Common Questions About Kidney Cancer

Your kidneys are organs that make urine to filter waste from your blood, help control the production of your bone marrow, and regulate your blood pressure.

What are the kidneys, and what do they do?

Your kidneys are two bean-shaped organs, each about the size of a fist. You have one on either side of your spine in the middle-to-lower back. They have three main roles:

• Filter waste from your blood and make urine
• Make the hormone erythropoietin that controls the production of red blood cells in your bone marrow
• Help regulate your blood pressure

Most people are born with two kidneys, but they aren’t both necessary. People who donate a kidney can do fine with one, generally developing no problems.

If your kidneys don’t work well, you can survive with the help of dialysis, a machine that filters your blood. You will usually need dialysis at least once a week, often more.

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What is kidney cancer?

About 90 percent of all kidney cancers are renal cell carcinomas (RCC). (The name comes from “renalis,” which means “related to the kidney” in Latin.)

The other 10 percent include transitional cell carcinomas, Wilms tumors (in children), and other rare tumors.

Types of renal cell carcinoma (RCC)

There are many different types of RCC. A pathologist will use a microscope to examine tissue from your tumor to determine which one you have, based on how they look.

Types include:

• Clear cell, the most common renal cell carcinoma
• Papillary, the second most common type
• Chromophobe
• Collecting duct, which is very rare 

Who gets kidney cancer?

More than 60,000 people in the United States are diagnosed with kidney cancer each year. Men get kidney cancer more often than women. People who smoke are more likely to have kidney cancer than nonsmokers.

Risk factors of kidney cancer include:

• Having Von Hippel-Lindau disease
• Family history of kidney cancer
• Obesity
• Regular contact with chemicals, such as cadmium, benzene, or asbestos

Many people with kidney cancer, however, have no known risk factors.

What are the symptoms of kidney cancer?

In the early stages, kidney cancer often causes no symptoms. As the cancer grows, symptoms may develop.

The most common symptoms of kidney cancer include:

• Blood in your urine
• Side or back pain
• A mass or lump in your 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.

How is kidney cancer diagnosed?

Your doctor can use several methods to determine if you have kidney cancer. They include:

• Medical history and physical exam. 
• Urine test. For this test, a small amount of urine is collected in a container. It is tested for blood, protein, bacteria, and cancer cells. 
• Blood tests. No blood test can detect kidney cancer. But a complete blood count (or CBC) and blood chemistry test can show signs in your blood that are linked with kidney cancer.
• Imaging tests. These tests take pictures of the inside of your body. They include CT scan, ultrasound, intravenous pyelogram (or IVP), and angiography.
• Biopsy. During a biopsy, your healthcare 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 is called fine needle aspiration (or FNA). But a biopsy often does not occur. In most cases, if a CT scan or an MRI shows possible kidney cancer, you will most likely have surgery to remove the tumor or your entire kidney. The pathologist then looks at the tissue taken during surgery to confirm the diagnosis.

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How is kidney cancer treated?

Someone with kidney cancer may have one or several of the following treatments:

• Surgery. Surgery removes the tumor from your kidney. The surgeon may remove your whole kidney or only the part of the kidney with the tumor. Surgery is the standard treatment for cancer that is confined to a 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 treats the cancer and reduces the chance that the cancer will spread to other parts of your body. This treatment uses medicines that may help stimulate your body's immune system to fight cancer cells.
• Radiation therapy. This can kill cancer cells using high-energy x-rays.
• Chemotherapy. This treatment tries to kill the cancer cells in your kidney and any cells that have spread to other organs.
• Ablation therapy. There are two main types of ablation therapy for kidney cancer. Your healthcare provider will insert a needle into an area of cancer cells. Radiofrequency ablation (or RFA) uses energy waves to kill cancer cells. Cryoablation uses extreme cold to kill cancer cells.

New treatments are tested in clinical trials. Before beginning treatment, ask your healthcare provider if there are any clinical trials that may be helpful to you.

Should I get a second opinion?

Many people with cancer get a second opinion from another kidney cancer specialist before deciding on treatment.

Some reasons to get a second opinion include:

• You are not comfortable with the treatment decision.
• You have a rare type of cancer.
• You have different treatment options.
• You are not able to see a cancer expert.
• Your health insurance requires a second opinion before you receive treatment. 

How can I get a second opinion?

• Ask your healthcare provider for the name of a specialist.
• Call the Cancer Information Service at 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 names of healthcare providers from a hospital, medical school or society, or cancer advocacy group.
• Ask people who have had kidney cancer for the names of their healthcare providers.

Can I live normally if I have a kidney removed?

After a kidney is removed, your remaining kidney takes over the work of both. Most people with only one kidney have no long-term health problems.

You should avoid anything that could harm your remaining kidney.

Talk with your healthcare provider if you start taking new medicines or have a bladder infection or other problems that could affect your kidney.

If your remaining kidney is damaged, you may need dialysis. With dialysis, a special machine does the kidneys' job of filtering your blood.

What's new in kidney cancer research?

Ways researchers are looking for ways to treat and cure kidney cancer include:

• Genetic therapy. Genetics is the study of genes, which are the instructions that direct 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 doesn’t treat kidney cancer well. 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.

What are clinical trials?

Clinical trials are studies of new kinds of cancer treatments. Healthcare providers conduct clinical trials to learn how well new treatments work and what their side effects are.

New treatments are compared with 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 Food and Drug Administration approves them. The studies also help increase understanding of cancer and help people who have cancer in the future.

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