Kidney Cancer

Symptoms and risk factors

What are common kidney cancer symptoms?

Not everyone with this cancer notices signs or symptoms, especially if the tumor is in early stages. As the cancer grows, signs of kidney cancer may include:

• Blood in the urine (hematuria)
• Pain during urination
• Pain in the pelvis
• A lump in the lower back or side
• Unexplained weight loss

Other noncancerous conditions may also cause these symptoms, so it's essential that you discuss anything unusual with a doctor.

Who has an increased risk of developing kidney cancer?

Risk factors are things that increase your risk of getting a disease. Having a risk factor doesn't mean you will develop cancer, as some people with this cancer have no associated risks. However, the following risk factors may increase your chances of kidney cancer:

• Smoking cigarettes
• Obesity
• Being male
• Having high blood pressure
• Having a family history of the disease
• Being on dialysis for advanced kidney disease
• Having certain rare inherited conditions

Screening and prevention

Can I prevent kidney cancer?

Although some cases are linked to inherited conditions, the cause of most kidney cancers is unknown. As a result, you can't prevent this disease. However, you may be able to lower your risk by:

• Quitting smoking
• Achieving a maintaining a healthy weight
• Managing your blood pressure through exercise and diet

There are no standard screening guidelines, and most people with the disease don't experience kidney cancer symptoms in early stages. However, tell your doctor if you know you have a high risk of disease due to a genetic predisposition or family history. They may recommend meeting with a genetic counselor who can provide personalized recommendations for cancer risk management.

Kidney cancer diagnosis

How is this cancer diagnosed?

Many instances of kidney cancer are detected incidentally on imaging performed for other health reasons, such as back pain or kidney stones. To diagnose the disease, your doctor may perform one or more of the following imaging tests:

• Ultrasound
• CT scan
• MRI
• PET scan
• Bone scan to check for the spread of cancer

Sophisticated imaging scans like CTs and MRIs make finding smaller tumors easier. Unlike other cancers, your doctor can typically determine if the mass on your kidney is malignant from an imaging scan, which may help you avoid a biopsy.

However, in certain scenarios, your doctor may also recommend a biopsy. This involves removing a tiny tissue sample from the tumor using a hollow needle. A pathologist will then examine the tissue under a microscope to gather additional information about your cancer.

Types of cancer

What are the types of kidney cancer?

The most common type of this cancer is renal cell carcinoma (RCC). This classification has several subtypes, including clear cell renal carcinoma and non-clear cell renal carcinomas. The unique characteristics of your renal tumor may affect your treatment options.

In addition to renal cell carcinoma, other types of kidney cancers include the following:

• Transitional cell carcinoma: These tumors begin in the lining of the renal pelvis, where the ureters connect to the kidneys
• Renal sarcoma: This rare type begins in the kidney's blood vessels or connective tissue
• Wilms tumor: These kidney tumors primarily affect children

It's also possible to have benign (noncancerous kidney tumors). Treatment for benign kidney tumors varies based on the size, location, and symptoms related to the mass.

What are the stages of kidney cancer?

Cancer stages describe the extent of disease, considering the tumor's size and how far it has spread. The stages range from one to four:

• Stage I: The tumor is within the kidney and is less than 7 cm
• Stage II: The tumor is within the kidney but larger than 7 cm
• Stage III: The tumor can be any size and may have spread to a major vein or nearby lymph nodes
• Stage IV (Metastatic disease): The tumor has spread beyond the kidney into the adrenal gland, lymph nodes, and/or other organs

Treatments

What are the kidney cancer treatment options?

After a kidney cancer diagnosis, patients will receive treatment recommendations based on several factors, including:

• The type and stage of the tumor
• The location and depth of the tumor within the kidney
• Kidney function
• Overall health

Your care will involve input from several cancer experts in different fields, including urologic oncology, radiation oncology, medical oncology, radiology, pathology, and others. This ensures we consider all options that will lead to the most successful outcome. Depending on each unique case, treatment options may range from active surveillance for very small tumors to open or minimally invasive surgery, ablative therapies, systemic therapies, and/or novel drugs available through clinical trials.

Surgery

Our urologic oncologists are experts in evaluating if surgery is an appropriate treatment option for you. If surgery is in your best interest, the type of surgery you'd benefit from will vary based on the size and location of your tumor, along with other factors. Many patients undergo one of the following:

• Partial nephrectomy: Also called kidney-sparing surgery, this procedure involves removing the tumor while leaving the rest of the healthy kidney to preserve kidney function.
• Radical nephrectomy: This procedure requires your surgeons to remove the entire kidney when it's affected by a large tumor.

Whenever possible, we use minimally invasive techniques such as laparoscopic and robotic surgeries to speed healing and recovery after surgery. During laparoscopic surgery, small instruments are placed into the abdomen, and the kidney or part of the kidney is removed through smaller incisions. This often results in reduced pain, shorter hospital stays, and a quicker return to normal activities than traditional surgery. Robotic-assisted surgery offers the same benefits, allowing your surgeon to operate with exceptional dexterity and precision.

In addition, our surgeons have exceptional experience performing even the most complicated surgeries alongside other specialists for cancers that have spread (metastasized) to minimize kidney cancer symptoms such as bleeding or pain.

Learn More About Urologic Surgery

Interventional Radiology (Ablation)

For some patients who cannot undergo surgery, our interventional radiologists may use imaging to guide minimally invasive procedures to kill cancer cells. These may include:

• Cryoablation, which uses cold temperatures to freeze the cancer cells
• Microwave ablation or radiofrequency ablation, which uses hot temperatures to heat the cancer cells

Learn More About Interventional Radiology

Chemotherapy

Chemotherapy uses powerful drugs to kill cancer cells located throughout the body. While this is often an effective treatment for other types of cancer, it is not often used for patients with kidney tumors.

Learn More About Chemotherapy

Immunotherapy and targeted therapy

Immunotherapy is a novel treatment that harnesses a person's immune system to identify and target cancer cells. One class of these drugs, called checkpoint inhibitors, is typically used to help manage metastatic kidney cancer. These are delivered intravenously in an outpatient setting throughout several visits. Similarly, targeted therapies are medications that can effectively attack cancer cells with specific molecular changes. Typically, these are given by mouth in pill form.

If your cancer has spread, a medical oncologist who is part of your care team will determine the therapies that will be most appropriate for you, including the proper dosage and frequency. Regular imaging will be used to evaluate their effectiveness, and you can expect your care team to help monitor any side effects and adjust treatment as necessary.

Learn More About Immunotherapy

Learn More About Targeted Therapy

Radiation therapy

This cancer treatment uses high-energy rays to destroy cancer cells. As part of your multidisciplinary team, radiation oncologists may recommend radiation therapy for patients who are not good candidates for surgery. In other instances, radiation helps manage painful symptoms associated with metastatic disease.

At MedStar Health, we offer the full range of advanced radiation technologies that allow us to pinpoint radiation to the tumor with incredible accuracy, thereby sparing as much healthy tissue as possible. Patients who undergo radiation therapy will receive some form of external beam radiation therapy, such as image-guided radiation therapy or stereotactic body radiation therapy.

Learn More About Radiation Therapy