About kidney cancer
More than 12,000 people are diagnosed with kidney cancer in the UK each year, and the incidence is increasing annually. Kidney cancer is now the seventh most common cancer in British adults; however, it is still considered to be a less common cancer, and around 4,400 people die from the disease every year. About half of all kidney cancers are diagnosed in people aged over 70.
Worldwide, there are about 340,000 new cases of kidney cancer a year, accounting for around 2% of all cancers. Globally, the incidence of kidney cancer has been increasing, mostly due to lifestyle factors, such as smoking and obesity, but in part due to better scanning facilities being able to pick up small tumours.
This section attempts to answer some of the more common questions asked about kidney cancer. If you have any further questions about the diagnosis, treatment and care of people with kidney cancer, please do not hesitate to email us or ring our helpline.
Kidney Cancer Basics
The International Kidney Cancer Coalition (IKCC) has produced a Kidney Cancer Basics booklet that gives a comprehensive and easy-to-understand overview of kidney cancer, diagnosis and treatment. We hope you find this booklet useful.
To download or print a pdf copy of the booklet, please click the the image below. The booklets are available in A5 format. If you wish to print on an A4 page, please use the layout option “2 pages per sheet” in the print options of your printer.
Please get in touch with us by email if you have any comments and would like to share your experience of using the booklet.
The kidneys are a pair of bean-shaped organs located near the middle of the back, one on either side of the backbone, level with the lower ribs. An adult kidney is about the size of a fist.
The kidneys filter and clean blood by removing waste products and toxins, which are eliminated from the body in urine. Urine is produced in tiny blood filters called nephrons in the kidney; there are about 1.2 million nephrons within each kidney. The urine is then carried through a tube called the ureter into the bladder, where it is stored until it is ready to be passed out of the body through another tube, called the urethra, during urination.
The main waste products in urine are: urea (from protein metabolism), creatinine (from muscle), uric acid (from metabolism of nucleic acids), bilirubin (from haemoglobin metabolism), and the broken down products of hormones. Some of these waste products are measured to test kidney function.
The kidneys also balance body fluids, regulate blood pressure, and produce hormones that aid in other important body functions, such as absorption of calcium in the gut and manufacture of red blood cells by the bone marrow.
A person can live a perfectly healthy life with one kidney, and if a kidney is removed as a result of cancer or for transplantation, there will not be any significant loss of kidney function in the remaining kidney.
Cancer is a group of diseases in which the cells grow uncontrollably, and have the ability to spread to other parts of the body. There are over 200 different types of cancer, each with its own characteristics. When cancer spreads, it takes its own characteristics with it. For example, if kidney cancer spreads from the kidney to the liver, the cells in the tumour in the liver will look like kidney cancer cells.
Our bodies are made up of cells. Each tissue and organ is made of these cells, which are all very different depending where they are in the body, for example in the liver, heart, blood or kidneys. Our bodies are always making new cells to enable us to grow, to replace worn-out cells, or to heal damaged cells after injury. Usually, this process is very controlled by the genes within the cells.
Cancer cells develop as a result of changes to these genes, called mutations. These changes may be caused by a number of factors, including environmental, dietary and genetic factors (which are inherited from parents). The cancer cell grows and multiplies to form a growth or mass, called a tumour. A tumour forms because the rate the cancer cell grows and multiplies is faster than the rate of cell death.
Tumours can be either malignant or benign. Malignant tumours are cancerous tumours. Malignant tumours have a number of characteristics different to that of normal cells. Cancer cells are also able to spread away from the original tumour into surrounding tissue and other areas of the body via the blood stream or the lymphatic system (metastasise).
There are several different types of kidney cancer, the most common being renal cell carcinoma (RCC). This accounts for about 85% of all kidney cancers. In RCC the cancerous cells originate in the lining (epithelium) of the kidney’s tubules; the small tubes inside the nephrons that filter blood and make urine.
There are also different sub-types of RCC, depending on which cells are affected:
- Clear cell is the most common sub-type (75-80% of cases)
- Papillary (or chromophilic, 10-15%)
- Chromophobe (5%)
- Collecting duct carcinoma
- Renal medullary carcinoma
- Mucinous tubular and spindle cell carcinoma
- Renal translocation carcinoma
- Unclassified RCC (the latter five are very rare and make up the remaining 5-10% of RCC tumours).
Some kidney cancers (about 6%-7% of the total) originate in the renal pelvis at the point where the kidney joins the ureter, a thin tube that carries urine from the kidney to the bladder. These are known as transitional cell carcinomas (TCC).
Less than 1% of kidney cancers are renal sarcomas, which originate in the kidney’s connective tissues.
Very rarely, a secondary tumour, called a metastasis, which has spread from a primary tumour elsewhere in the body, might be found on the kidney. In these cases, the cancer is not kidney cancer and needs to be treated accordingly.
Sometimes benign (not cancerous) tumours may grow on the kidney. These are called renal oncocytomas, and make up about 5% of all kidney tumours.
There are some significant differences in treatment for the various types and sub-types of kidney cancer. It is, therefore, important to know precisely what kind of kidney cancer has been diagnosed so you receive the right treatment. However, the vast majority of patients have the clear cell sub-type of RCC.
Von Hippel-Lindau syndrome (von Hippel-Lindau disease) is a rare condition that affects about 1 in 40,000 people in the UK. It is due to a faulty gene; in about 4 out of 5 cases the gene is inherited from one or other parent, but in 1 in 5 people with von Hippel-Lindau syndrome it occurs as a result of a new gene change (mutation), with no family history.
The condition leads to changes in the way some blood vessels are formed, and this causes tumours of blood vessels (called haemangioblastomas) in certain parts of the body. The places most often affected are the brain (particularly a part of the brain called the cerebellum), the spinal cord, and the retina (the lining of the back of the eye). These tumours are non-cancerous (benign), but sometimes can be quite serious because of where they develop. About 28-45% of people with von Hippel-Lindau syndrome develop kidney cancer.
More information on von Hippel-Lindau syndrome can be found on the VHL Family Alliance website.
Wilms’ tumour (sometimes called nephroblastoma) is a very rare type of kidney cancer that affects children. It is named after a German doctor, Dr Max Wilms (1867-1918), who first described it. Wilms’ tumour afflicts about 80 children per year in the UK, and is curable in 90% of cases.
A nephroblastoma is abnormal tissue that grows on the outer part of one or both kidneys. Children with this condition are at risk of developing a Wilms’ tumour. It is thought that nephroblastomas originate from specialised cells in the developing embryo known as metanephric blastema, which are involved in the development of the child’s kidney while they are still in the womb. These cells usually disappear at birth, but in many children with Wilms’ tumour, cells called nephrogenic rests can still be found on the kidneys.
Wilms’ tumours are categorised as favourable or unfavourable, depending on how the tumour cells appear under the microscope. Unfavourable tumour cells look very large and not like normal kidney cells. These cells are called anaplastic (large and abnormal), and the cancer is less likely to be cured. However, about 95% of Wilms’ tumours have favourable histology and a high chance of a cure.
Kidney cancer is the seventh most common cancer in UK adults, with around 12,500 new cases diagnosed in 2014, and 4,400 deaths from kidney cancer in the same year. Kidney cancer accounts for 3% of all new cancer cases in the UK.
It has been estimated that the lifetime risk of developing kidney cancer is 1 in 52 for men and 1 in 87 for women.
About half (50%) of all kidney cancers are diagnosed in people aged over 70 years (2011-2013).
Kidney cancer is, therefore, a less common cancer. However, the incidence of kidney cancer is increasing globally, including the UK, where incidence rates have increased by a third (34%) over the last decade. This increase is mainly attributable to lifestyle factors, such as smoking and obesity, but could also be due to improvements in imaging technology leading to the incidental detection of asymptomatic kidney tumours.
Data from Cancer Research UK for the year 2014, unless specified otherwise.
In all forms of cancer, the development of a tumour is triggered by abnormal changes (mutations) in particular genes within the body’s cells. The various factors that are linked to the genetic changes responsible for kidney cancer are still not fully understood, but certain risk factors are known to be associated with an increased tendency to develop kidney cancer:
- Age and gender – tumours within the kidney have been found in any age group but are most common in people over 55, and they are more common in men than in women
- Lifestyle factors – the major risk factors for kidney cancer are obesity (70% increased risk) and cigarette smoking (50% increased risk). Cigarettes contain chemicals that damage the genes of kidney cells, called carcinogens
- Certain medical conditions and treatments – such as cystic kidney disease, dialysis, renal stones, hypertension, and previous abdominal radiotherapy, can increase the likelihood of developing kidney cancer
- The classic symptoms of kidney cancer are haematuria (blood in the urine), loin pain and abdominal mass, but only 10% of people present with all three of these symptoms together
- Back pain, night sweats, polycythaemia, and a left-sided varicocele (in men) can also lead to a diagnosis of kidney cancer
- More than 50% of renal tumours are now detected when using ultrasound for non-specific symptoms, such as general abdominal pain, hypertension, malaise, weight loss, anorexia, anaemia, elevated C-reactive protein, or abnormal liver function tests
- Unfortunately, 25-30% of people with kidney cancer present with symptoms of metastatic disease, such as; a persistent cough, frequent headaches, bone pain, or abnormal liver function tests.
These symptoms can be caused by many other conditions, apart from kidney cancer, so it is important to have them checked out by a doctor.
Currently, there are no screening programmes for kidney cancer in the UK. Doctors use their clinical experience, scans and various tests to diagnose kidney cancer. Your doctor may use different tests and investigations, depending on which signs and symptoms you have.
If you have blood in your urine (haematuria), your family doctor or GP will usually test your urine to rule out infection. If there is no evidence of infection, or the haematuria continues, you will usually be referred to hospital for further tests and scans.
The most common tests carried out at the hospital are:
- Renal ultrasound scan – used to detect and differentiate between tumours and cysts on the kidney
- Computerised tomography (CT) – used to get detailed pictures of organs in the body. This can help characterise a lump in the kidney if one is found
- Chest X-ray – an X-ray of organs and bones within the chest
- Urine test – to test for blood and protein in the urine
- Blood tests – to test kidney and liver function
- Cystoscopy and/or CT urogram – this might be done to differentiate between transitional cell carcinoma (TCC) and renal cell carcinoma (RCC).
The majority of kidney cancers are initially discovered by scans (ultrasound or CT scan), showing a mass or lump on the kidney. This does not prove it is kidney cancer, however, and it must be examined under the microscope to be sure. Sometimes your doctor may recommend immediate surgery; other times your doctor might order a biopsy. During a biopsy, a thin needle is used to remove some cells from the tumour. A doctor will then look at the cells to see if they are cancerous or not. Up to 20% of small kidney masses (or lumps) are non-cancerous.
The advantage of early detection is successful removal of the affected kidney to prevent the spread of the disease. As the tumour grows and the lymph nodes become involved, the 5-year survival-rate drops as the cancer spreads.
If you have a small tumour that has not spread (stage 1), and you are elderly, or have significant medical problems, it may be safer to carefully monitor the cancer with scans and visits to see the doctor. This is called active surveillance, and it can be used for people where the risk of dying during an operation outweighs the benefits of surgery. Kidney cancers that are smaller than 3 cm are very unlikely to spread elsewhere; however, these tumours still need to be followed up in case the cancer starts to grow.
Surgery is usually the first treatment for kidney cancer, and may be all that is required if the cancer is at an early stage. Surgery to remove kidney cancers is carried out by a specialist surgeon called an urologist.
- Radical nephrectomy – surgery to remove the entire kidney along with the primary tumour, surrounding fatty tissue, and sometimes the adrenal gland. Local lymph nodes are also removed to help determine if the cancer has spread. Radical nephrectomy can be done with a large cut (open surgery) or by keyhole surgery (laparoscopic surgery).
- Partial nephrectomy – surgery to remove only the part of the kidney containing the cancer, and sparing the remaining healthy kidney tissue. Partial nephrectomy can be done with a large cut (open surgery) or by keyhole surgery (laparoscopic surgery).
- Robot assisted surgery – a type of laparoscopic surgery in which a special machine or robot is used by the surgeon to help carry out the surgery. The surgeon has a 3D view of the inside of your tummy and the area can be magnified 10-12 times. Robotic surgery is only available at a few specialist centres in the UK.
For some people an operation is not possible due to their age or other serious medical problems. And some people decide against having surgery. It may still be possible to treat small, early stage kidney cancer without using surgery:
- Cryotherapy/cryoablation – a non-invasive treatment where a number of small probes are inserted through the skin (percutaneous) into the tumour, and then cooled with liquid nitrogen to freeze the cancer cells and kill them. Cryotherapy is usually carried out under general anaesthetic or sedation.
- Radiofrequency ablation (RFA) – a non-invasive treatment where heat from an electric probe inserted through the skin into the tumour is used to destroy the cancer cells. RFA is carried out using local anaesthetic, and sometimes sedation.
- Stereotactic radiotherapy – a new type of radiotherapy that directs a high dose of radiation into the tumour, but avoids damaging surrounding tissues and organs.
These treatments are not widely available in NHS hospitals, and are only available in a few specialist centres.
After you have had your operation, you will be able to discuss a follow-up care plan with your medical team. You will be monitored for signs that the cancer has come back (recurrence), or spread of the cancer to other parts of the body.
The frequency of your follow-up visits will depend on whether you had any complications during your surgery, how well your remaining kidney is working, and the risk of recurrence or spread of the cancer. Generally, people have follow-up visits at 6 months and 1 year after surgery, and then annually for at least 5 years.
If you are at low risk of cancer spread or recurrence, you should have an ultrasound scan or chest X-ray, and blood tests to check kidney function at each visit. If you are at intermediate or high risk of cancer spread or recurrence, you should have a CT scan and blood tests at each visit. Patients with an intermediate or high risk of cancer spread or recurrence, or those with complications after their operation may be seen more frequently.
Additional treatment can be given after surgery to reduce the chance of the cancer coming back. These are called adjuvant treatments, and include targeted therapies and radiotherapy for kidney cancer. However, recent clinical trials of adjuvant treatment using two targeted therapies called sunitinib and sorafenib have failed to show a benefit for patients and have not helped to stop the cancer from coming back.
Kidney cancer that has spread is also called advanced or metastatic kidney cancer. Once cancer has spread to other organs in the body, it usually cannot be cured. However, there are a number of treatments that can be used to keep the cancer under control, sometimes for many years.
Different specialists, such as medical oncologists, urologists and medical radiologists, may recommend combinations of different treatments. A team of specialists will work with you and your GP to help control your symptoms and help you to live as normal a life as possible. Treatments for advanced kidney cancer include:
- Surgery – often the first treatment for advanced kidney cancer. Although surgery cannot cure kidney cancer that has spread, surgery may be recommended to reduce symptoms, especially pain and discomfort. This is called debulking surgery or cytoreductive surgery.
- Targeted therapies – drugs that target specific biological signals in the cancer cells to stop cell growth and the development of a new blood supply to the tumour (angiogenesis). Treatments that interfere with the development of a blood supply are called anti-angiogenic agents. Targeted therapies used for the treatment of advanced kidney cancer are tyrosine kinase inhibitors, such as sunitinib, pazopanib, sorafenib and axitinib, and mTOR inhibitors, such as everolimus and temsirolimus.
- Immunotherapies – drugs that boost the body’s immune system to destroy cancer cells. Immunotherapies that are still sometimes used for the treatment of advanced kidney cancer are cytokines, such as interferon and interleukin 2. Another type of immunotherapy that is being tested for use in advanced kidney cancer are checkpoint inhibitors, such as nivolumab, pembrolizumab and ipilimumab.
- Radiotherapy – although kidney cancer cells are not very sensitive to radiation, radiotherapy can still be used to help control the symptoms of advanced kidney cancer, particularly neuropathic pain. Stereotactic radiotherapy can also be used to treat metastases in the brain, liver, lung and pancreas.
- Palliative care – includes all the treatments that your medical team recommends to improve your symptoms (especially pain) and your quality of life. You can receive palliative care from when you are diagnosed with cancer and throughout your treatment. Palliative care also includes looking after the spiritual, social and psychological wellbeing of the patient.
Alternative therapies are treatments that are not standard medical treatments, and which might not have been scientifically proven to be effective against cancer. These treatments may be recommended by well-intentioned friends and relatives, or found on the Internet. Some alternative therapies can even be harmful, especially if taken with prescription drugs. Some examples of alternative therapies include high-dose vitamins, herbal products, or extreme diets. It is important that you let your doctor or nurse know if you are considering alternative therapies for cancer.
Complementary therapies – complement established medical treatments, improving quality of life and symptoms. These include mindfulness meditation, relaxation techniques, remedial massage therapy, psychotherapy, prayer, yoga, acupressure and acupuncture. If there were any chance that the kidney cancer has spread to bones, chiropractic treatment or osteopathy would not be a good idea.
This is a difficult question to answer, because each person’s cancer responds differently to each treatment. Also, doctors are never completely certain that all the cancer has been removed during surgery and by other treatments; cancer cells that can’t be seen with CT scans could be carried in the lymphatic system or blood stream to trigger a recurrence of the cancer at a later date.
If the cancer is removed by surgery at an early stage, i.e. when it is contained within the kidney and has not spread, then you stand a good chance of living a long time. However, regular check-ups are essential for all kidney cancer patients, including those who appear to be free from the disease after surgery.
If the cancer has spread outside the kidney, and to other organs, such as the lymph nodes, lungs, liver, bones or brain, then the cancer is unlikely to be cured. In these cases, the disease can be kept under control for many months, or even years, with drugs such as tyrosine kinase inhibitors, e.g. sunitinib, pazopanib and axitinib.
Some patients respond better than others to treatment, and a very small proportion of patients may even go into remission and their cancer disappears completely. It is not yet known why some patients respond better than others, but we are learning more each year about the biochemical pathways in cancer cells that determine response to various drug treatments.
If you would like to know more, the following websites contain some comprehensive and reliable information about kidney cancer and its treatment:
NHS Choices is the official website of the NHS in England, and the UK’s biggest health website providing an award winning, comprehensive health information service with thousands of articles, videos and tools.
Macmillan Cancer Support provides a support service for cancer patients, with advice about money worries and getting back to work, and information about various cancers. Download a pdf of the latest Macmillan Understanding Kidney Cancer booklet here.
Kidney Cancer UK (previously James Whale Fund for Kidney Cancer) has some comprehensive information about kidney cancer on the website and provide a free Understanding Kidney Cancer booklet to patients upon request.
10forIO website is an information project of the International Kidney Cancer Coalition (ikcc.org). The purpose of this website is to provide a central resource for patient organisations to access information about immune-oncology (referred to as IO), specifically as it applies to renal cell carcinoma.
The European Association of Urology (EAU) Renal Cell Cancer (RCC) Guidelines Panel has compiled these clinical guidelines to provide urologists with evidence-based information and recommendations for the management of RCC.
It must be emphasised that clinical guidelines present the best evidence available to the experts, but following guideline recommendations will not necessarily result in the best outcome. Guidelines can never replace clinical expertise when making treatment decisions for individual patients, but rather help to focus decisions – also taking personal values and preferences, and the individual circumstances of patients into account.
Read the full EAU guidelines here. These guidelines were updated in March 2018.
Please note, these guidelines have been written for urologists and oncologists, and the terminology used is not patient-friendly. If you need clarification of these guidelines, please get in touch with us by email. Talk to your doctor or your hospital team about any concerns or issues that you have about the way your kidney cancer is being managed.