Kidney Cancer

Each year in the United States, about 51,000 adults will learn that they have kidney cancer. If you have been told that you have the disease, here are some things you should know.

There are two main types of kidney cancer: Renal cell cancer and transitional cell cancer. Renal cell is the most common type in adults. It begins in the lining of the renal tubules (tiny tubes) in the kidney. The renal tubules clean the blood and make urine. Renal cell cancer may metastasize, which means it may spread to other parts of the body, most often the bones or lungs. Statistics show that about 30% of people who are diagnosed with renal cell cancer develop advanced (metastatic) disease.

Transitional cell cancer is far less common than renal cell. Another type of kidney cancer, called Wilm's tumor, is most often seen in children.

This A-Z guide is about renal cell cancer.

What causes kidney cancer?

The cause of kidney cancer is unknown, but certain risk factors are linked to the disease. (A risk factor is anything that increases a person's chance of getting a disease.) Different cancers have different risk factors. Some risk factors are under your control (smoking); others are not (gender and race). Having a risk factor for a disease does not necessarily mean you will get the disease, but it may raise your risk.

Possible risk factors for kidney cancer are:

• Smoking
• Being much above normal weight (obese)
• Contact with certain substances on the job (asbestos, cadmium [a type of metal], certain herbicides, benzene, other organic solvents, particularly trichloroethylene, and coke from furnaces in steel plants).
• Some types of radiation treatment.
• A past history of long-term use of a pain relieving drug called phenacetin. (This drug is banned and has not been used in the United States for over 20 years).
• High blood pressure (also called hypertension). It is unclear if the higher risk is caused by drugs used to treat high blood pressure or by the condition itself, or both.
• Gender and race. The disease is seen about twice as often in men than in women. Black people have a slightly higher rate of renal cell cancer than white people.
• Having advanced chronic kidney disease (CKD) that requires dialysis treatment.
• Family history. Brothers and sisters of people with kidney cancer have a much higher chance of getting the disease.
• Certain rare genetic diseases, such as von Hippel-Landau disease and others. People with these conditions have a much higher risk for getting kidney cancer.

A person may be able to lower the risk of kidney cancer by avoiding those risk factors that can be controlled. For example, stopping smoking may lower the risk, and controlling body weight and high blood pressure may help as well. Avoiding contact with harmful chemicals is also important.

What are the symptoms of kidney cancer?

In the early stages, renal cell cancer usually causes no clear signs or symptoms. However, as the tumor grows, symptoms may include:

• Blood in the urine (hematuria)
• A lump or mass in the area of the back near the kidneys

Less often, patients may have:

• A constant pain in the side near a kidney
• High blood pressure or anemia (a decrease in the number of red blood cells in the blood)

These symptoms can also be caused by less serious problems such as a benign (non-cancerous) cyst (fluid-filled tumor) or an infection. If you have any of these symptoms, check with your doctor. He or she will do some tests to find out what is causing your problem.

How is kidney cancer found?

Your doctor will check your general health and may do blood and urine tests. He or she may also feel the abdominal area for any lumps or masses. The doctor usually orders tests and images of the kidneys and nearby organs. These may include:

• CT (computed tomography) scan, MRI (magnetic resonance imaging) or ultrasound, which can show if a tumor is present and help tell whether it is benign (non-cancerous) or malignant (cancerous).
• An IVP (intravenous pyelogram), a series of x-rays that use an injection of dye to better view the kidneys.

If the diagnosis is still unclear after the above tests, a biopsy may be needed. This test is done by checking a sample of tissue under the microscope for cancer cells.

If kidney cancer is found, the doctor will decide the stage of the disease in order to plan treatment. This may mean more MRI and x-ray studies. Arteriography (x-rays of the blood vessels) may be done to give your doctor more information about what type of treatment is needed. A chest x-ray can help show whether the cancer has spread to the lungs, and bone scans can show whether it has spread to the bones.

How is kidney cancer treated?

Like most types of cancer, kidney cancer treatment depends on the stage of the disease, the patient's general health and age and other factors. You may be treated by a team of specialists including a urologist (specialist in diseases of the urinary system), oncologist (cancer specialist) and a radiation oncologist (specialist in treating cancer with radiation). The team may also include an oncology nurse, social worker and other health care professional.

Kidney cancer is usually treated with a combination of nephrectomy (surgical removal of all or part of the kidney), radiation therapy, immunotherapy, chemotherapy and hormone therapy. Your treatment choices should be discussed with your medical team.

Surgery:

Nephrectomy (surgical removal of all or part of the kidney) is the most common treatment for kidney cancer. Thousands of nephrectomies are done in the United States every year for kidney cancer as well as for other diseases.

Note: A nephrectomy may also be used to remove a healthy kidney from a living or deceased person for the purpose of transplantation.

There are two basic types of nephrectomies for kidney cancer: open partial nephrectomy and open radical nephrectomy. In the partial type, the surgeon removes just the part of the kidney that has the tumor. The radical procedure involves removal of the entire kidney, often along with the adrenal gland above the kidney, the surrounding fatty tissue, and any involved lymph nodes. These types of surgery may use a large opening to directly reach the diseased kidney, or may be performed using laparoscopic technique, depending on the surgeon's preference (see below).

A less invasive type of surgery—called minimally invasive surgery—has gained popularity for treating kidney cancer. This procedure uses a laparoscope (tube-like instrument with a tiny camera and forceps to remove the kidney) passed through small openings in the abdomen. The procedure is called laparoscopic nephrectomy. The advantages of laparoscopic surgery include a shorter hospital stay, faster recovery, and less post-operative pain.

Laparoscopy can be used for both radical and partial nephrectomies and achieves the same goals as traditional surgical techniques.

Sometimes before surgery, a procedure called arterial embolization may be used. A special gelatin material is injected through a plastic tube to clog the main kidney blood vessel. This shrinks the tumor by taking away the oxygen-rich blood and other material it needs to grow.

Radiation Therapy:

Radiation therapy uses high-energy x-rays to kill cancer cells. Called external beam therapy, it focuses radiation from outside the body directly on the cancer. It is like getting an x-ray, it is painless, but the beam is stronger.

Radiation therapy may be used when a person's general health is too poor to have surgery. However, radiation does not do a very good job of treating kidney cancer. It is sometimes used to relieve pain when the cancer has spread to the bone.

This treatment can be given as an outpatient in a hospital or a clinic.

Side effects of radiation may include:

• Mild skin rash, similar to sunburn
• Nausea and diarrhea
• Tiredness

Radiation to the chest area may injure the lungs and cause shortness of breath. Most side effects often go away after a short time.

Immunotherapy:

Immunotherapy, sometimes called biologic therapy, is a form of treatment that uses the body's own natural ability (immune system) to fight cancer. Immunotherapy is limited to the treatment of advanced metastatic kidney cancer since it can be hard to give and may cause serious side effects.

The main drugs used in immunotherapy are called cytokines (proteins that turn on the immune system). Interleukin-2 (IL-2) and interferon-alpha are two types of cytokines used to treat advanced kidney cancer. Using both cytokines in low doses was once thought to lower the number of serious side effects. Most doctors now think that high-dose interleukin-2 alone has a better chance of shrinking the tumor. However, there are major side effects with this treatment.

Among the possible side effects of cytokine therapy, especially high-dose IL-2, are:

• Extreme fatigue
• Low blood pressure (hypotension)
• Fluid build-up in the lungs
• Trouble breathing
• Kidney damage
• Heart problems
• Intestinal bleeding
• Diarrhea or abdominal pain
• High fever and chills
• Rapid heart beat
• Mental changes

Chemotherapy:

Chemotherapy is the use of drugs to kill cancer cells. It is the usual treatment for many cancers, but it has shown only partial value against kidney cancer. Because many chemotherapy drugs kill healthy cells along with cancer cells, there are a number of side effects with this form of treatment.

Newer drugs are available that work differently than standard chemotherapy. They have been helpful in the treatment of advanced kidney cancer. Called targeted therapies, these drugs specifically target the gene changes in cells that cause cancer.

Among the new drugs used to treat advanced kidney cancer are:

• Sorafenib (Nexavar)
• Sunitinib (Sutent)
• Temsirolimus (Torisel)
• Bevacizumab (Avastin)

Some of these drugs have been shown to slow the growth of the cancer; others work by blocking a cell protein that normally helps cell growth. One works by slowing the growth of new blood vessels.

One experimental drug called axitinib showed promising results in almost half of patients with a specific type of metastatic kidney cancer. These patients typically have a poor response to drug treatment.

Although they work in different ways, none of these drugs have been shown to cure kidney cancer.

Nutrition during cancer treatment

It is important to eat well for good nutrition during cancer treatment. Good nutrition means getting enough calories and nutrients to help prevent weight loss and regain strength. Patients who eat well often feel better and have more energy.

Some people find it hard to eat well during treatment. This is because their treatment may cause them to lose their appetite or have side effects like nausea, vomiting or mouth sores, which can make eating difficult. For some people, food tastes different. Others may not feel like eating because they feel uncomfortable or tired.

Where can I find support?

Living with a serious illness is not easy. People with cancer and those who care about them face many problems and challenges. Coping with these problems often is easier when you have helpful information and support from friends and relatives. Also, it helps many people to meet in support groups to talk about their concerns with others who have or have had cancer. In support groups, patients share what they have learned about dealing with cancer and the effects of treatment.

Keep in mind that each person is different, and the same treatments and ways of dealing with cancer may not work for everyone. Always discuss the advice of friends and family with members of your health care team.

What about the future?

Kidney cancer is a serious disease, but in most cases, the earlier it is found, the better the outcome. Kidney cancer can often be cured if found and treated before it has spread. Many researchers are trying to find better ways to find kidney cancer at an early stage. Late-stage kidney cancer is harder to treat and the prognosis is less positive. However, new drugs are available which show promise in managing advanced kidney cancer.

Where can I get more information?

You should speak to your doctor and health care team. You can also get more information from the following organizations:

• National Cancer Institute, 1-800-4-CANCER (1-800-422-6237), or online at http://cancer.gov
• National Kidney and Urologic Disease Information Clearinghouse (NKUDIC), a service of the National Institute of Diabetes, Digestive and Kidney Diseases. Call 1-800-891-5390 or visit the website at www.niddk.nih.gov

Date Reviewed: March 2009

Thank you so much to the people affected by kidney cancer and your caregivers who took the time to complete NKF's Kidney Cancer Survey. Your participation was the first step in understanding your needs for education and support as you, and other patients and caregivers, face challenges in managing kidney cancer and protecting kidney function. We sincerely appreciate your efforts, and look forward to sharing the survey results with you soon. So please stay tuned!

If you would like more information, please contact us.

©2013 National Kidney Foundation. All rights reserved. This material does not constitute medical advice. It is intended for informational purposes only. No one associated with the National Kidney Foundation will answer medical questions via e-mail. Please consult a physician for specific treatment recommendations.