Kidney cancer

Facts

About 90 percent of kidney cancers are a type called renal cell carcinoma, which usually forms a single tumor in one of the person’s two kidneys. 

Seattle Cancer Care Alliance (SCCA) offers comprehensive treatment from a team of experts who specialize in all types kidney cancer.

Kidney image

What is kidney cancer?

Kidney cancer starts in the kidneys, a pair of organs that lie in the back of your abdomen. Each is about the size of a fist. 

  • Your kidneys make urine by removing waste and extra water from your blood.
  • They also make substances to help control blood pressure and to make red blood cells.
  • At the top of each kidney is an adrenal gland. A layer of fatty tissue and an outer fibrous tissue surround the kidney and adrenal gland. 

While kidneys are important, you actually need less than one complete kidney to function. Some people who do not have any working kidneys survive with the help of dialysis — using a specially designed machine that filters their blood.

Red blood cell A type of blood cell that carries oxygen in the body.

Types

There are four types of kidney cancer — renal cell carcinoma (RCC), transitional cell carcinoma, Wilms tumor and renal sarcoma. 

Renal cell carcinoma

RCC accounts for about 90 percent of kidney cancers. It arises from the lining of the tiny tubules inside your kidney that filter your blood and make urine. 

Usually it grows as a single mass within a kidney. Occasionally there are two or more tumors in one kidney or even tumors in both kidneys at the same time. 

There are several subtypes of RCC, including:

  • Clear cell — the most common form, affecting about 70 percent of people with RCC. It is associated with another condition called von Hippel-Lindau syndrome. 
  • Papillary kidney cancer — which accounts for about 10 percent of RCC cases. It is associated with hereditary papillary RCC, hereditary leiomyomatosis and RCC syndromes.
  • Chromophobe renal cell carcinoma — a rare type, accounting for about five percent of cases. Birt-Hogg-Dube syndrome, a specific genetic mutation, is associated with chromophobe RCC.
  • Collecting duct renal cell carcinoma — which is very rare.
  • Translocation renal cell carcinoma — which is rare but increasing. It appears in late adolescence and young adulthood.
  • Unclassified renal cell carcinomas — which don’t fit into any of the other categories or may have more than one type of cell. They often include aggressive tumors that don’t respond well to traditional therapies for RCC.
Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant.
Transitional cell carcinoma

Transitional cell carcinomas account for five to 10 percent of all kidney cancers. Also known as urothelial carcinoma, this type of cancer does not start in the kidney but in the renal pelvis (where urine goes before it enters the ureter). 

Wilms tumor

Wilms tumor, also known as nephroblastoma, almost always occurs in children. 

Renal sarcoma

Renal sarcoma is the most rare kidney cancer and accounts for just one percent of all kidney cancer cases. It is treated like other sarcomas.

Symptoms

Kidney cancers often don’t cause symptoms in the early stages.

When symptoms do occur, they may include:

  • Blood in your urine
  • Low back pain on one side
  • A mass or lump on the side or lower back
  • Fatigue
  • Loss of appetite
  • Weight loss
  • Recurrent fevers not associated with colds or flu
  • Swelling of your ankles and legs

Conditions other than cancer may cause the same symptoms as kidney cancer. If you have any symptoms that concern you, talk to your doctor.

Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Diagnosing

If your doctor suspects you may have kidney cancer, they will do a physical exam to look for signs of the disease and ask about your symptoms, medical and family history and risk factors.

You might also have any or all of these tests:

  • Biopsy — to remove cells and examine them under a microscope, both to diagnose cancer and identify the type of cell involved, which is important in planning treatment
  • Genetic tests — to look for gene mutations if you have relatives who were diagnosed with kidney cancer, especially at a younger age, or who have a genetic condition that is a risk factor for kidney cancer
  • OncoScan CGAT — a new chromosome genomic array test at SCCA that can help identify genetic changes useful in diagnosing kidney cancer, determining the subtype, understanding the risk of recurrence and outlook for survival and guiding therapy decisions
  • Imaging tests — such as ultrasound, intravenous pyelogram (IVP), computed tomography (CT) scan or magnetic resonance imaging (MRI) scan to help find out whether a suspicious area is cancerous or to determine if cancer has spread
  • Blood tests — to check the number of blood cells, electrolytes and enzyme levels, which may identify abnormalities caused by kidney cancer
Chromosome Part of a cell that contains genetic information. Except for sperm and eggs, all human cells contain 46 chromosomes. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Magnetic resonance imaging A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. A procedure in which radio waves and a powerful magnet linked to a computer are used to create detailed pictures of areas inside the body. These pictures can show the difference between normal and diseased tissue. MRI makes better images of organs and soft tissue than other scanning techniques, such as computed tomography (CT) or X-ray. MRI is especially useful for imaging the brain, the spine, the soft tissue of joints and the inside of bones. Mutation Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Any change in the DNA sequence of a cell. Mutations may be caused by mistakes during cell division, or they may be caused by exposure to DNA-damaging agents in the environment. Mutations can be harmful, beneficial or have no effect. If they occur in cells that make eggs or sperm, they can be inherited; mutations that occur in other types of cells are not inherited. Certain mutations may lead to cancer or other diseases. A mutation is sometimes called a variant. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.

Stages

Staging is the process of finding out how far cancer has spread within the tissue where it started or to other parts of the body. The treatment that your doctor recommends will be based, in large part, on the stage of your cancer.

There are two types of staging for kidney cancer:

  • Clinical stage — your doctor’s best estimate of the extent of your disease, based on the results of your exam, lab tests and imaging studies
  • Pathological stage — based on the same factors as your clinical stage, plus what is found during surgery, if you have surgery, and examination of the removed tissue

Kidney cancer is assigned an overall stage of I, II, III or IV, with IV being the most advanced.

Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Staging Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. Performing exams and tests to learn the extent of the cancer within the body, especially whether the disease has spread from where it first formed to other parts of the body. It is important to know the stage of the disease in order to plan the best treatment.

Risk factors

Risk factors for kidney cancer include:

  • Age — The risk of kidney cancer increases as you age. Kidney cancer is uncommon before age 45. It occurs most often in people 55 or older. The average age at diagnosis is 64.
  • Sex — RCC is about twice as common in men as in women.
  • Smoking — Smokers are twice as likely to get kidney cancer as nonsmokers.
  • Obesity and diet — Being overweight and having a high-fat diet increase your risk.
  • Exposure to certain environmental substances — Asbestos, cadmium and organic solvents are among the substances that raise kidney cancer risk.
  • Genetic and hereditary factors — Having kidney disease or a family history of kidney cancer puts you at greater risk.
  • High blood pressure — Risk for kidney cancer is elevated in people with high blood pressure.
  • Race — For reasons that are unclear, African-Americans have a slightly higher rate of RCC.

Several hereditary syndromes that result from a faulty gene increase kidney cancer risk:

  • Von Hippel-Lindau syndrome
  • Birt-Hogg-Dube syndrome
  • Hereditary papillary RCC
  • Hereditary leiomyomatosis and RCC syndrome

People with Lynch syndrome may also be at greater risk.

Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Hereditary In medicine, this describes the passing of genetic information from parent to child through the genes in sperm and egg cells. Also called inherited.

How common is kidney cancer?

Kidney cancer is among the 10 most common cancers in both men and women. Each year about 65,000 people in the United States are diagnosed with the disease.

While the rate of people diagnosed with kidney cancer has been slowly rising since the 1970s, the death rate has been slowly declining since the 1990s.