Kidney (Renal Cell) Cancer

Topic Overview

What is kidney cancer?

Kidney cancer starts when abnormal cells grow out of control in one or both kidneys. The kidneys are two bean-shaped organs located on either side of the spine, just below the ribs. They filter wastes from the blood and help balance water, salt, and mineral levels in the blood.

Another name for kidney cancer is renal cancer. "Renal" means having to do with the kidney.

This topic is about renal cell carcinoma, the most common type of kidney cancer. About 8 or 9 out of 10 people with kidney cancer have this type.1, 2

Kidney cancer that is found early often can be successfully treated. But when it isn't found early, the cancer may spread, or metastasize, to other parts of the body, such as the lymph nodes, the lungs, the bones, or the liver.

What causes kidney cancer?

Experts aren't sure what causes kidney cancer. But there are certain things that make you more likely to get this cancer. Your risk is higher if you:

  • Smoke. Experts estimate that around 24 to 30 out of 100 cases of kidney cancer are directly related to smoking.2
  • Have a job that regularly exposes you to certain chemicals or minerals, such as asbestos, gasoline, and cadmium (used in manufacturing).
  • Use too much pain medicine for a long time.
  • Have certain inherited conditions, such as von Hippel-Lindau disease.

What are the symptoms?

Kidney cancer doesn't usually cause symptoms at first. It's often discovered by imaging tests—tests that produce pictures of the inside of the body—that are done for other reasons.

After it begins to spread, kidney cancer may cause one or more of these symptoms:

  • Blood in the urine.
  • A lump that can be felt in the lower back or belly.
  • Pain in the side or the back.

How is kidney cancer diagnosed?

If your symptoms make your doctor think that you may have kidney cancer, he or she will order imaging tests. The pictures from these tests usually show whether there is cancer in your kidney and how far it may have spread.

How is it treated?

Whenever possible, doctors use surgery to remove kidney cancer. When the cancer is in its early stages and hasn't spread, doctors are often able to remove it all, and no further treatment is needed.

When surgery isn't possible, doctors may use:

When kidney cancer is found before it has spread, about 9 out of 10 people will live 5 years or longer.3 Doctors use 5-year survival rates to show the percentage of people still alive 5 years after treatment. Of course, many people live much longer than that. In fact, for many people, the cancer never returns.

After the cancer has spread beyond the kidney, how long a person lives usually depends on how much the cancer has spread. The more the cancer has spread, the lower the survival rate.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org

Frequently Asked Questions

Learning about kidney cancer:

Being diagnosed:

Getting treatment:

Supportive care:

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  Cancer: Controlling Cancer Pain

Symptoms

Many kidney cancers, especially in early stages, cause no symptoms. Many people only find out they have early-stage kidney cancer because they had imaging tests—tests that produce pictures of the inside of your body—for some other reason.

As it grows, kidney cancer may cause one or more of the following symptoms:

  • Blood in the urine. This is often blood that you can see with the naked eye. But sometimes it's present in microscopic amounts, so the urine has to be tested to find the blood cells.
  • A lump that can be felt in your belly or in your side.
  • Pain in the side or the back.
  • Unexpected weight loss.
  • A fever that keeps coming back.
  • Anemia.
  • Extreme tiredness.

Kidney cancer that has spread to other parts of the body will cause different symptoms, depending on where it has spread. For example, cancer that spreads to the lungs may cause coughing and shortness of breath. Cancer that spreads to the bones may cause bone pain.

Exams and Tests

To see if you may have kidney cancer, your doctor will do a physical exam. Then he or she may order one or more tests to look for evidence of cancer, such as:

  • A urine test.
  • Blood tests, such as a complete blood count and a creatinine test.
  • Tests that show pictures of your kidneys (imaging tests), such as:
    • A CT scan. This test may involve injecting dye through a catheter in your vein to make the picture clearer.
    • An ultrasound.
    • An MRI. This test may involve injecting dye in your vein to make the picture clearer.

Many cases of early kidney cancer are found during imaging tests that were looking for some other problem.

The imaging tests used to diagnose kidney cancer also show what stage your cancer is. This helps you and your doctor decide on the best treatment.

Treatment Overview

Surgery to remove all or part of the kidney usually cures kidney cancer that hasn't spread. There are two kinds of surgery:

  • Radical nephrectomy. The surgeon removes the entire kidney, the layer of fat around the kidney, the tube (ureter) that drains urine from the kidney to your bladder, the adrenal gland, and nearby lymph nodes.
  • Partial nephrectomy. The surgeon removes only the part of the kidney that is diseased, which allows the remaining part of the kidney to work normally. You may hear your doctor call this "nephron-sparing" surgery.

Surgery may not be a good choice for many older people or for people who have serious health problems that increase the risk of surgery.

When surgery isn't an option, arterial embolization may be used to shrink the tumor. This procedure blocks the blood flow to a tumor. In rare cases, this may be done before surgery.

After it is treated, kidney cancer may come back, sometimes many years after treatment.

Although radiation and chemotherapy are common treatments for many types of cancer, they usually don't work very well on kidney cancer. Treatments still being studied include using ultrasound waves or high-intensity radiation to destroy the cancer.

Active surveillance

Active surveillance means that, instead of treating the cancer, your doctor will use regular imaging tests to watch the cancer.

Very small kidney tumors—usually found while doctors are looking for some other problem—may not be cancer and may never grow. And other small tumors that are cancer may grow quite slowly.

Treatment of advanced or metastatic cancer

Surgery is sometimes used to remove cancer that has spread. The surgery is usually followed by other treatment, such as:

These treatments may also be used without surgery.

Pain is one of the main concerns of people with advanced kidney cancer. But cancer pain can almost always be controlled. Treatments that may help include:

  • Surgery. Sometimes surgery can help ease pain by removing some of the cancer that has spread to other parts of the body.
  • Radiation. Like surgery, this treatment can help with pain by killing some of the cancer that has spread.
  • Chemotherapy. Although kidney cancer cells are usually resistant to the drugs used in chemotherapy, this treatment is sometimes used when other treatments haven't worked.
  • Pain medicines.
  • Nerve blocks.
Click here to view an Actionset.Cancer: Controlling Cancer Pain

Clinical trials

After kidney cancer has spread, it is harder to treat. Your doctor may talk to you about being in a clinical trial. For some people, this may be the best treatment choice.

Additional information about kidney cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/kidney.

Supportive care

Cancer treatment has two main goals: curing cancer and making your quality of life as good as possible. Palliative care can improve your quality of life by helping you manage your symptoms. It also can help you with other concerns that you may have when you are living with a serious illness.

For some people who have advanced cancer, a time comes when treatment to cure cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But this isn't the end of treatment. You and your doctor can decide when you may be ready for hospice care.

It can be hard to decide when to stop treatment to prolong your life and shift the focus to end-of-life care. For more information, see the topics:

Complementary treatment

People sometimes use complementary treatment along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some treatments that may be helpful include:

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary treatment, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any such treatments. They are not meant to take the place of standard medical treatment.

Home Treatment

Managing side effects

You can do things at home to help manage your side effects. If your doctor has given you instructions or medicines to treat these symptoms, be sure to use them. In general, healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms.

Here are some tips on handling side effects:

  • Get some physical activity every day, but don't get too tired. Keep doing the hobbies you enjoy as your energy allows.
  • Get enough sleep. Home treatment for sleep problems includes removing distractions from your bedroom and avoiding caffeine.
  • Don't smoke. Smoking can make kidney cancer worse. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good. For more information, see the topic Quitting Smoking.
  • Home treatment for pain includes taking over-the-counter pain medicines and applying heat or cold to the area that hurts.
  • Home treatment for nausea or vomiting includes watching for and treating early signs of dehydration, such as having a dry mouth or feeling lightheaded when you stand up. Eating smaller meals may help. So can a little bit of ginger candy or ginger tea.
  • Home treatment for diarrhea includes resting your stomach and being alert for signs of dehydration. Check with your doctor before using any nonprescription medicines for your diarrhea. Be sure to drink enough fluids.
  • Home treatment for fatigue includes getting extra rest and managing your energy.

Managing stress

Having cancer and being treated for it can be very stressful. There are steps you can take to reduce your stress. Some people find that it helps to talk about their feelings with family and friends. Others find that spending time alone is what they need.

If your emotional reaction to cancer gets in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services. And a local chapter of the American Cancer Society can help you find a support group.

Having cancer can change your life in many ways. For support in managing these changes, see the topic Getting Support When You Have Cancer.

References

Citations

  1. Jonasch E, et al. (2008). Renal neoplasia. In BM Brenner, SA Levine, eds., Brenner and Rector's The Kidney, 8th ed., vol. 2, pp. 1350–1375. Philadelphia: Saunders Elsevier.
  2. Linehan M, et al. (2011). Cancer of the kidney. In VT DeVita Jr et al., eds., DeVita, Hellman and Rosenberg's Cancer: Principles and Practice of Oncology, 9th ed., pp. 1161–1182. Philadelphia: Lippincott Williams and Wilkins.
  3. American Cancer Society (2011). Cancer Facts and Figures 2011. Atlanta: American Cancer Society. Available online: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-029771.pdf.

Other Works Consulted

  • Campbell SC, et al., (2009). Guideline for Management of the Clinical T1 Renal Mass. Linthicum, MD: American Urological Association Education and Research. Available online: http://www.auanet.org/content/media/renalmass09.pdf.
  • American Cancer Society (2011). Detailed Guide: Kidney Cancer (Adult)—Renal Cell Carcinoma. Available online: http://www.cancer.org/Cancer/KidneyCancer/DetailedGuide/index.
  • Jonasch E, et al. (2008). Renal neoplasia. In BM Brenner, SA Levine, eds., Brenner and Rector's The Kidney, 8th ed., vol. 2, pp. 1350–1375. Philadelphia: Saunders Elsevier.
  • National Cancer Institute (2010). Renal Cell Cancer Treatment PDQ: Treatment—Health Professional Information. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/renalcell/HealthProfessional.
  • National Cancer Institute (2010). Renal Cell Cancer Treatment PDQ: Treatment—Patient Information. Available online: http://www.cancer.gov/cancertopics/pdq/treatment/renalcell/Patient.
  • National Cancer Institute (2010). What You Need to Know About Kidney Cancer (NIH Publication No. 10-1569). Available online: http://www.cancer.gov/cancertopics/wyntk/kidney.

Credits

By Healthwise Staff
E. Gregory Thompson, MD - Internal Medicine
Christopher G. Wood, MD, FACS - Urology, Oncology
Last Revised October 22, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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