What is Kidney Cancer?

Symptoms

Kidney Cancer Symptoms

Kidney tumors may not hurt or show any signs. Sometimes a growth in the kidney can cause:

  • Blood in the urine
  • Pain in the side, abdomen or back that doesn’t go away
  • A lump in your abdomen
  • Loss of appetite and weight loss for no known reason
  • Anemia and fatigue

If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon where it spreads. Short breath or coughing-up blood may occur when cancer is in the lung. Bone pain or fracture may occur when cancer is in the bone. Neurologic symptoms may occur when cancer is in the brain.

Causes

What Causes Kidney Cancer?

Cancer in the kidney is linked to the following risks:

  • Smoking
  • Obesity
  • Chronic high blood pressure
  • Misusing certain pain medicine for a long time
  • Von Hippel-Lindau syndrome
  • Tuberous sclerosis
  • Family history of kidney cancer

Diagnosis

How is Kidney Cancer Diagnosed?

Unfortunately, there are no blood or urine tests that directly detect kidney cancer. Most often a tumor is diagnosed during routine screening for people with genetic risks (e.g. Von Hippel-Lindau disease, tuberous sclerosis). Or it is found when a person sees a doctor about an unrelated problem.

The National Cancer Institute (NCI) lists these tests most often used to diagnose kidney cancer:

  • Physical exam and history: A health care professional will examine your body to check general signs of health. They will also check for lumps or anything else that seems unusual. They will ask about your health habits, past illnesses and treatments.
  • Ultrasound exam: An image of your kidneys and organs may first be taken with an ultrasound. Here, high-energy sound waves (ultrasound) are bounced off internal tissues or organs and make images.
  • Blood chemistry studies: Blood samples are checked to look for certain substances released into the blood by your organs. If amounts are higher or lower than normal, it is a sign of disease.
  • Urinalysis: A sample of your urine is tested to see the color and contents. Unusual levels of sugar, protein, red blood cells, and white blood cells can indicate a problem.
  • Liver function test: A sample of blood is checked to measure the enzymes released by the liver. Unusual levels may be a sign that cancer has spread to the liver.
  • Intravenous pyelogram (IVP): A series of x-rays of the kidneys, ureters, and bladder are taken to see if cancer is found there. A contrast dye is injected through a vein. It moves through these organs, and x-rays are taken to look for blockages.
  • CT scan (CAT scan or computed tomography): This procedure makes a series of detailed pictures inside the body, taken from different angles. The pictures are made by a computer linked to an x-ray machine. A dye may be used to help see the organs or tissues more clearly.
  • MRI (magnetic resonance imaging): This imaging exam uses a magnet, radio waves and a computer to make detailed pictures of organs. Your doctor will get a clearer image of abnormal growths through these images.
  • Biopsy: A biopsy is when cells or tissues of an organ are removed and studied. The sample is viewed under a microscope by a pathologist. A pathologist is a doctor who can check for signs of cancer. For renal cell cancer, a thin needle is inserted into the tumor and a sample of tissue is removed for the biopsy.

If your tests show you have kidney cancer, you will want to talk with a cancer specialist. The doctors who can help include:

  • A urologist: a surgeon who specializes in treating diseases of the urinary system and reproductive systems
  • A radiation oncologist: a doctor who treats cancer with radiation therapy
  • A medical oncologist: a doctor who treats cancer with medicines such as immunotherapy

Grading and Staging

What are the Stages and Grading of Kidney Cancer

Kidney Cancer Stage 1
Kidney Cancer Stage 1
Cancer Research UK

Kidney Cancer Stage 2
Kidney Cancer Stage 2
Cancer Research UK

Kidney Cancer Stage 3
Kidney Cancer Stage 3
Cancer Research UK

Kidney Cancer Stage 4
Kidney Cancer Stage 4
Cancer Research UK

For more information on the TNM system and kidney cancer staging, click here.

If cancer cells are found, your doctor will need to know the tumor stage and grade. The stage is a category used to rank how much the cancer has grown and/or spread. For kidney cancer, the “TNM” staging system is often used. The grade is a way to rank how quickly the cancer is growing. The Fuhrman grading system is often used. A carefully diagnosed grade and stage will help your health care team find the best treatment.

Staging

The American Joint Committee on Cancer (AJCC) is the most common kidney cancer staging system used. For kidney cancer, this system is known as the TNM system. It describes three pieces of information:

  • T describes the size of the main (primary) tumor and whether it has grown into nearby areas.
  • N describes how much it has spread to nearby (regional) lymph nodes. Lymph nodes are small bean-sized collections of immune system cells.
  • M describes whether the cancer has spread (metastasized) to other parts of the body. The most common sites of spread are to the lungs, bones, liver, brain, and distant lymph nodes.

Numbers or letters provide more details about each of these factors. The grades 0 through 4 show increasing severity. The letter X means “not enough information is available.”

Staging the cancer helps to predict your long-term health and survival. For example, cancers with higher T stage, lymph node or other metastasis have a worse outcome. These patients may want to consider other treatments.

These descriptions define the main kidney cancer stages:

  • Stage I: The tumor is confined to the kidney and less than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
  • Stage II: The tumor is confined to the kidney and greater than 7.0 cm in size. There is no spread to lymph nodes or distant organs.
  • Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade into other adjacent organs or those with distant metastasis.
  • Stage IV: There are several combinations of T, N, and M categories that are included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall, and those with distant metastases.

TNM Staging Categories

Primary tumor (T):
TX: Primary tumor cannot be assessed
T0: No evidence of primary tumor
T1: Tumor 7.0 cm or less, confined to the kidney
T1a: Tumor 4.0 cm or less, confined to the kidney
T1b: Tumor 4.0-7.0 cm, confined to the kidney
T2: Tumor greater than 7.0 cm, limited to kidney
T2a: Tumor > 7 cm and less than 10.0 cm, confined to the kidney
T2b: Tumor > 10 cm, confined to the kidney
T3: Tumor extends into major veins or perinephric tissues but not into the adrenal gland and not beyond Gerota's fascia
T3a: Tumor extends in the renal vein or its segmental branches, or tumor invades perirenal and or renal sinus fat but not beyond Gerota's fascia
T3b: Tumor extends into the vena cava below the diaphragm
T3c: Tumor extends into vena cava above diaphragm or invades the wall of the diaphragm
T4: Tumor invades beyond Gerota's fascia (including contiguous extension into the ipsilateral adrenal gland

N - Regional lymph nodes
NX: Regional nodes cannot be assessed
N0: No regional lymph node metastasis
N1: Metastasis in regional lymph node(s)

M - Distant metastasis
MX: Distant metastasis cannot be assessed
M0: No distant metastasis
M1: Distant metastasis

Treatment

Treatment Options

The treatment plan that you choose with your doctor depends on many things:

  • Tumor grade and stage
  • Your age
  • Your overall health and health history
  • Your anatomy (the anatomy of your kidney collection system)

Options include:

When kidney cancer is caught early, the chances of a surgical cure are good. Overall the outlook depends on two things:

  1. How aggressive the cancer cells are. Low-grade disease is less aggressive. It has a lower chance of spreading to other organs. High-grade disease is more aggressive with a higher chance of spreading.
  2. How far the tumor has spread. If the tumor does not involve nearby lymph nodes or other tissue, there is a good chance for cure. Additional treatments would not be needed. If the cancer has spread, your doctor will probably recommend additional treatment.

After Treatment

What Can I Expect After Treatment?

The speed of your recovery depends on your treatment. A minimally invasive approach (less injury to the body) will lead to a quicker recovery. The best treatment is often the one that offers the best long-term outcome. If your surgeon removed one kidney and the remaining kidney works well, you should enjoy a good quality of life and health. One good kidney can usually do the work of two.

After treatment you will need continued checkups to watch for a re-growth of cancer. After treatment, your doctor will perform many of the same tests used to diagnose the cancer. These visits and tests should continue at least yearly throughout your life.

Protecting Your Kidney after Surgery

If the surgery leaves you with only one kidney, you should avoid a few things. For example, avoid major contact sports (e.g., football, karate or boxing), or NSAIDs (nonsteroidal anti-inflammatory drugs, e.g., aspirin and ibuprofen). In rare cases, these drugs can cause kidney damage. Depending on how well your kidney functions, you may need to avoid dyes used in some imaging tests. You may also want to limit the salt and protein in your diet. Your urologist may recommend you see a Nephrologist for monitoring your kidney function after surgery.

Treating problems like high blood pressure, diabetes, high cholesterol, and obesity, can help prevent future kidney damage.

More Information

More Information

What Questions Should I Ask My Health Care Provider?

  • Do I have kidney cancer or something else?
  • What is the stage and grade of my cancer and what does that mean?
  • Has it spread anywhere else?
  • Do I need other tests before we can decide on treatment?
  • What are my treatment options? Which do you recommend and why?
  • What are the chances my cancer can be cured?
  • What are the chances that my cancer will return after treatment?
  • What risks or side effects should I expect from treatment? For how long?
  • What should I do to prepare for treatment? What will it be like?
  • What will we do if the treatment doesn’t work?
  • Can you recommend another urologist for a second opinion?
  • Is there anything I can do to protect my health from here?
  • How often will I need to have checkups after treatment?

Frequently Asked Questions

Should I have a biopsy of the tumor?

For kidney tumors, biopsy is usually not helpful. This is because most biopsies have a risk of inaccurate results. Most often, the doctor will choose to remove the tumor without performing a biopsy. It may be done if other tests suggest that the lesion is from infection, swelling or a different type of cancer.

Does the adrenal gland need to be removed along with the kidney?

If the adrenal gland appears to contain a tumor, then it is removed. Otherwise, a surgeon will try to preserve the adrenal gland while removing the kidney tumor. If one must be removed, a person can live a normal life with only one adrenal gland.

Do I need any additional treatment after surgery?

When the tumor is not cancerous, no additional treatment is needed. When the tumor is cancer, the surgery often serves as adequate treatment. If the cancer has metastasized you most likely will need further treatment once recovered from surgery.

Can I live a normal life with one kidney?

Yes, most people can live a normal life with one working kidney. Even in cases when the remaining kidney is not 100% functional, people can still live a normal life. Dialysis is rarely necessary.

What can I do to prevent the return of kidney cancer?

There are no proven ways to prevent cancer from returning. Still, avoiding risks will help. For example, stop smoking. It is extremely important to follow up with your doctor on a regular basis.