A cancer diagnosis is a scary prospect for anyone, but luckily treatments have evolved over the years. Today, there are numerous treatment options for various different forms of cancer including kidney cancer. By knowing your options, you can discuss your concerns with your healthcare professional and create your treatment plan.
A Kidney Cancer Overview
Kidney cancer occurs when there is abnormal cell growth in the tissue of the kidneys. These cells form a mass or tumor and a malignant or cancerous tumor can spread to other tissues and organs in the body.
Kidney cancer is most common in the 65 to 74 age group, but men are twice as likely to develop the disease compared to women. Additionally, it is more common in Black and Native American groups. It is far less common in children, but approximately 600 children a year are diagnosed with a form of kidney cancer called a Wilms tumor in the U.S.
The Types of Kidney Cancer
Kidney cancer is not the most common form of cancer, it represents approximately 3.7% of all cancer cases in the U.S. However, this means that each year over 62,000 Americans receive a kidney cancer diagnosis.
There are several types of kidney cancer.
RCC
RCC or renal cell carcinoma is the most common type of kidney cancer in adults, accounting for 85% of all kidney cancer cases. RCC usually develops as one tumor in one kidney, but it can affect both of your kidneys. The cancer tends to begin in the cells lining the kidney tubules, which are the miniscule tubes that bring nutrients and fluid back to the blood.
Transitional Cell Cancer
This type of kidney cancer is approximately 6% to 7% of cases. It usually begins in the area called the renal pelvis, where the ureter joins the main part of the kidney. Transitional cell cancer can also occur in the bladder or ureters.
Renal Sarcoma
This is the least common type of kidney cancer, with only 1% of all kidney cancer cases. It starts in the connective tissues of the kidneys, but if not treated, it may spread to nearby bones and organs.
Wilms Tumor
Kidney cancer tends to affect older adults, but children can develop Wilms tumors and this type of cancer is 5% of kidney cancer cases.
Signs of Kidney Cancer
Unfortunately, kidney cancer does not tend to produce noticeable symptoms in the early stages, but as the tumor grows, you may start to experience symptoms. This does mean that kidney cancer is not often diagnosed until it has started to spread.
Signs or Symptoms of Kidney Cancer
| Sign | Description | Possible Cause |
|---|---|---|
| A lump in your kidney area | A mass or swelling felt on the side or lower back. | Tumor growth in or around the kidney. |
| Tiredness | Persistent fatigue and low energy levels. | Anemia, cancer-related metabolic changes. |
| Loss of appetite | Reduced desire to eat, leading to weight loss. | Cancer-related systemic effects. |
| Flank pain | Pain on one side of the lower back or abdomen. | Tumor pressing on surrounding tissues. |
| Blood in your urine (Hematuria) | Pink, red, or cola-colored urine. | Tumor affecting kidney function or blood vessels. |
| High blood pressure | Increased blood pressure readings. | Kidney dysfunction affecting blood pressure regulation. |
| High calcium (Hypercalcemia) | Elevated calcium levels in the blood. | Cancer-related hormone imbalances. |
| Anemia | Low red blood cell count, leading to weakness. | Reduced kidney function affecting red blood cell production. |
| Weight loss | Unexplained loss of weight. | Cancer-related metabolic changes. |
| A general sense of feeling unwell | Persistent discomfort or malaise. | Body’s response to cancer or kidney dysfunction. |
Diagnosis
If you have any of the symptoms of kidney cancer, you should consult your healthcare provider for a complete history and physical exam. Your doctor may order some tests to help diagnose the underlying issue.
Blood Tests
Blood tests count the number of different types of blood cells and measure the electrolytes in the body. Your blood will be drawn to see if you have anemia, which would present as too few blood cells or impaired kidney function, recorded by the creatinine levels.
Urinalysis
You’ll need to provide a sample of urine and it will be tested for traces of blood. While these may be invisible to the human eye, minuscule amounts of blood can be detected by testing a sample, which can indicate an issue with your kidneys.
CT Scan
This is a special form of X-ray, which uses a computer to create images inside your body. The technician will use intravenous contrast, which is a form of dye, which can be traced moving through the body during the scan. If you have impaired kidney function, you may not be able to receive this dye.
Ultrasound
This type of testing uses high frequency sound waves, which are transmitted through the tissues of the body to create an image that is displayed on a monitor. This technology is often used in pregnancy to check the status of the fetus, but it can also help detect tumors, as they have a different density compared to healthy tissue.
MRI
MRI or magnetic resonance imaging uses a large magnet and radio waves to produce images of the inside of the body on a computer screen.
Biopsy
To confirm a cancer diagnosis, your doctor may need to perform a biopsy. This is where a thin needle is inserted directly into the tumor to remove a small sample of the tissue. This tissue can then be examined under a microscope by a pathologist to check for cancer cells. Unfortunately kidney mass biopsies can be unreliable, so your healthcare professional may not recommend this testing.
The Causes of Kidney Cancer
There are no exact known causes of cancer, but there are a number of risk factors associated with the disease.
Obesity
Obesity is a risk factor for developing kidney cancer. Generally, the more overweight the person is, the higher the risk.
Smoking
Smokers are at a greater risk for developing kidney cancer. Long term and heavier smokers are at higher risk compared to social smokers.
High Blood Pressure
Hypertension or high blood pressure has been shown to be linked with an increased risk of developing kidney cancer.
Long Term Dialysis
Dialysis is a treatment option for those with compromised kidney function. It involves passing your blood through a special machine to clean it. Unfortunately, long term dialysis can increase the risk of developing kidney cancer.
Radiation Therapy
Although kidney cancer is more common in men, there is an increased risk for women who have received radiation therapy for reproductive organ cancer.
Family History
If you have family members who have had kidney cancer, there is an increased risk, you may develop the disease.
Gene Mutations
Genes contain the instructions for the function of the cell, but mutations can occur. Changes in some genes can increase the risk for kidney cancer.
VHL
VHL or von Hippel-Lindau disease is an inherited disorder, which causes noncancerous tumors in the blood vessels. Unfortunately, people with this condition have a greater risk of developing kidney cancer.
Tuberous Sclerosis Complex
This disease causes intellectual disabilities and seizures, but sufferers also have an increased risk of developing tumors in different organs including the kidneys.
How Serious is a Kidney Tumor?
There is no easy answer to this question, as some tumors are benign, which means that they are non cancerous. Generally, this type of tumor is smaller and will not spread to other parts of the body. The most common treatment for a benign kidney tumor is surgical removal.
If your tumor is malignant or cancerous, it will be classified into one of four stages. The stage of the cancer is determined by the size and location of the tumor, the degree to which the cancer has spread to other organs or tissues and the extent to which lymph nodes are affected.
The cancer stage will aid planning treatment and provide insight into how serious it is.
- Stage I: If a tumor is 7 centimeters or smaller across and is only in the kidney with no spreading to lymph nodes or other tissues, it is stage I.
- Stage II: If the tumor is larger than 7 centimeters across, but it is still limited to the kidney and has not spread to other tissues, it is stage II.
- Stage III: When the tumor has spread to major blood vessels, the tissues surrounding your kidney or to the nearby lymph nodes, it is stage III.
- Stage IV: If the tumor has spread to the adrenal gland, other organs or distant lymph nodes, it is stage IV.
Tumors are also given a grade, according to how abnormal the cells look. Tumor grading can inform healthcare professionals how fast it is likely to grow. High grade tumors have cells which don’t look like normal cells, and they divide rapidly. These tumors tend to grow more quickly and spread compared to low grade tumors.
Kidney Cancer Treatment Options
Depending on the stage of your cancer, you may have one or more treatment options. Your healthcare team will consist of a urologist, an oncologist, a radiologist and other specialist doctors and nurses, who will meet to discuss the suitable treatments. This multidisciplinary team or MDT will assess your general level of fitness and health, the location and size of the tumor, whether the cancer has spread and other factors to create treatment options.
Regular Scans and Monitoring
If the tumor is small, it may not require immediate treatment, so your doctors may recommend monitoring with regular scans. This is known as active surveillance and is most appropriate for those with other health conditions or issues that may make surgery inadvisable.
Surgery
This is the most common treatment for kidney cancer, specifically when the cancer has not spread. The surgeon may remove all or part of the kidney to remove the tumor. In cases where the cancer has spread, surgery may be advised to relieve pain or other symptoms resulting from the advanced cancer.
Cryotherapy
Cryotherapy or cryoablation is freezing the cancer cells to kill them. The procedure involves putting a needle through the skin into the affected area of the kidney and using cold gas to freeze the cancer cells. This treatment is used if the tumor is small and isolated.
Radiofrequency or Microwave Ablation
This treatment uses heat to kill the cancer cells. A needle is inserted into the kidney through the skin, heating the cancer cells with radiofrequency or microwave energy. This treatment tends to be used if the tumor is small or if there are several tumors in one or both kidneys.
Embolisation
Embolisation restricts the blood supply and a treatment for kidney cancer is to embolize the renal artery, preventing blood flow to the cancer or the entire kidney. This can slow down the tumor growth, particularly if you are unable to have surgery or are having pain and other symptoms.
Radiotherapy
This treatment uses high energy rays, which are similar to x-rays. The radiotherapy can destroy cancer cells and it can help to control the symptoms of advanced kidney tumors or reduce the size of a tumor to make it more operable.
The type and number of treatments will depend on where the cancer has spread. There are specialist cancer centers that offer radiotherapy, so you may need to travel for treatment.
Immunotherapy
Immunotherapy uses your immune system to fight the cancer. This can help to target the cancer cells, leaving the normal cells able to grow and survive. Immunotherapy may be used following surgical tumor removal if there is a higher chance of it recurring.
The treatment protocol is typically introducing the therapy into the bloodstream approximately every three to six weeks for up to one year.
Immunotherapy may also be used in combination with targeted cancer drugs if you have cancer caused by von Hippel-Lindau disease or you have advanced kidney cancer. There are a number of different drug combinations, and the aim is to relieve symptoms and control the cancer.
Generally, the treatment options will be determined by the stage of the kidney cancer. Surgery tends to be the main treatment for stages one, two and three kidney cancer. However, if the tumor is less than 4 centimeters, you’re older or you have a lot of other health issues, your doctor may recommend close monitoring, as surgery may not be advisable.
Often surgery can cure stage one and stage two cancers that are contained within the kidney. Stage three cancer is known as locally advanced, which means that it has spread outside the kidney into nearby tissues. If the surgeon can remove all of the tumor, surgery may provide a cure. If there is a higher chance of the tumor recurring, you may need to take medications or immunotherapy drugs after your surgery.
If you have stage four kidney cancer, the cancer has spread to other parts of your body, which means it is classified as advanced kidney cancer. Although the initial tumor was in your kidney, you may have secondary or metastasized cancer in other tissues or organs. Since there are few noticeable symptoms in early cancer, you may already have advanced cancer when you are first diagnosed.
If the cancer has not extensively spread, and you are generally healthy, your healthcare professional may recommend surgery. You may also require immunotherapy after the tumor removal to reduce the chances of it returning.
If you are unable to have surgery, there are still several treatment options that may slow or stop the growth of the tumor.
What if Kidney Cancer Returns?
Once you’ve completed kidney cancer treatment, you will need to have regular follow up appointments with your doctors. This is to monitor your recovery and check if there are signs that cancer has returned.
Unfortunately, kidney cancer can reoccur. If you’ve already had part of the kidney removed, further surgery may be required to remove the remainder of the kidney. If you previously did not have surgery and you are well enough, your doctor may suggest removing the kidney, which may eliminate the cancer completely in some cases.
If the cancer returns in another part of the body, the treatment will depend on the location of the tumor. It may be possible to have surgery to remove the secondary cancer, but it is unlikely to cure the cancer. Instead surgery may provide relief from symptoms. The main treatment for secondary cancer is immunotherapy and/or targeted drugs, which can slow or stop the growth of the tumor.
If you or a loved one has received a kidney cancer diagnosis, it is a scary and daunting prospect, but there are numerous treatment options. Your healthcare professional will be able to assess your medical history, symptoms and test results to determine the most appropriate treatment options. You can then discuss treatments, along with benefits and potential drawbacks to decide an appropriate course of treatment.
Fortunately, new treatment options and techniques are continually being developed, so there is hope for the future. Even if you are not a suitable candidate for surgery now, the doctors can monitor you or recommend other treatment options which may slow or stop the growth of the tumor to relieve your symptoms and make other treatments including surgery possible later.
You can discuss any concerns or questions you have with your healthcare team, so you can be fully informed of the treatment options and feel comfortable with the course of treatment, This will help you to feel more in control and informed of what to expect and how you can continue with the things you like to do and enjoy in your everyday life, so you can maintain a good quality of life with your family and loved ones.
