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Department of Urology

Kidney Cancer

Overview

Kidney cancer is the 3rd most common urologic cancer and accounts for 2-3% of adult cancers.  Renal cell carcinoma is the most common type of kidney cancer and can be one of several subtypes.  Most detected kidney cancers are confined to the kidney, but the proportion of cancers that have spread outside the kidney (metastatic kidney cancer) has largely remained the same over the last 20 years.

Symptoms

Most patients with kidney cancer do not have any symptoms and the tumor is found on an imaging study that was obtained for another indication, like abdominal pain.  The most common symptoms that occur from kidney cancer include blood in the urine and flank, or side pain.
In a majority of patients with kidney cancer, no cause is found and the cancer is said to be spurious.  The two major risk factors for kidney cancer are smoking or tobacco use and genetics.  Smokers are more than twice as likely to get kidney cancer as non-smokers.  Genetic mutations that are inherited also increase one’s likelihood of developing kidney cancer.  The most common genetic diseases associated with kidney cancer is von Hippel Lindau disease.
Smoking and a family history of kidney cancer are the major risk factors for kidney cancer.  Obesity may be associated with kidney cancer.

Diagnosis

Radiologic tests usually identify the cancer and help determine whether cancer has spread beyond the kidney:
•    CT scan or MRI of the abdomen
•    Chest x-ray or CT scan of the chest
•    Bone scan, if there is concern about spread to the bones
•    MRI of the brain, if there is concern about spread to the brain

The problems that occur from having kidney cancer include: bleeding into the kidney or bleeding in the urine, damage to the kidney and renal failure, growth of the kidney cancer into the blood vessels draining the kidney with potential extension into the inferior vena cava (the largest vein in the body carrying blood back to the heart), deep venous thrombosis or blood clot formation in the large veins of the legs, and symptoms from spread of cancer to other parts of the body, including the lymph nodes, lungs, liver, bones, and the brain.

Treatment

Surgery

Kidney cancer is best treated with surgery, either with a Radical Nephrectomy to remove the whole kidney, or Partial Nephrectomy to remove the tumor but preserve the rest of the kidney.  Surgery is performed laparoscopically when the tumor size and location and patient history allow for use of this minimally-invasive option.

Radiation therapy

Radiation is typically only used to treat kidney cancer that has spread to the bone.

Systemic therapy

Systemic therapy refers to treatment of kidney cancer cells throughout the body and is used in patients with metastatic kidney cancer.  Several new drugs are now being used that have promise for patients with metastatic kidney cancer.

Self Care

Most patients with kidney cancer have no symptoms and the cancer was found incidentally on a workup for another problem.  Occasionally, patients require management of pain or bleeding related to their kidney cancer.  Surgery for kidney cancer can require large incisions that require a recovery period of 6-8 weeks.  The recovery after laparoscopic kidney cancer surgery is much shorter.

Additional Reading

National Cancer Institute – Kidney Cancer
National Cancer Institute Fact Sheet

Physicians

John L. Gore, MD, MS
Jonathan Harper, MD
Daniel W. Lin, MD
Jonathan L. Wright, MD, MS