Below are some common questions about kidney cancer.
Q: What are the kidneys, and what do they do?
A: The kidneys are 2 bean-shaped organs. Each is about the size of a fist. You have 1 on either side of your spine in the middle-to-lower back. They have 2 main roles:
- Filter waste from the blood and make urine
- Make the hormone erythropoietin that controls the production of red blood cells in the bone marrow
- Help regulate blood pressure
Most people are born with 2 kidneys, but you can survive with only 1. You can also survive with no kidneys. People with no kidneys or kidneys that don’t work survive with the help of dialysis. Dialysis uses a special machine to filter the blood.
Q: What is kidney cancer?
A: This is cancer that starts in the kidney. The most common type of kidney cancer is called renal cell carcinoma (RCC). The term renalis from the Latin word for kidney. About 90% of all kidney cancers are RCC. The other 10% are transitional cell carcinomas, Wilms tumors (in children), and other rare tumors.
Q: Are there different types of renal cell carcinoma (RCC)?
A: Yes, there are many different types of RCC. A pathologist can name them under a microscope based on how they look. Here are some of the types:
- Clear cell, the most common type of RCC
- Papillary, the second most common type
- Collecting duct, which is very rare
Q: Who gets kidney cancer?
A: More than 60,000 people in the United States are told they have kidney cancer each year. Men get kidney cancer more often than women. People who smoke are more likely to get kidney cancer than nonsmokers. Here are some other risk factors:
- Having Von Hippel-Lindau disease
- Family history of kidney cancer
- Regular contact with chemicals, such as cadmium, benzene, or asbestos
However, many people with kidney cancer have no known risk factors.
Q: What are the symptoms of kidney cancer?
A: In the early stages, kidney cancer often causes no symptoms. As the cancer grows, symptoms may develop. The most common symptoms in people with kidney cancer include:
- Blood in the urine
- Side or back pain
- A mass or lump in the side or lower back
- Ongoing tiredness
- Appetite loss
- Fast weight loss that happens without any effort to lose weight
- Fever with no known cause
- Leg or ankle swelling
- High blood pressure
People with kidney cancer may have any combination of these symptoms.
Q: How is kidney cancer diagnosed?
A: There are various ways to find out if a person has kidney cancer. They include:
- Medical history and physical exam. The health care provider asks about the person's medical history. He or she also asks about the person's family history of kidney cancer and other conditions that may be related to kidney cancer. The health care provider will also do an exam.
- Urine test. For this test, a small amount of urine is collected in a container. It is then tested for blood, protein, bacteria, and cancer cells.
- Blood tests. There is no blood test that can diagnose kidney cancer. But a complete blood count (CBC) and blood chemistry test can show signs in the blood that are linked with kidney cancer.
- Imaging tests. These are tests used to take pictures of the inside of a person's body. They include CT scan, ultrasound, Intravenous pyelogram (IVP), angiography, and other tests.
- Biopsy. During a biopsy, the health care provider removes a small piece of the tumor. A pathologist then looks at this sample under a microscope. For kidney cancer, the type of biopsy used is called fine needle aspiration (FNA). But a biopsy is often not done. In most cases if a CT scan or an MRI shows possible kidney cancer, surgery is most often done to remove the tumor or the entire kidney. The pathologist then looks at the tissue taken during surgery to confirm the diagnosis.
Q: How is kidney cancer treated?
A: Someone with kidney cancer may have only 1 of the following treatments. Or they may have more than 1:
- Surgery. This is done to remove the tumor from the kidney. The whole kidney may be taken out, or only the part of the kidney with the tumor may be removed. Surgery is the standard treatment for cancer that is confined to the kidney and has not spread to other organs.
- Targeted therapy. These medicines attack specific areas in the cancer cells or target the tumor's blood supply. This is the most common treatment for more advanced kidney cancers.
- Biological therapy. This is used to treat the cancer and reduce the chance that the cancer will spread to other parts of the body. This treatment uses medicines that may help stimulate the body's immune system to fight cancer cells.
- Radiation therapy. This is used to kill cancer cells using high energy X-rays.
- Chemotherapy. This is used to try to kill the cancer cells in the kidney and those that have spread to other organs.
- Ablation therapy. There are 2 main types of ablation therapy used to treat kidney cancer. They’re both done by putting a needle into an area of cancer cells. Radiofrequency ablation (RFA) uses energy waves to kill cancer cells. Cryoablation uses extreme cold to kill cancer cells.
Health care providers are always finding new ways to treat kidney cancer. New treatments are tested in clinical trials. Before beginning treatment, it's a good idea to ask your health care provider if there are any clinical trials that may be helpful to you.
Q: Should everyone with kidney cancer get a second opinion?
A: Many people with cancer get a second opinion from another health care provider before deciding on treatment. Here are some of the many reasons to get a second opinion:
- You are not comfortable with the treatment decision.
- You have a rare type of cancer.
- There are different ways to treat the cancer.
- You are not able to see a cancer expert.
- Your health insurance requires a second opinion before treatment is started.
Q: How can someone get a second opinion about a diagnosis of kidney cancer?
A: Here are ways to find someone to give a second opinion:
- Ask the health care provider for the name of a specialist.
- Call the Cancer Information Service. The number is 800-4-CANCER (800-422-6237). Callers can learn about centers and programs supported by the National Cancer Institute (NCI) or visit the NCI website.
- Call the Kidney Cancer Association. The number is 800-850-9132, or visit their website.
- Get the names of health care providers from a hospital, medical school or society, or cancer advocacy group.
- Ask people who have had kidney cancer for health care providers' names.
Q: If I have 1 kidney removed, can I live normally?
A: After a kidney is removed, the remaining kidney takes over the work of both. Most people with only 1 kidney have no long-term health problems. However, you should avoid anything that could harm the remaining kidney. It is very important to talk with your health care provider if you start taking new medicines or if you have a bladder infection or other problems that could affect your kidney. If the remaining kidney is damaged, you may need dialysis. With dialysis, a special machine does the kidneys' job of filtering the blood.
Q: What's new in kidney cancer research?
A: Researchers are looking for ways to treat and cure kidney cancer in these ways:
- Genetic therapy. Genetics is the study of genes, which are the "instructions" that direct our cells to make people what they are. Scientists are looking at several genes that may be related to the reason normal kidney cells change into cancerous cells. This may help them decide which treatments are better for certain types of RCC.
- Biologic therapy. Biologic therapy includes new medicines that are being tested in clinical trials. Combining these medicines with other types of treatment is also being tested.
- Chemotherapy. Chemotherapy is not very effective in fighting kidney cancer. But researchers are testing new types of medicines. They believe that understanding why kidney cancer cells are so resistant to chemotherapy will provide answers that can help make new and better chemotherapy and other treatment methods.
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Health care providers do clinical trials to learn how well new treatments work and what their side effects are. New treatments may then be compared to the current treatment to see if they work better or have fewer side effects. People who take part in a clinical trial may benefit from access to new treatments before the FDA approves them. The trials also help increase our understanding of cancer and help people who have cancer in the future.
March 30, 2020
Knoble, Jeanna, MD [nM], Stump-Sutliff, Kim, RN, MSN, AOCNS