Kidney Cancer – Information, Treatment & Support

Most people have two kidneys. They sit at the back of the body, just underneath the rib cage.

About the kidneys

Their role is to filter the blood to remove waste products, which they convert into urine. Urine is carried from each kidney, through a tube called a ureter to the bladder, where it is stored and later expelled from the body, when you pass urine.

About kidney cancer

About 90% of kidney cancers are renal cell cancers (RCC). They are sometimes called renal adenocarcinoma. There are different subtypes of renal cell cancer which can be identified by looking at the cells under a microscope. There is a rarer type of kidney cancer, known as transitional cell cancer (TCC), which starts in the cells lining the central area of the kidney (the renal pelvis).

What causes kidney cancer?

Doctors don’t know exactly what causes kidney cancer, but a number of things are known to increase the risk of developing it. These include: cigarette smoking, being overweight (obese), high blood pressure (hypertension), having advanced kidney disease (especially those who need to have dialysis) and exposure to certain materials may also affect a person’s risk, i.e. working with blast furnaces or coke-ovens and being exposed to cadmium, lead or asbestos at work. Most kidney cancers are not inherited. There are some rare conditions, such as von Hippel-Lindau disease, where an inherited faulty gene increases the risk of developing kidney cancer.

Kidney cancers don’t always cause symptoms. It is becoming increasingly common for kidney cancer to be diagnosed by chance. If there are symptoms, these may include:

  • Blood in the urine. (if you ever see blood in your urine, always get it checked out.)
  • Painful spasms in the ureters or bladder.
  • Lump in the area of the kidney.
  • Dull pain in the side.
  • Persistent high temperature, night-sweats, tiredness and weight loss.

TIP: If you have any of these symptoms you should have them checked by your doctor – but remember, most people with these symptoms won’t have kidney cancer. Other more common conditions such as an infection or stones in the bladder or kidneys are often the cause.

After visiting a GP a referral will probably be made to a hospital for some tests. They will ask for a sample of urine, and may also take a blood sample. Depending on the results of these tests, the GP will make another referral to hospital for expert advice and treatment.

These may include:

  • IVU or IVP (intravenous urogram): A dye is injected into a vein in the arm, and travels through the bloodstream to the kidneys. The doctor can watch on a screen how the dye passes through the kidneys and can pick up any problems. The dye will probably make the patient feel hot and flushed for a few minutes but this feeling goes away after a short time.
  • Ultrasound scan: Using sound waves to build up a picture of the inside of the tummy (abdomen) including the kidneys. It is a painless test and only takes a few minutes. A gel is spread onto the abdomen. A small device, which produces sound waves, is rubbed over the area. The echoes are turned into a picture by a computer.
  • Cystoscopy: This test doesn’t look at the kidneys but is used to check the bladder lining for signs of bleeding. Usually done under local anaesthetic and takes about 20 minutes. A small, flexible, fibre-optic tube with a light at the end (cystoscope) is passed into the tube that leads to the bladder (urethra). This allows the doctor to look at the whole lining of the bladder and urethra. The patient may have some soreness when they pass urine for the first time after the test, however this will pass.
  • Image-guided biopsy: A biopsy is a sample of tissue from the body. A doctor uses an ultrasound to guide them to the area of kidney where the biopsy will be taken. This is known as an ultrasound- or CT-guided biopsy. Before the scan, a local anaesthetic is injected to numb the area over the kidney. The kidney is then scanned to produce pictures on a screen. This helps the doctor to accurately guide a needle through the skin and into the kidney. The doctor draws a small sample of tissue into the needle before removing it.

If the test results show a form of kidney cancer, the patient will be referred to a doctor who is specialises in the treatment of kidney cancer.

Once the cancer has been diagnosed, it will be staged and graded.

Staging:

The stage of a cancer describes its size and whether it has spread. Once the doctors know the stage of the cancer, they can decide on the most appropriate treatment. The most commonly used staging system for kidney cancer is called the TNM system:

  • T: refers to the tumour size.
  • N: refers to whether lymph nodes are affected.
  • M: refers to whether the cancer has spread to other parts of the body (metastases)

Tumour size (T)

  • T1a: smaller than 4cm in size and limited to the kidney.
  • T1b: between 4cm and 7cm in size and is limited to the kidney.
  • T2: larger than 7cm but is still limited to the kidney.
  • T3: Tumour is growing into the adrenal gland OR into the fat around the kidney OR into one or both large blood vessels close to the kidney (renal artery and renal vein).
  • T4: The cancer has spread outside the tissue that surrounds the kidney.

Lymph nodes (N)

The N refers to whether the cancer cells have spread into the lymph nodes close to the kidney. There are three stages.

These are:

  • N0: no Cancer cells in any lymph nodes.
  • N1: Cancer cells in one lymph node.
  • N2: Cancer cells in two or more lymph nodes.

If the cancer cells have spread to the lymph nodes, the nodes are said to be positive.

Metastases (M)

  • If the cancer cells have not spread, this is described as M0. If cancer cells have spread to other parts of the body it is said to be M1. If the cancer has spread it is called secondary or metastatic kidney cancer.

Grading:

Grading refers to the appearance of the cancer cells under the microscope. The grade gives an idea of how the cancer may behave. It goes from 1–4. A grade 1 cancer will usually grow more slowly and be less likely to spread than a higher grade cancer, grade 4.

A team of doctors and other staff at the hospital will plan the treatment. It will depend on the size of the tumour and where it is. Treatment may be coordinated by an oncologist (a doctor who specialises in treating cancer with chemotherapy)a renal surgeon (a surgeon who specialises in kidneys) and a radiologist (a doctor who specialises in treating cancer with radiation).

Treatment may involve:

  • Chemotherapy
  • Radiotherapy
  • Surgery

Most people have chemotherapy to shrink to size of the tumour and to get rid of any cancer cells around the body. This is usually followed with surgery to remove the tumour. More chemotherapy and radiotherapy usually follows.

Chemotherapy for kidney cancer:

This treatment works by disrupting the growth, size and division of cancer cells. The drugs may be taken as tablets or capsules or by injection into a vein (intravenously). This means that the surgery will be less invasive. Often chemo starts again after surgery to kill any remaining cancer cells and stop them from spreading. This is called adjunct chemotherapy. For more information about chemotherapy, go to our chemotherapy page.

Surgery for kidney cancer:

The aim of surgery is to remove the tumour and is often the only treatment that is needed. There are different types of surgery for kidney cancer.

  • Nephrectomy: Removal of the kidney. It is possible to live a completely normal life with just one kidney.
  • Partial nephrectomy: Removal of tumour and the part of the kidney surrounding it.
  • Embolisation: blocking off the blood supply to the tumour and so cuts off the supply of oxygen and nutrients to the tumour.

For more information about surgery, go to our surgery page.

Radiotherapy for kidney cancer:

Radiotherapy treats cancer by using high-energy x-rays, which destroy the cancer cells.

For more information about radiotherapy, go to our radiotherapy page.

Side effects:

There are some side effects of the treatments for kidney cancer which can be found in our side effects page.

Join CanTeen’s online community to chat with other young people about kidney cancer, its treatment… or anything really.