Kidney Cancer

We typically have two kidneys—each located above the waist on either side of the backbone. The kidney’s job is to remove waste product from our blood through tiny filters called tubules. Renal cell cancer (RCC) is a malignant growth that originates in these tubules.

Since the 1990s, the incidence of RCC has increased due to the introduction of more advanced diagnostic technology such as ultrasound and CT scans identifying some cancers which might not have been found otherwise. The American Cancer Society estimates about 73,820 new cases of kidney cancer (44,120 in men and 29,700 in women) will be diagnosed in 2019. Additionally, about 14,770 people will die from this disease.

Although a singular cause of RCC is unknown, research indicates several contributing factors, including:

• Cigarette smoking
• Obesity
• Misuse of certain pain medicines
• Genetic conditions

Although most patients have no symptoms, patients should call a doctor if they experience:

• A lump in the abdomen
• Pain in the flank or side
• Decreased appetite
• Low blood count (anemia)
• Unexplained weight loss
• Blood in the urine (hematuria)

Testing usually includes blood work, urinalysis, a CT scan or an MRI, and a biopsy. A CT scan can identify a growth in the kidney. Once the diagnosis is confirmed, further tests (blood test to check the health of the liver, chest X-ray, bone scan) help determine if the cancer has spread beyond the kidney.

Knowing the stage of the disease helps inform the treatment plan:

• Stage I: Growth or tumor no larger than 7 cm found in kidney.
• Stage II: Tumor is larger than 7 cm found only in kidney.
• Stage III: Cancer found in kidney and extending locally into major veins or perinephric tissues.
• Stage IV: Cancer has spread beyond the kidney.

We base our kidney cancer treatment approach on each patient’s situation.

Treatments for local growth (stages I and II) include:

• Active surveillance: Small renal tumors (less than 3 cm) and elderly patients with multiple medical issues may elect to take an active surveillance approach, with follow-up to monitor symptoms and physical examination. Repeat imaging will observe the mass for growth and other changes.
• Surgery: Depending on the tumor’s size, the stage of the disease, and the overall condition of the patient, the surgeon removes all or part of the kidney surrounding the tumor. This surgery is by far the most common treatment. Minimally invasive techniques using laparoscopy or robotics can often replace larger-incision approaches, reducing pain, hospitalization, and recovery time.
• Percutaneous therapy: Small tumors are treated with cryoablation (freezing) or radiofrequency ablation.
• Systemic therapy: Many new and promising immunologic therapies and targeted molecular approaches are available to treat renal cancer that has spread outside the kidney.

Metastatic growths (stages III and IV):

• Surgery: While not curative, surgical removal of the kidney prior to starting chemotherapy may enhance the effectiveness of the treatment.
• Chemotherapy and immunotherapy: New treatments are available for RCC, with encouraging results in initial studies.