What to Know About Kidney Cancer

Your doctor has just delivered the news: You have kidney cancer.

You probably never thought much about your kidneys, those fist-sized, bean-shaped organs that filter blood and make urine. You do know it’s possible to live with only one, which seems hopeful.

An early diagnosis is a reason for optimism, says UNC Health urologic oncologist Hung-Jui (Ray) Tan, MD, MSHPM.

“When it is diagnosed in an early stage, most patients will be able to manage it,” he says. “We have several good options for treating kidney cancer in stage 1.”

Unfortunately, kidney cancer is sometimes found later because it has few symptoms and there’s no standard screening for people at average risk. If the cancer has spread beyond the kidney, it’s harder to treat.

“Advanced or metastatic kidney cancer is really serious,” Dr. Tan says. “But the field has been evolving over the past few years.”

Who Gets Kidney Cancer?

If you or someone you love has kidney cancer, you are not alone. Anyone can get kidney cancer, but the average age of people when they are diagnosed is 64. It’s very uncommon in people younger than 45. Kidney cancer is twice as common in men than in women, and it’s more prevalent among Black Americans, Native Americans and Alaska Natives.

More than 81,000 cases of kidney cancer are diagnosed in the United States each year, and about 15,000 people die from the disease annually. It is among the 10 most common types of cancer for both men (1 in 46 lifetime risk) and women (1 in 80).

About 93 percent of people whose cancer has not spread beyond the kidney survive for at least five years after they are diagnosed. The five-year survival rate is 72 percent if the cancer has spread to nearby structures or lymph nodes. If the cancer has spread to distant parts of the body, including the lungs, brain, liver or bones, the five-year survival rate is 15 percent.

Risk Factors for Kidney Cancer

There are several risk factors that may contribute to developing kidney cancer, Dr. Tan says. Some are within a person’s control, but many are not. You are more likely to be diagnosed with kidney cancer if you have one or more of these risk factors:

  • Smoking, which is a risk factor for many cancers
  • Obesity, which may cause changes in certain hormones that can lead to kidney cancer
  • High blood pressure (taking medication to control it does not appear to lower the risk)
  • Family history of kidney cancer
  • Workplace exposures to substances such as trichloroethylene, which is used as a refrigerant, cleaner and degreaser
  • Advanced kidney disease, especially if the patient needs dialysis
  • Genetic and hereditary factors, including sickle cell trait and disease

Symptoms of Kidney Cancer

Early kidney cancer has few distinguishing symptoms, Dr. Tan says. The symptoms that might appear are often similar to symptoms of other, more common conditions.

“Most of the time, it’s diagnosed by accident—you’re having imaging done for another disease,” he says. “There can be symptoms, though, especially for more advanced disease.”

Symptoms of kidney cancer may include:

  • Blood in the urine
  • Low back pain on one side (not caused by injury)
  • An abdominal mass or bulge
  • Fatigue
  • Loss of appetite
  • Unexplained weight loss
  • Unexplained and lasting fever
  • Anemia

Kidney stones, though very painful, are not considered to be a major risk factor for kidney cancer, Dr. Tan says.

Patients who have an increased risk of kidney cancer, including those who have inherited conditions and those with a family history of kidney cancer, may want to talk to their doctor about getting tests, such as CT, MRI or ultrasound scans, at younger ages.

How Kidney Cancer Is Treated

Doctors have more tools to treat kidney cancer than ever before.

“The field is evolving,” Dr. Tan says. “Surgery has been the standard of care and continues to play a big role in treatment. But now, we have several new options and approaches that can be considered.”

If the cancer has not spread outside the kidney, then surgery to remove the tumor or the entire kidney can be curative, he says. Doctors may also remove the adrenal gland, which sits on top of the kidney, and nearby lymph nodes, depending on the cancer’s location and stage.

For small tumors that are often slow-growing and sometimes noncancerous (benign), a doctor may recommend active surveillance. This involves using imaging tests (ultrasound, CT or MRI scan) every three to six months to monitor.

If a patient is too sick for surgery but still needs treatment, the doctor may recommend thermal ablation, which uses either heat or cold energy inserted into the tumor through a needle to destroy cancer cells. In some instances, radiation may be an option.

For advanced or metastatic kidney cancer, targeted therapy and immunotherapy are becoming a bigger part of treatment, Dr. Tan says. These therapies are different from chemotherapy, which is not very effective at treating kidney cancer.

Chemotherapy is designed to kill cancer cells, while targeted therapy blocks the growth of new blood vessels that feed cancer cells or proteins in cancer cells that help them grow. Immunotherapy boosts a person’s own immune system so it can find and kill cancer cells more effectively. For patients with metastatic kidney cancer, immunotherapy with or without targeted therapies has increasingly become the first-line treatment, with surgery used more selectively.

“The key is to work with your doctor to find the treatment that is right for you,” Dr. Tan says.

If you have questions about your health, talk to your doctor. If you need a doctor, find one near you.