Kidney Cancer

Most kidney cancers begin as a single tumor inside the kidney. As the cancer grows, it may spread through the kidney to lymph nodes and other areas of the body.

Renal cell carcinoma

About 90% of kidney cancers are renal cell carcinomas (RCC), also known as renal cell cancer or renal cell adenocarcinoma. RCC usually beings as a single tumor in one kidney, but in some cases there may be multiple tumors in one or both kidneys.

There are several subtypes of RCC:

• Clear cell renal cell carcinoma is the most common type of renal cell carcinoma. About 7 out of 10 people with RCC have this type. Under a microscope, clear cell RCC cells appear very pale or clear.
• Papillary renal cell carcinoma makes up about 1 in 10 renal cell carcinomas. Papillary carcinomas grow in slender, finger-like projections in the tumor. These cells may look pink under a microscope.
• Chromophobe renal cell carcinoma makes up about 5% of RCCs (about 5 out of 100). These cancer cells appear pale like clear cells, but are much larger and have other unique features.
• Unclassified renal cell carcinoma is a rare type that doesn’t fit any other category or contains more than one type of cancer cell.
• Rare types of renal cell carcinoma are very rare and each make up less than 1% of RCCs. These include:
• Collecting duct RCC
• Multilocular cystic RCC
• Medullary carcinoma
• Mucinous tubular and spindle cell carcinoma
• Neuroblastoma-associated RCC

Transitional cell carcinoma

About 5 to 10 of every 100 kidney cancers are transitional cell carcinomas (TCCs), also known as urothelial carcinomas. These start in the transitional cells that line the renal pelvis, which is where the kidneys meet the ureters that carry urine out of the body. Under a microscope, these cancers look like other urothelial carcinomas, such as bladder cancer.

Wilms tumor (nephroblastoma)

Wilms tumors almost always develop in children. They are rare in adults.

Renal sarcoma

Renal sarcoma is a rare type of kidney cancer that starts in the blood vessels or connective tissue.  

Many of the causes of kidney cancer are not known. According to the American Cancer Society, researchers do know that some cases are related to inherited gene mutations or exposure to cancer-causing substances, such as those in tobacco smoke or workplace chemicals.

Known kidney cancer risk factors include:

Gender

Renal cell carcinoma (RCC) affects about twice as many men as women.

Tobacco use

Smoking raises the risk of kidney cancer. Your risk drops if you quit smoking, but it can take years to match the risk level of a non-smoker.

Being overweight/obese

Obesity may cause changes in some hormones that can increase the risk of RCC.

Exposure to certain workplace substances

Exposure to certain substances — including cadmium, herbicides and organic solvents — has been shown to increase kidney cancer risk.

High blood pressure

People with high blood pressure have an increased risk of kidney cancer.

Advanced kidney disease

People who have advanced kidney disease have a higher risk of RCC, especially if they require dialysis.

Family history of kidney cancer

A strong family history of renal cell cancer, especially among siblings, can increase risk.

Inherited risk factors

Some rare inherited conditions can cause kidney cancer. These include:

• Von Hippel-Lindau disease
• Hereditary papillary renal cell carcinoma
• Hereditary leiomyoma-renal cell carcinoma
• Birt-Hogg-Dube (BHD) syndrome
• Familial renal cancer
• Cowden syndrome
• Tuberous sclerosis
• Hereditary renal oncocytoma

Having any of these risk factors does not mean you will develop kidney cancer. But if you’re concerned about your risk, especially if you have a family history of kidney cancer or inherited gene mutations, talk with your doctor.

Some kidney cancers are found early, before they have spread beyond the kidney. Others are not detected until they have reached an advanced stage. There are no screening exams to detect the disease in people of average risk. If you have an increased risk of kidney cancer, your doctor may want to test for it.

Preventive factors

The following protective factors may help prevent kidney cancer:

• Avoid tobacco
• Maintain a healthy weight
• Avoid exposure to harmful substances in the workplace

Some signs and symptoms of kidney cancer include:

• Blood in the urine
• Low back pain on one side
• A mass or lump on your lower back or side
• Fatigue
• Loss of appetite
• Unintended weight loss

Many of these symptoms are general and may be caused by non-cancerous conditions, such as a viral infection or a urinary tract infection (UTI). But let your doctor know if you experience symptoms, so that you can identify and treat any potential problems.

If you have kidney cancer symptoms or you have a high risk of kidney cancer, your doctor may recommend testing. Scripps physicians use advanced imaging and lab tests to diagnose kidney cancer. These may include:

Urinalysis

This simple urine test can detect blood and other substances in the urine. Blood in the urine may be a symptom of kidney cancer, but it can be caused by other conditions as well.

Intravenous pyelogram (IVP)

During an IVP, the physician injects an iodine-based dye into a vein, and then takes a series of X-ray images to look for any abnormal growths as the dye passes through the kidneys.

Biopsy

During a biopsy, the doctor removes a small tissue sample from the kidney to be examined under a microscope.

Ultrasound

Ultrasound uses sound waves to show any growths on the kidney, which may be tumors.

Computed tomography (CT) scan

A CT scan is an imaging test that captures images of the body from different angles. The images are combined to create detailed cross-sectional views of organs, bones and blood vessels.

Magnetic resonance imaging (MRI)

MRI relies on a powerful magnet, radio waves and advanced digital technology to provide detailed images of organs, bone and soft tissue.

Positron emission tomography (PET) scan

A PET scan involves a type of radioactive sugar that existing cancer cells will quickly absorb so they can be identified under a special camera. It’s combined with a CT scan to give physicians the ability to view a picture of potentially cancerous areas through the PET while also seeing more detailed images from a CT scan.

Kidney cancer stages indicate how far the cancer may have grown beyond the kidneys to other parts of the body. This helps doctors determine the best course of treatment.

Stage I

In stage I kidney cancer, the tumor is 7 cm across or smaller and has not spread beyond the kidney.

Stage II

In stage II kidney cancer, either:

• The tumor is larger than 7 cm across but has not spread beyond the kidney; or
• The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland or Gerota’s fascia (the fibrous tissue that surrounds the kidney). There is no spread to lymph nodes or distant organs.

Stage III

In stage III kidney cancer, the main tumor can be any size and may be outside the kidney, but it has not spread beyond Gerota’s fascia. Cancer has spread to nearby lymph nodes, but has not spread to distant lymph nodes or other organs.

Stage IV

In stage IV kidney cancer, either:

• The main tumor is growing beyond Gerota’s fascia and may be growing into the adrenal gland. It may or may not have spread to nearby lymph nodes, but has not spread to distant lymph nodes or other organs; or
• The main tumor can be any size and may have grown outside the kidney. It may or may not have spread to nearby lymph nodes and has spread to distant lymph nodes and/or other organs.

A kidney cancer diagnosis can turn your world upside down. It’s completely normal to feel anxious, scared, depressed or overwhelmed. Learning all you can about your diagnosis and your options can help you make informed, confident decisions about the next steps to take.

Questions and considerations

Here are some questions you may want to ask your doctor or health insurance provider regarding your diagnosis:

• Should I get a second opinion?
• How do I find a specialist?
• What is my cancer treatment plan?
• Will I have to miss work/school?
• What are the side effects of kidney cancer treatment?
• How successful is my treatment likely to be?
• What costs will be covered by insurance?
• Which costs will I be responsible for?

Your Scripps cancer team is here to help you find the answers you need to take an active role in your care. In addition, there are a number of community resources that provide education, information and helpful resources — often at no cost.

Learn more about the many cancer patient resources available to you and your loved ones via Scripps.

Your Scripps cancer care team includes professionals from every area of oncology, including urologists, surgeons, radiation oncologists, medical oncologists and nurses who specialize in cancer care. Learn more about how Scripps puts you at the center of care.

Your Scripps cancer care team will customize your treatment plan based on several factors, including:

• The stage of your cancer
• Whether your cancer has spread
• Your age and overall health

Treatment for kidney cancer typically involves surgery. Other treatments, such as radiation, may be given before or after surgery.

Kidney cancer surgery

Surgical treatments for kidney cancer include:

• Partial nephrectomy to remove the tumor in the kidney and some of the surrounding healthy tissue
• Simple nephrectomy to remove the entire kidney
• Radical nephrectomy to remove the entire kidney along with nearby lymph nodes, adrenal gland and surrounding tissues.
• Kidney transplant to receive a new kidney when a patient no longer has a functioning kidney, but many people can live with just one kidney 
• Regional lymphadenectomy (also called lymph node dissection) to remove nearby lymph nodes to see if they contain cancer

Many of these procedures can also be performed with robot-assisted surgery though the Scripps Minimally Invasive Robotic Surgery Program.

Radiation therapy

Radiation therapy may be part of a kidney cancer treatment plan before surgery to shrink the tumor, or after surgery to eliminate remaining cancer cells. Scripps provides the most advanced radiation treatments for kidney cancer, including intensity-modulated radiation therapy (IMRT).

An advanced form of radiation therapy, IMRT allows the radiation oncologist to specify the dose of radiation for the tumor while restricting the dose to surrounding healthy tissues.

Immunotherapy

Immunotherapy, also known as targeted therapy or biologic therapy, is designed to use the body’s immune system to fight cancer. Anti-angiogenic agents, such as monoclonal antibodies and kinase inhibitors that prevent blood vessels from forming in a tumor, may be used as part of a targeted therapy regimen for kidney cancer. Biologic therapy drugs, such as interleukin-2 (IL-2) and interferons, have been shown to help the body’s immune system fight cancer.

Chemotherapy

If targeted or biologic therapies are not successful, chemotherapy may be part of the treatment plan.

Some cancer treatment plans may involve clinical trials. Talk with your physician about whether a kidney cancer clinical trial is right for you.

For a list of clinical trials that are currently enrolling patients, see our current list of clinical trials.

Your Scripps cancer team will develop a customized treatment plan outlining the treatments and therapies we recommend for your care. Before you begin treatment, you and your physician will review your plan together and discuss any questions or concerns you may have.

Your kidney cancer treatment plan generally includes:

• Family and medical history
• A summary of your cancer diagnosis and staging information
• Diagnostic testing completed (e.g., imaging, biopsy, lab tests)
• Plans for surgery, radiation, immunotherapy and/or other treatments
• Potential side effects of treatments
• Contact information for your cancer care team members

Along with helping you understand your course of treatment and encouraging discussion between you and your physician, your plan helps your team coordinate your care. You also can share your treatment plan with other providers who may be involved in your medical care.

Your kidney cancer care team includes health and medical professionals from a wide range of specialties. Scripps will customize your team to ensure you have the expertise and support you need.

Your team may include:

• Urologists
• Surgeons and surgical oncologists
• Radiation oncologists
• Medical oncologists
• Registered nurses
• Nurse navigators
• Dietitians
• Oncology social workers

Visit your cancer care team for more on Scripps Cancer Center's multidisciplinary approach to treatment.