kidney cancer are candidates for treatment with a vaccine.
Cancer can be a result of an abnormal genetic mutation or exposure to certain toxic substances. The incidence of kidney cancer has been rising worldwide, but death rates remain stable. This increase may be due to better computerized tomography (CT) scanning techniques, which allow doctors to spot more cancers than in the past.
Kidney cancer can run in families and is linked to a few rare, hereditary genetic syndromes. These include hereditary papillary renal cell carcinoma, which affects up to 5% of people with this type of kidney cancer; and Birt-Hogg-Dube syndrome, which can cause noncancerous or cancerous tumors in the kidneys as well as lung cysts. However, most kidney cancers occur spontaneously.
There are several things you can do to reduce your risk of developing kidney cancer, including eating a balanced diet, exercising regularly, not smoking or using tobacco products and controlling other health conditions such as high blood pressure and obesity. Getting tested for certain diseases and avoiding toxins, like the metals asbestos and cadmium found in some work environments, can also lower your risk.
If you have a family history of kidney cancer or a genetic condition that increases your risk, speak with a doctor about genetic counseling. A simple blood test can determine whether you are at increased risk and may benefit from a genetic screening program.
Most people with kidney cancer don’t have any symptoms. This is because the tumours are very small and grow inside your kidneys. They are also deep in the body and hard to feel during a physical exam.
A biopsy can help your doctor confirm the diagnosis of kidney cancer. A needle is used to remove a sample of tissue, which is then examined under a microscope.
Pain in the area of your kidneys is one symptom of kidney cancer. It’s usually in the lower back on the side of your body between your ribs and hips (flank). It may feel like a pressure or ache that goes around to your upper abdomen or lower leg. You may also feel a lump.
Kidney cancer often doesn’t cause symptoms in its early stages, especially if it’s small and hasn’t spread to your lymph nodes or other tissues. However, more advanced cancers might cause pain or a mass in your flank or abdomen.
In some cases, a tumor may cause blood in the urine. This can happen when the tumor grows or when it blocks urine drainage, which can lead to a blood clot. It may also occur when the kidney tumor secretes substances that affect your body’s normal functions. This is called paraneoplastic syndrome. Examples include von Hippel-Lindau disease, hereditary papillary renal cell carcinoma and Birt-Hogg-Dube syndrome.
Your doctor or healthcare professional (HCP) will take a history of your symptoms and examine you. They may recommend imaging tests, such as a CT scan or an ultrasound, to see what is causing your pain or swelling. They may also recommend a biopsy to check for cancer.
The kidneys are 2 bean-shaped organs that sit on the sides of the body beneath the rib cage. They produce urine, which is the waste from the body. Cancer that develops in the kidney can cause blood in the urine. The blood is usually visible and may look pink. It may come and go, depending on how much the kidney is affected.
The doctor can find the source of the blood in the urine through a test called a urinalysis, which examines the urine for signs of infection. If the urinalysis shows bacteria or white blood cells, the doctor will do another test to check for cancer.
A MRI can show the location of the kidney tumour and how far it has spread in the body. The doctor can also do a biopsy to get a sample of the tumour for further tests.
A treatment called arterial embolization can shrink a tumor and prevent it from getting the oxygen and nutrients it needs to grow. It involves inserting a thin tube into the main blood vessel that carries blood to the kidney. Then the doctor injects small pieces of a special gelatin sponge into the blood vessel, blocking its flow and shrinking the tumour.
The kidneys are on each side of your body at the base of the spine (on the right and left sides, just below the ribs). Tiny tubules inside them filter the blood and remove waste to make urine. Then the urine passes through a tube (ureter) to the bladder. The bladder holds the urine until it is empty. Kidney cancer occurs when the kidney cells change and grow out of control, forming a mass that may invade surrounding tissue and organs.
There are 2 kinds of kidney cancer. One, called renal cell cancer, starts in the lining of tubes in the kidney. The other, called transitional cell carcinoma, starts in the cells that line the area of the kidney where urine collects before it moves to the bladder.
A tumor in the kidney or on the ureters can cause a buildup of fluid between the membranes that line the lungs (the pleura). This is called a pleural effusion. It can be painful and sometimes it can lead to shortness of breath. Fluid can be removed with a procedure called a thoracentesis. Or it can be prevented by placing an irritating substance in the pleural cavity, which causes the lining to scar and not hold fluid.
Often, kidney cancer causes a loss of appetite, which can be accompanied by a feeling of weight loss (cachexia). Some people may also feel very tired, and this fatigue doesn’t improve with rest.
Kidney cancer can also cause a fever that comes and goes, and this is called an intermittent fever. The cancer cells can also produce fluid in the body, which can lead to swelling of the feet, ankles, legs and hands (edema).
Many people with kidney cancer don’t have any symptoms at first. This is because the tumours are small in the early stages. The tumours can be detected on a scan or an x-ray done for another reason.
If the doctor suspects that a person has a kidney tumor, he or she will order tests to find out whether the cancer is in one or both of the kidneys, and how far it has spread. A urinalysis may show traces of blood in the urine (haematuria). A renal arteriogram can help diagnose the location of the tumour by inserting a thin tube into the main blood vessel that flows to the kidney. A treatment that shrinks the tumour by blocking the flow of blood to it is called an arterial embolization.
Kidney cancer starts when abnormal kidney cells grow out of control and form a tumor. Your doctor diagnoses it by reviewing your medical history, doing a physical exam and taking blood and urine tests.
Your doctor may recommend active surveillance, in which you have regular tests to look for signs that the cancer is growing or spreading. You might also receive drugs to prevent or treat symptoms.
In general, kidney cancer treatment depends on the stage and grade of your tumor, as well as your age and overall health. It may include surgery, ablation, targeted drug therapy or immunotherapy, or a combination of these treatments. Your care team will recommend the best option for you.
Your tumor is classified as one of four stages based on how abnormal its cells look and how quickly they grow. Your doctor also gives it a grade, which tells how aggressive the tumor is. A higher grade and stage mean the cancer is more likely to spread beyond your kidney.
The most common treatment options for advanced renal cell carcinoma are surgery, ablation and targeted drug therapy or immunotherapy. Medications that are taken by mouth or injected into a vein (intravenously) go into the bloodstream and reach cancer cells throughout your body. These medications can kill cancer cells or stop them from dividing. They may also prevent your tumor from growing new blood vessels that it needs to grow.
For people with small tumors in their kidney, your surgeon can remove the affected part of the kidney (partial nephrectomy). For larger tumors, or those that have already spread to the adrenal gland or other organs, you might undergo surgery called a radical nephrectomy. This operation removes the entire kidney and some of the surrounding fatty tissue. In some cases, your doctor might also remove the adrenal gland and nearby lymph nodes.
Medications called kinase inhibitors, which are given by mouth or intravenously, can target specific proteins that help cancer cells grow. Several of these drugs — including sunitinib, pazopanib and cabozantinib — have been approved to treat clear and nonclear types of renal cell cancer. These medicines work best when combined with other treatment approaches.
Doctors use chemotherapy to destroy cancer cells that have spread in the body. They give the medications by mouth or through a vein (intravenously). Chemotherapy drugs also can be given along with targeted therapy and immunotherapy.
Kidney tumors are treated by urologists (doctors who manage urinary tract conditions) and genitourinary medical oncologists (doctors who specialize in kidney cancer). They may suggest clinical trials to help test new treatments or reduce side effects from treatment. NCI’s Specialized Programs of Research Excellence and National Clinical Trials Network provide a wide range of clinical trials that can be searched using this link.
Surgery is a common treatment for kidney cancer. When it is possible, doctors remove the kidney and sometimes the adrenal gland. This is called radical nephrectomy. Occasionally, doctors can remove only part of the kidney (partial nephrectomy) when it is smaller than 4 centimeters or when other health problems make it hard to save the entire kidney.
Some kidney cancers grow so slowly that they don’t cause any symptoms for a long time. In these cases, doctors might choose to monitor the person by checking for tumors with regular imaging tests. This is called active surveillance and it might be an option for people who are very old or frail.
Some types of kidney cancer spread to the bone. When this happens, the cancer cells form a new tumor in the bone (metastasis). Doctors treat metastatic kidney cancer with chemotherapy and radiation. They might also use these therapies to ease the pain and other symptoms of the disease. The chemotherapy medications they use are similar to those used for other types of cancer. The radiation therapy they use may be X-rays or high-energy particles.
Radiation uses high-energy rays to destroy cancer cells and relieve pain (palliative therapy). It’s usually given five days a week for several weeks. Our radiation oncologists use advanced technology to carefully target the tumor, spare healthy kidney tissue, and limit side effects. Our team also includes a highly skilled interventional radiologist who performs ablation procedures, which can be done on an outpatient basis at our hospitals.
Surgery can be used to remove small kidney tumors that are confined to the kidney and haven’t spread beyond the organ. At MD Anderson, our surgeons often perform minimally invasive surgery using a laparoscope or robot-controlled procedure. For larger tumors, we may perform a partial nephrectomy or a radical nephrectomy to remove the affected kidney and some of the surrounding tissue. Our surgeons are experts at performing these surgeries through small incisions, reducing the risk of complications and speeding your recovery.
When a tumor has spread beyond the kidney, we can reduce symptoms and prolong survival with medications, radiation and sometimes chemotherapy. The medications — called targeted therapies — work by interfering with specific molecules that help cancer cells grow and spread. Some targets include the proteins that the cancer creates or the genes that control how they’re made. Other targets block the blood supply to the tumor, stopping it from getting the nutrients it needs.
Kidney cancer that has spread to other organs may be treated with radiofrequency ablation, cryoablation or stereotactic body radiation therapy. These are procedures performed by our urologists who specialize in kidney cancer, as well as by our radiologists. Our team can also perform a renal mass biopsy, in which a thin needle is inserted into the tumor to remove a sample for testing.
Immunotherapy uses drugs to help your body’s immune system fight cancer cells. It can be used with other treatments or on its own.
Some types of immunotherapy work by blocking the protein that helps cancer cells hide from your immune system, which then allows your own immune cells to destroy them. Other immunotherapies use drugs to encourage your own immune system to attack cancer cells that have already spread to other parts of your body (advanced kidney cell cancer or metastatic kidney cancer).
Researchers are investigating new treatment methods and combinations of existing medications, including immunotherapy, for people with all stages of kidney cancer. These are called clinical trials. You might be able to participate in a trial for kidney cancer, or you might want to talk to your doctor about other options.
One type of immunotherapy for advanced kidney cell cancer is interferon-alpha, a drug that affects how cells divide. It can slow the growth of tumors and cause some side effects, such as tiredness. It is often given in combination with bevacizumab (Avastin), which blocks the blood vessels that cancer cells use to grow and spread.
Other kinds of immunotherapy for advanced kidney cancer are immune checkpoint inhibitors. These drugs, which include avelumab (Bavencio) and nivolumab (Opdivo), work by blocking proteins on immune cells that prevent them from attacking cancer cells. These drugs can be given as a pill or as a drip into a vein (intravenously).
A clinical trial found that giving an immunotherapy drug after surgery improved disease-free survival rates for people with advanced kidney cancer at high risk of recurrence. The results were published in the New England Journal of Medicine.
Kidney tumors are often treated by urologists (doctors who manage urinary tract conditions) and genitourinary medical oncologists (doctors who specialize in cancer of the kidneys, ureters, and adrenal glands). They use a variety of treatments and technologies, including surgery, chemotherapy, targeted therapy, and immunotherapy.
Most kidney tumors are benign, or noncancerous. Benign tumors usually grow very slowly and don’t spread to other parts of the body. Surgical removal is the most common treatment. Occasionally, the doctor may monitor a benign tumor with regular physical exams and blood tests or scans. In these cases, doctors will look for signs that the tumor is growing or causing symptoms, such as blood in the urine (urinalysis).
If a tumor has grown very large and is affecting your quality of life, you may have an operation to remove it. The surgery is called nephrectomy. It is most commonly done using laparoscopic or robotic techniques, which are less invasive than traditional surgery. The surgeon uses a thin tube with a camera on the end (laparoscope) and tools inserted through small cuts in the tummy (abdomen). You will be under general anesthesia for this surgery.
Some people with kidney cancer that has spread to other places in the body have a more specialized operation to remove these cancers. This is called cytoreductive surgery and can be used to control the cancer for longer or to try to cure it.
Some types of kidney cancer respond better to certain drugs than others. These are called targeted therapies, because they target the genes or proteins that contribute to cancer growth and survival, without harming healthy cells. They include a group of medicines called tyrosine kinase inhibitors, which prevent the cancer from getting the chemical signals it needs to grow.
The most common type of kidney cancer is called renal cell carcinoma (RCC). It starts in the lining of small tubes in your kidney. It has several subtypes, including clear cell and papillary RCC. Another rare type, chromophobe RCC, has pale, large cells. These cancers are less likely to spread.
The most common type of kidney cancer is renal cell carcinoma (RCC). It forms in tiny tubules inside your kidney that direct substances your body needs, like water and nutrients, to your bloodstream, and filter waste out of your body as urine. RCC can start in one or both of your kidneys. It may also spread to other parts of your body, including other kidneys, bones, and lungs.
There are several subtypes of RCC. The most common is clear cell RCC, which accounts for 85% of all kidney cancers. Another is chromophobe RCC, which starts in cells that line the kidney’s collecting ducts and can be found as an incidental finding. Still others include transitional cell carcinoma and oncocytoma, which tend to grow more slowly and are less likely to spread than other types of kidney cancer.
Your doctor will use tests to find out how advanced the cancer is, and whether it has spread within your kidney or to other parts of your body (metastasis). These tests can help your healthcare team make treatment choices that best match your condition.
A specialist called a pathologist will look at your tumor under a microscope to see what kind of cells it has. Then your doctor will use this information to categorize the tumor into a grade. The lower the grade, the more like normal cells it is. High-grade RCC grows more quickly and is more likely to spread than low-grade cancers.
Renal medullary carcinoma (RMC) is a rare malignancy that occurs predominantly in young people of African ethnicity who have sickle cell disease or sickle cell trait. It is thought that RMC arises within the renal medulla in response to oxidative stress and hypoxia caused by sickling of red blood cells that pass through this organ.
Most RMC cases are diagnosed after a patient experiences symptoms including blood in the urine and pain around the kidney area. This cancer is most often found in the right kidney, but can also be found in the left. RMC is an aggressive malignancy with a poor prognosis, and most patients die within a year of diagnosis.
It is hard for doctors to predict who will get this type of kidney cancer. Most cases of RMC happen in people who have hemoglobinopathies that involve sickling, but it can occur in people without these conditions as well. People with sickle cell hemoglobinopathies may have a less severe form of this tumor called RCCU-MP, which has a better prognosis than RMC.
This patient was a 25-year-old female with a history of Sickle cell trait who presented with right flank pain and hematuria. Initial imaging revealed a right renal cystic lesion of 4.5 cm in diameter. A subsequent CT pelvis scout showed a poorly circumscribed mass in the renal medulla and renal pelvis that was later diagnosed as RMC.
In this rare subtype of kidney cancer, tumor cells infiltrate the renal medulla and occupy space within the collecting duct. CDC is a distinct pathology subtype of RCC, accounting for 1% to 2% of all epithelial renal cell carcinomas.1,2 Most patients present with advanced disease and have a poor prognosis.
CDC is usually found on imaging, such as CT or MRI. When a doctor suspects CDC, they may perform a biopsy, or take a small sample of the tissue, to confirm their diagnosis. The biopsy is then examined under a microscope. A biopsy isn’t always necessary, but it can be helpful in determining the stage of your cancer — how big it is and whether or not it has spread to nearby tissue.
In some cases, a biopsy may show that your cancer has sarcomatoid features. This means that it has cells with highly disorganized structures under the microscope and may be more aggressive than other forms of RCC. Although sarcomatoid features are not considered to be a separate subtype of kidney cancer, doctors are aware that these features can make your cancer harder to treat. In addition to chemotherapy and surgery, some people with CDC have been treated with immunotherapy, which is a type of medicine that targets your body’s immune system. There are several immunotherapy options available for RCC with sarcomatoid features, including the combination of ipilimumab and nivolumab (Yervoy), axitinib and pembrolizumab (Keytruda), lenvatinib and cabozantinib (Cabometyx), and atezolizumab (Tecentriq) and bevacizumab (Avastin). Clinical trials testing new treatments for this group of patients are ongoing.
A small percentage of tumors found in the kidney are benign, or non-cancerous. Benign tumors typically don’t grow large enough to cause symptoms. If they do, they may need to be removed through surgery. These include angiomyolipomas (renal hamartoma), lipomas (rare kidney fat tumors) and renal cysts. These are more common in women and usually don’t cause pain or blood in the urine. They are also seen more frequently in people with a genetic disorder called tuberous sclerosis, which causes tumors to develop in the skin, eyes and kidneys.
Pathologists look at the shape of the cancer cells under a microscope to give the tumors a grade. They assign a higher grade to cancers that are more aggressive and more likely to spread. This is why it’s important to tell your doctor if you have any symptoms of kidney cancer.
Some RCC subtypes, including clear cell and chromophobe RCC, can show disorganized features under the microscope. When this happens, doctors call the cancer “sarcomatoid.” It’s not a specific type of kidney cancer, but there is promising scientific research into immunotherapy treatments for this type of RCC. These include the approved combination of ipilimumab and nivolumab, as well as other experimental immunotherapy drugs. Currently, only about 1 in 3 unclassified RCC patients benefit from immunotherapy. Molecular alterations that can be targeted with these medications include CHECK2 alterations, PBRM1 alterations and ALK translocations.