Advanced care and treatment for renal cancer
Advanced care and treatment for renal cancer
Scripps MD Anderson Cancer Center is a leader in caring for people with genitourinary cancers, including kidney cancer. Our oncology specialists treat kidney cancer with advanced therapies designed to eliminate cancer and prevent recurrence, including minimally invasive surgery that uses small incisions, potentially resulting in shorter hospital stays and a faster recovery, and immunotherapy to harness the power of the body’s own immune system. In addition, Scripps is internationally recognized for kidney transplantation expertise.
About kidney cancer
Kidney cancer is a genitourinary cancer that starts in the kidneys, the two bean-shaped organs attached to the back wall of the abdomen. Also known as renal cancer, kidney cancer is among the top 10 most common cancers in women and men.
The average age of kidney cancer diagnosis is 64. The disease is rarely found in people younger than 45. The lifetime risk for developing kidney cancer is about 1 in 63. Men have a higher risk than women.
Types of 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 is a rare type of kidney cancer that starts in the blood vessels or connective tissue.
Kidney cancer causes, risks and family history
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:
Renal cell carcinoma (RCC) affects about twice as many men as women.
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.
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.
Kidney cancer prevention, screenings and early detection
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.
The following protective factors may help prevent kidney cancer:
- Avoid tobacco
- Maintain a healthy weight
- Avoid exposure to harmful substances in the workplace
Kidney cancer symptoms, diagnosis and stages
As with most cancers, the earlier kidney cancer is found, the more likely it is to be successfully treated. Learn more about kidney cancer symptoms, diagnostic testing and stages below.
Kidney cancer symptoms
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
- 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:
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.
During a biopsy, the doctor removes a small tissue sample from the kidney to be examined under a microscope.
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
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.
In stage I kidney cancer, the tumor is 7 cm across or smaller and has not spread beyond the kidney.
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.
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.
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.
Understanding your diagnosis
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.
Treatment and clinical trials
When you’ve been diagnosed with kidney cancer, you want a team of expert cancer specialists on your side. Scripps MD Anderson’s multidisciplinary oncology teams fight kidney cancer using the latest evidence-based treatments and therapies. Surgery is part of nearly every kidney cancer treatment plan, and whenever possible, Scripps surgeons will use advanced minimally invasive surgical techniques to minimize your discomfort, and reduce your hospital stay and recovery time.
Our approach to treating kidney cancer
Your Scripps MD Anderson 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.
Kidney cancer treatment options at Scripps MD Anderson
Your Scripps MD Anderson 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 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, 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.
If targeted or biologic therapies are not successful, chemotherapy may be part of the treatment plan.
Kidney cancer clinical trials
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 custom cancer treatment plan
Your Scripps MD Anderson 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 cancer care team
Your kidney cancer care team includes health and medical professionals from a wide range of specialties. Scripps MD Anderson will customize your team to ensure you have the expertise and support you need.
Your team may include:
- Surgeons and surgical oncologists
- Radiation oncologists
- Medical oncologists
- Registered nurses
- Nurse navigators
- Oncology social workers
Visit your cancer care team for more on Scripps MD Anderson's multidisciplinary approach to treatment.
Kidney cancer treatment locations
Scripps diagnoses and treats kidney cancer at numerous locations throughout San Diego County. From Chula Vista and La Jolla to Encinitas and beyond, our extensive network of Southern California cancer care centers includes:
- Four Scripps hospitals on five campuses
- Outpatient clinics
- Specialty cancer treatment centers
We are now offering Video Visits for some specialty care appointments. If you are interested in scheduling a Video Visit, contact the provider’s office directly. The doctor’s office will work with you to determine if this is the right type of visit for you.
For details on specific centers and their services, visit cancer care locations.
Support groups, services and resources
As leaders in kidney cancer care, we know what it takes to fight a winning battle. That’s why we equip our patients with the support and resources necessary to achieve their best possible outcome. From connecting you with support groups and services to empowering you with the latest resources and research, Scripps offers a comprehensive lineup to help you along every step of your cancer journey.
Kidney cancer support groups for patients, family members and survivors
In support of our patients, survivors, their family members and the community, we host a handful of cancer support groups as well as a range of free workshops and health and wellness events on a number of topics, such as:
- Expressive writing
Check the current list of support offerings or contact your oncology social worker or cancer care coordinator.
For info about other cancer support groups in the San Diego community, call the American Cancer Society at 800-227-2345.
Support services for cancer patients
We are here for you — not only as your oncologists, but as a robust multidisciplinary team of experts who understands that your cancer journey is about much more than your medical treatment. Specifically, Scripps MD Anderson offers a variety of patient support services to ensure your physical, psychological and emotional well-being as well as resources for dealing with the logistical and financial aspects of cancer care. Our services and resources include:
- Oncology nurses and nurse navigators with extensive clinical expertise in cancer care to help guide you and your caregivers to make informed decisions and ensure your optimal care.
- Palliative care to provide an extra layer of supportive care to manage pain and relieve symptoms, offer emotional and spiritual support, and improve your quality of life.
- Oncology social workers specially trained to provide counseling, connect you with community and medical resources, assist with transportation and housing and coordinate care after discharge.
- Our registered dietitian nutritionists offer individualized nutrition support for patients whose efforts to optimize their nutrition may be affected by cancer symptoms or treatment side effects.
- Referrals and professional care from experts in psychology, psychiatry and emotional health, including individual and family counseling to help with the emotional challenges of cancer.
- Physical rehabilitation and occupational therapy services, including wound care, voice therapy and swallowing therapy, lymphedema therapy, balance and vestibular rehabilitation, yoga and more.
- Scripps Center for Integrative Medicine for patients interested in mind-body healing through acupuncture, biofeedback, herbal nutrition, massage therapy, integrative cancer care and more.
- Nondenominational spiritual care offered by our chaplains to help coordinate spiritual care with your own clergy, rabbi or spiritual advisor.
- Visiting patient services if you reside beyond San Diego and want help arranging appointments or learning more about short-term lodging.
For the full spectrum of offerings, please visit our cancer patient support services section.
Additional resources for patients, caregivers and family members
Patient education is an integral part of understanding and coping with your cancer diagnosis and treatment. To stay informed, we encourage our patients, along with their caregivers and family members, to:
- Bookmark the Scripps glossary of cancer terms for easy referencing.
- Download the appointment form and list of medications form on our resources page.
- Consult your oncology team for educational materials and a list of trusted online sources beyond the Scripps site.
Navigating cancer might seem overwhelming — especially with so much information online. To ensure you receive the most accurate details, always look to your multidisciplinary team of cancer care experts first.