Kidney Cancer | Chris O'Brien Lifehouse

This information has been prepared to help you understand more about kidney cancer.

Many people feel understandably shocked and upset when they are told they have kidney cancer. This information is intended to help you understand the diagnosis and treatment of this type of cancer.

We cannot advise you about the best treatment for you. You need to discuss this with your doctors. However, we hope this information will answer some of your questions and help you think about the questions you want to ask your doctors or other health carers.

The kidneys

The kidneys are part of the body’s urinary system. They are positioned near the middle of the back, on either side of the spine and are bean-shaped organs, each about the size of a fist.

The main function of the kidneys is to filter the blood and remove any excess water, salt and waste products. The filtered materials are converted into urine.

The kidneys are made up of small units called nephrons that filter blood. They regulate blood pressure and volume, the blood’s acid-base balance (pH), and levels of electrolytes and metabolites. There are approximately one million nephrons in each kidney.

The kidneys also produce certain hormones, which help control the production of red blood cells and regulate the body’s calcium levels.

If one kidney is damaged or diseased, the other kidney is usually able to take up the extra work. Many people are able to live quite normally with one functioning kidney.

What is kidney cancer?

Kidney cancer occurs when cells in the kidney become abnormal and grow uncontrollably. In the early stages, a tumour forms that is confined to the kidney. However, as the cancer grows, it may spread (metastasise) to other parts of the body.

Kidney cancer can also be a secondary cancer which has spread from a primary cancer in another part of the body.

Types of kidney cancer

Renal cell carcinoma:
About 90% of all kidney cancers are renal cell carcinoma (RCC), which develops in the nephrons of the kidney. Usually only one kidney is affected, but in rare cases cancer may develop in both. Types of RCC include clear cell carcinoma (the most common type), papillary, chromophobic, oncocytic and sarcomatoid kidney cancers.

Urothelial carcinoma:
Urothelial (or transitional cell) carcinoma is a less common type of kidney cancer which begins at the point where the kidney and ureter meet. The ureter is the tube that joins the kidney to the bladder. Rarer types of kidney cancer:

Rarer types of kidney cancer:

These are several other less common types of kidney cancer:

  • Renal sarcoma – affects the connective tissue of the kidney.
  • Renal lymphoma – starts in the lymphatic tissue of the kidney.
  • Wilms’ tumour – a type of kidney cancer that is more common in children than adults.

How common is it?

If you would like to read any facts or statistics about kidney cancer, please refer to the Cancer Institute NSW website:
http://www.cancerinstitute.org.au/cancer-in-nsw/cancer-facts/kidney-cancer

Causes of kidney cancer

The exact causes of kidney cancer are not known, however some factors will increase your risk:

  • Gender – men are at a higher risk of developing kidney cancer than women.
  • Smoking – people who smoke have almost twice the risk of developing kidney cancer as non-smokers. Up to one-third of all kidney cancers are thought to be related to smoking.
  • Heavy use of certain medications – these include diuretics and pain-killers containing phenacetin. Phenacetin is no longer used in pain-killers, but people who used to take such pain-killers (most likely prior to 1970) may have an increased risk.
  • Exposure to certain substances – people who are or have been regularly exposed to certain substances, including asbestos, lead, cadmium, herbicides or organic solvents, may have an increased risk of kidney cancer.
  • Family history – people who have family members with kidney cancer, especially a sibling, are at increased risk. Having certain inherited conditions such as Hippel-Lindau disease or Birt-Hogg-Dubé syndrome also increases your risk of kidney cancer.
  • Obesity – excess body fat may cause changes in certain hormones that can lead to kidney cancer.
  • High blood pressure – a common risk factor in people who are overweight.
  • Kidney disease – people with advanced kidney disease have a higher risk of developing kidney cancer.

What are the symptoms?

Many people with kidney cancer do not experience any symptoms and, as a result, it is often detected when you visit the doctor for another reason. If symptoms do occur, the most common symptoms are:

  • blood in the urine (haematuria)
  • a change in urine colour to a dark, rusty or brown hue
  • pain in the lower back on one side that is unrelated to an injury
  • pain or a lump in the abdomen or side (flank)
  • constant tiredness
  • unexplained weight loss
  • fever that is unrelated to cold or flu
  • swelling of the abdomen or outer body parts, e.g. ankles, legs
  • anaemia (low red blood cell count) or polycythaemia (high red blood cell count)

These symptoms are common to many conditions and may not be a sign of kidney cancer. However, if you are concerned you should see your doctor and they will be able to arrange further tests.

Your doctor will often do a number of tests before they diagnose kidney cancer. Once they have confirmed the diagnosis they will probably conduct further tests to determine whether the cancer has spread to other parts of the body.

There are four categories of tests:

Blood and urine tests are simple procedures that can give an indication of whether or not cancer is present.

Urine test

A urine test allows the doctor to look for traces of blood and other abnormalities, such as proteins, that may be present but not visible to the naked eye. A urine test can also look for cancer cells in the urine.

Blood test

A blood test checks for changes in the blood that can be caused by kidney cancer, such as:

  • too few or too many red blood cells
  • high calcium levels
  • high levels of certain enzymes
  • changes in salt levels

Internal examination is often conducted when blood is detected in the urine. The doctor will look inside the bladder to see where the blood is coming from.

Cystoscopy

Your urologist will pass a tiny telescope (cystoscope) through your urethra and into your bladder to check for bleeding, tumours or other abnormalities. You will be given a general or local anaesthetic so that you are not in pain.

Ureteroscopy

Your urologist may also want to examine the ureters. This can be done by extending the tip of the cystoscope.

Imaging tests are usually conducted to make a diagnosis or to see if the cancer has spread. You will probably have at least one of the following tests, and possibly more than one.

Ultrasound

A scan that uses soundwaves to build up pictures of your organs. A gel is spread over the abdomen or back and a device called a transducer is moved over the area for a few minutes. The soundwaves echo when they encounter something dense, such as an organ or tumour, and a computer can then create a picture using the echoes.

You will probably be asked to drink a lot of water before the ultrasound so that your bladder is full. The ultrasound is painless and will take approximately 15-20 minutes.

CT scan

A CT (computerised tomography) scan is a procedure that uses x-ray beams to compile many pictures of the body. CT scans are useful for identifying a tumour in the kidney and checking whether cancer has spread to other organs and tissues.

You may have an injection of a special dye into your veins before the scan. The dye will help to make the picture clearer. You will be asked to lie still on a table while the CT scanner, which is large and round like a doughnut, slowly moves around you. A CT scan is painless and takes about 30-40 minutes.

MRI scan

An MRI (magnetic resonance imaging) scan uses a combination of magnetism and radio waves to build up detailed cross-sectional pictures of the body. Only a small number of people with kidney cancer will undergo an MRI. It is usually used to find out if the cancer has gone into the renal vein or spread to the spinal cord.

A special dye may be injected into your veins before the scan. You will lie on a couch in a metal cylinder – a large magnet – that is open at both ends. The scan takes up to an hour and it is painless.

Chest X-ray

A chest X-ray may be used to see whether cancer has spread to your lungs or ribs. It only takes a few minutes and is painless and safe.

Radioisotope bone scan

If you have a very large tumour or advanced cancer you may undergo a radioisotope bone scan. This scan will tell your doctor whether any cancer cells have spread to the bones and also how well you are responding to treatment.

A radioactive dye will be injected into a vein, usually in your arm. After the dye has moved throughout your bloodstream, your body will be scanned with a machine that is able to detect radioactivity.

Tissue sampling involves the removal of fluid or cells from the body so that tissue can be examined under a microscope.

Biopsy

You will probably be asked to drink a lot of water before the ultrasound so that your bladder is full. The ultrasound is painless and will take approximately 15-20 minutes.

A tissue biopsy is not usually used for the diagnosis of kidney cancer. However it may be recommended if:

  • there is a possibility that the tumour in the kidney may be a secondary cancer that has spread from elsewhere in the body (metastatis)
  • the doctor suspects the tumour is not cancer (benign), and could be managed through surveillance rather than treatment.

A biopsy can usually identify the type of cancer cells in the body and is conducting using one of two methods:

  • Needle core biopsy – a sample of tissue is removed from the kidney with a needle under local anaesthetic.
  • Fine needle aspiration biopsy – a thin needle is inserted through the skin into the kidney to remove either fluid or cells, usually without anaesthetic.

Staging

Staging and grading your kidney cancer can help your care team work out what treatment is best and what your prognosis (or expected outcome) is.

Staging tells the doctor how far the cancer has spread.

The most common staging system used for kidney cancer is known as the TNM system:

T (Tumour) 1-4: indicates the size of the tumour and whether it has spread to nearby tissues. The higher the number, the more likely the cancer has spread beyond the kidney.

N (Nodes) 0-3: indicates whether cancer has spread to nearby lymph nodes. No nodes affected is 0; increasing node involvement is 1, 2, or 3.

M (Metastasis) 0-1: indicates whether the cancer has spread, or metastasised, to other parts of the body. The 0 means that the cancer has not spread; 1 means the cancer has spread.

Grading describes how fast cancer cells are likely to grow. Kidney cancer is graded using the Fuhrman system:

Grade 1: The cancer cells look fairly normal, are probably growing slowly and are not likely to spread.

Grade 2: The cancer cells appear slightly abnormal and might grow more rapidly.

Grade 3: Most cells appear abnormal and the cancer might grow quickly.

Grade 4: No cancer cells look normal and they are more likely to grow and spread rapidly.

Prognosis

Prognosis means the expected outcome of a disease. In most cases, the earlier that kidney cancer is diagnosed, the better your prognosis will be. However, about one in three kidney cancers are advanced at the time of diagnosis.

It is not possible for any doctor to give you a prognosis that is 100% accurate but they will be able to discuss the likely outcome with you, taking into account the stage of your cancer and other factors such as your age and general well-being. You will need to talk with your doctor about your prognosis, what treatment options are best for you and what you might expect the outcome to be.

Health professionals

You will be cared for by a range of health professionals who specialise in different aspects of your treatment. Health professionals who may care for you include:

  • General practitioner (GP) – arranges the first tests to investigate your symptoms.
  • Urologist – specialises in diseases and surgery of the urinary system.
  • Nephrologist – specialises in caring for people with conditions that cause kidney (renal) impairment or failure.
  • Medical oncologist – prescribes and coordinates targeted therapies and chemotherapy.
  • Radiation oncologist – prescribed and coordinates radiotherapy.
  • Nurses – support you through all stages of your cancer treatment.
  • Cancer care coordinator or clinical nurse consultant (CNC) – supports patients and families throughout treatment and liaises with other staff.
  • Dietician – recommends an eating plan to follow while you’re in treatment and recovery.
  • Social workers, counsellors, physiotherapists and occupational therapists – link you to support services and help with emotional, physical or practical issues.

Treatment

Treatments for kidney cancer include surgery, radiofrequency, ablation and drug treatment. The best treatment for you will depend on many factors, including the stage and grade of your cancer. You will be able to discuss your treatment options with your doctor and decide which option is best for you.

Active surveillance

If your tumour is small (less than 4cm) you may have the option of active surveillance. Many small tumours are benign, and those that are cancerous may not grow enough during your lifetime to pose a serious risk.

Active surveillance allows the tumour to be managed via regular ultrasounds or CT scans and avoids side effects that are associated with treatment, including loss of kidney function.

Surgery

Surgery is the main treatment for people with kidney cancer, although it is not a treatment option for all patients. Kidney surgery is usually carried out under a general anaesthetic. The surgeon will remove as much of the cancer as possible through a cut in the side of your abdomen. Alternatively, you may be able to have keyhole surgery (laparoscopy) through several small incisions.

You may have one of the following operations:

A radical nephrectomy

A radical nephrectomy involves the removal of your whole affected kidney. The adrenal gland above the kidney, surrounding fatty tissue and nearby lymph nodes may also be removed. However, it is not always possible to remove all of the cancerous tissue.

A partial nephrectomy

Renal cell carcinoma can be treated by partial nephrectomy, involving the removal of part of the kidney. It is a more complex procedure than a radical nephrectomy but has the advantage that more of the kidney can be preserved. It is often used for people with cancer in both kidneys or with only one working kidney.

Surgery for advanced cancer

Sometimes, surgery may be an option to remove secondary tumours that have spread to other parts of the body.

Radiofrequency ablation

Radiofrequency ablation (RFA) is a type of treatment that uses radio waves to heat and destroy cancer cells. This treatment, which is still being evaluated, is sometimes used for patients who can’t have surgery.

In RFA treatment, a needle is inserted into the tumour under anaesthesia. An electrical current passes into the tumour, destroying the cells and creating scar tissue.

In most cases, patients only require a single RFA treatment. The treatment takes approximately 15 minutes. Side effects, which include pain or fever, can be managed with medication.

Cryotherapy (cryosurgery)

Cryotherapy is a treatment that freezes and kills cancer cells. It is a relatively new treatment that is still being evaluated; however, some trials have shown that cryotherapy is not as effective as surgery, and is not suitable for kidney tumours over 4cm.

In this treatment, a probe is inserted into the tumour (usually through a cut in the abdomen or back) and liquid nitrogen is injected. This freezes the area and destroys cancer cells.

Cryotherapy typically takes about an hour. You may have to stay in hospital overnight, and your doctors will help you manage any pain with medications.

Arterial embolisation

Arterial embolisation is a procedure that can be used to block the artery that provides blood to the kidney. The aim is to reduce the size of the tumour, by blocking blood flow, food and oxygen from getting to the kidney and the tumour.

The main risk associated with arterial embolisation is that cancer cells may break off and spread to other parts of the body.

Targeted therapies

Some newer treatments called targeted therapies attack specific cancer cells or blood vessels, to stop or slow down their growth or reduce the size of the tumour. Tyrosine kinase inhibitors (TKIs) and mTOR inhibitors have recently been trialled in people with advanced kidney cancer. Both drugs block chemical messengers, or enzymes, that are produced by the body’s cells. These enzymes tell cells when to divide and grow.

For renal cell carcinoma that has spread beyond the kidney, TKIs (and sometimes mTOR inhibitors) are the most common treatment offered. They are often used instead of conventional chemotherapy, as they usually have fewer side effects.

Immunotherapy (biologic therapy)

Immunotherapy involves boosting the body’s own immune system to help it fight off disease. It has been used to treat advanced kidney cancer, but is not a standard treatment for other types of kidney cancer. Drugs used in immunotherapy are developed from cytokines, which are proteins that naturally occur in the body and stimulate the immune system.

Targeted therapies are usually used in place of immunotherapy. However, immunotherapy is still commonly used in countries without access to targeted therapies.

Chemotherapy

Chemotherapy is the treatment of cancer with anti-cancer (cytotoxic) drugs. The aim of chemotherapy is to kill cancer cells while doing the least possible damage to healthy cells. It may be given for advanced cancer that has spread (metastasised) to other parts of the body.

Chemotherapy is only very occasionally used to treat kidney cancer.

Chemotherapy is given by injection into a vein (intravenously). Your treatment schedule will vary depending on your individual situation and will be determined by your care team.

Radiotherapy

Radiotherapy uses high energy X-rays to kill cancer cells or injure them so they cannot multiply. Radiotherapy is not effective in treating primary kidney cancer. However, it may be used as palliative treatment.

The length of treatment will depend on the type and size of the cancer.

Palliative treatment

Palliative treatment helps improve people’s quality of life by alleviating symptoms of cancer, without trying to cure the disease.

Often treatment is concerned with pain relief and stopping the spread of cancer, but it can also involve the management of other physical and emotional symptoms.

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