Kidney Cancer

A kidney tumor is an abnormal growth within the kidney. Kidney cancer is slightly more common in males and is usually diagnosed between the ages of 50 and 70 years. The most common kidney cancer is called renal cell carcinoma. If found early, the survival rate for patients with kidney cancer can range from 79-100%.

The Kidneys and Urinary System

The kidneys, ureters and bladder are part of your urinary tract. The kidney is the main filter of the body and thus performs many bodily functions, such as controlling fluid balance, regulating electrolytes (e.g., sodium, potassium, calcium, magnesium), preventing acid buildup, eliminating waste products, producing urine, and regulating blood pressure.

What are Risk Factors for Kidney Cancer?

The following associations may increase the risk of developing kidney cancer:

  • smoking
  • hypertension
  • obesity
  • family history of kidney cancer
  • chronic kidney failure and/or dialysis
  • diet with high caloric intake or fried/sauteed meat
  • Von Hippel-Lindau syndrome
  • tuberous sclerosis

What are the Symptoms for Kidney Cancer?

Many kidney tumors do not produce symptoms, but may be detected incidentally during the evaluation of an unrelated problem. Compression, stretching and invasion of structures near the kidney may cause pain (in the flank, abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ.

How is Kidney Cancer diagnosed?

The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, an evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray and blood tests.

What are the Stages of Kidney Cancer?

Grade:  how aggressive the tumor looks under the microscope; a higher grade implies a worse prognosis.

Stage I: The tumor is confined to the kidney and less than 7.0 cm in size. There is no spread to lymph nodes or distant organs.

Stage II: The tumor is confined to the kidney and greater than 7.0 cm in size. There is no spread to lymph nodes or distant organs.

Stage III: There are several combinations of T and N categories that are included in this stage. These include tumors of any size, with spread into the lymph nodes adjacent to the kidney or into the large veins leading from the kidney to the heart (venous tumor thrombus). This stage does not include tumors that invade into other adjacent organs or those with distant metastasis.

Stage IV: There are several combinations of T, N, and M categories that are included in this stage. This stage includes any cancers that have invaded into adjacent organs such as the colon (large bowel) or the abdominal wall, and those with distant metastases.

How is Kidney Cancer Treated?

Localized (confined to the kidney)

There are three main treatment options: surveillance, tumor removal, and tumor ablation. Chemotherapy, hormone therapy and radiation therapy are not effective treatments for localized kidney cancer.

  • Active Surveillance
    • Involves monitoring small kidney masses for growth
  • Partial nephrectomy
    • Can be done open or robotic
    • Involves only removing the part of kidney with the tumor in it
    • Involves 1-2 nights in the hospital
  • Radical nephrectomy
    • Can be done open, laparoscopically, or robotically
    • The entire kidney and tumor are removed
    • Involves 1-2 nights in the hospital

Metastatic (spread outside of the kidney)

There are three main treatment options: immunotherapy, tumor removal with immunotherapy, and targeted therapy. Chemotherapy and radiation therapy are not effective treatments.

  • Immunotherapy
    • Stimulates your immune system to attack cancer
    • Examples include IL-2 and Interferon
  • Radical nephrectomy with immunotherapy
  • Targeted therapy
    • Medicine that prevents blood flow to the tumor
    • Examples include Sunitinib, Sorafenib, Temsirolimus, Bevacizumab

What can I expect after treatment?

After treatment for kidney cancer, routine life-long surveillance is necessary. Surveillance typically consists of periodic assessment by a physician, blood tests and X-rays.

Kidney function: When kidney tissue is removed (nephrectomy) or destroyed (by ablation or embolization), the remaining functional kidney tissue usually works sufficiently to avoid problems. Nonetheless, kidney function should be assessed periodically after treatment.

Prognosis: The two most important prognostic factors are tumor stage and grade. The basic concept is that the more extensive the tumor (and thus the higher the stage), the less likely that treatment will achieve cure. Higher grade also implies a lower chance of cure.

Frequently Asked Questions

Should I have a biopsy of the tumor?
In cases where kidney cancer is likely, the current standard of practice is to remove the tumor without performing a biopsy. In very select situations, a biopsy may be recommended when the clinical scenario and radiographic images suggest that the lesion may be from infection, inflammation or cancer from another organ.

Do I need any additional treatment after surgery?
When the tumor is malignant, most cases can be adequately treated with surgery alone. Additional treatment (in the form of immunotherapy or anti-angiogenic treatments) may be considered when there is advanced local cancer stage (T3 or T4), spread to the lymph nodes or metastasis to distant organs.

Can I live a normal life with one kidney?
Most patients can live a normal life with a single, adequately functioning kidney. Even in cases when the remaining kidney is functioning sub-optimally, the patient may still be able to live a normal life. Dialysis is rarely necessary.

After kidney surgery, can I do anything to protect my remaining kidney?
In patients with only one kidney, it may be prudent to avoid collision/contact sports (football, hockey, boxing, soccer, basketball, etc.) and limited contact sports (baseball, gymnastics, skiing bicycling, etc.) to prevent traumatic injury to the remaining kidney. It may also be prudent to avoid routine use of medicines that can cause kidney damage.

Some medical conditions, such as high blood pressure (hypertension), diabetes, high cholesterol and obesity, have the potential to cause deterioration of kidney function. Treatment of these conditions may prevent kidney damage.

What can I do to prevent the recurrence of kidney cancer?
There are no proven ways to prevent recurrence of kidney cancer; however, it may be prudent to stop smoking. It is extremely important to follow up with your physician on a regular basis.

If you have questions regarding Kidney Cancer, please contact Potomac Urology at our Alexandria or Woodbridge office at (703) 680-2111!