Kidney (Renal Cell) Cancer

What is kidney cancer?

Most cancers are named after the part of the body where the cancer first begins, and kidney cancer is no exception. Kidney cancer begins in the kidneys, two large, bean-shaped organs - one located to the left, and the other to the right of the backbone. Renal is the Latin word for kidney, and kidney cancer may also be referred to as renal cancer.

What are the different types of kidney cancer?

Nearly 36,000 persons in the US are expected to be diagnosed with kidney and pelvic renal cancers in 2005, with the most common type called renal cell cancer. The information contained on this page refers to renal cell cancer.

What are the risk factors for renal cell cancer?

The exact cause of renal cell cancer is unknown. However, there are certain risk factors that increase the likelihood of the disease. These risk factors, according to the American Cancer Society, are as follows:

• smoking
  Smoking doubles the risk of kidney cancer.

• asbestos
  Studies show a link between exposure to asbestos and kidney cancer.

• cadmium
  There may be a link between cadmium exposure and kidney cancer. Cadmium may increase the cancer-causing effect of smoking.

• family history
  Family history of kidney cancer increases a person's risk.

• gender
  Men are twice as likely to develop renal cell cancer than women.

• von Hippel-Lindau syndrome
  This is a disease caused by a gene mutation that increases the chances of renal cell cancer.

• tuberous sclerosis
  Patients who have this disease are more likely to develop renal cell cancer.

• diet
  A high-fat diet increases a person's risk of kidney cancer.

• obesity
  Obesity increases a person's risk of kidney cancer.

• long-term dialysis
  Patients who have been on dialysis for a long time may develop kidney cysts, which may be one cause of renal cell cancer.

What are the symptoms of renal cell cancer?

The following are the most common symptoms of renal cell cancer. However, each individual may experience symptoms differently. Symptoms may include:

• blood in the urine
• rapid, unexplained weight loss
• low back pain (not caused by an injury)
• loss of appetite
• swelling of ankles and legs
• mass or lump in the belly
• fatigue
• recurrent fever (not caused by a cold or the flu)
• high blood pressure (less frequently)
• anemia (less frequently)
• unrelieved pain in the side

The symptoms of renal cell cancer may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is kidney cancer (renal cell cancer) diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for kidney cancer may include the following:

• blood and urine laboratory tests

• intravenous pyelogram (IVP) - a series of x-rays of the kidney, ureters, and bladder with the injection of a contrast dye into the vein - to detect tumors, abnormalities, kidney stones, or any obstructions, and to assess renal blood flow.

• renal angiography (Also called arteriography.) - a series of x-rays of the renal blood vessels with the injection of a contrast dye into a catheter, which is placed into the blood vessels of the kidney, to detect any signs of blockage or abnormalities affecting the blood supply to the kidneys.

• other imaging tests (to show the difference between diseased and healthy tissues), including the following:
  
  
  • computed tomography scan (Also called a CT or CAT scan.) - a noninvasive procedure that takes cross-sectional images of the brain or other internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
    
    
  • magnetic resonance imaging (MRI) - a noninvasive procedure that produces two-dimensional (2D) view of an internal organ or structure, especially the brain and spinal cord.
    
    
  • ultrasound (Also called sonography.) - a diagnostic imaging technique that uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs. Ultrasounds are used to view internal organs as they function, and to assess blood flow through various vessels.

Based on results of other tests and procedures, a biopsy may be needed. A biopsy is a procedure in which a sample of the tumor is removed and sent to the laboratory for examination by a pathologist. Biopsy is the only sure way to diagnose cancer.

Treatment for kidney cancer:

Specific treatment for kidney cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• surgery
  Surgery to remove the kidney is called a nephrectomy and it is the most common treatment for kidney cancer. The following are different types of nephrectomy procedures:
  
  
  • radical nephrectomy - the whole kidney is removed along with the adrenal gland, tissue around the kidney, and, sometimes, lymph nodes in the area.
    
    
  • simple nephrectomy - only the kidney is removed.
    
    
  • partial nephrectomy - only the part of the kidney that contains the tumor is removed.
    

The remaining kidney is generally able to perform the work of both kidneys.

• external radiation (external beam therapy) - a treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes. External radiation may also be used to relieve pain when kidney cancer has spread to the bone.
  
  
• biological therapy (also called biological response modifier (BRM) therapy, or immunotherapy) - a cancer treatment that fights cancer by using materials made by your own body, or made in a laboratory, to boost, direct, or restore your body's natural defenses against disease.
  
  
  • interferon - a biological drug used to treat renal cell cancer. Interferon boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects may include flu-like symptoms (such as fever, chills, and headache) and temporary liver problems.
    
    
  • interleukin - a biological drug used to treat advanced stages of renal cell cancer. Interleukin boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects include flu-like systems (such as fever, chills, and headache), swelling, and change in blood counts.
    
    
• chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells. The oncologist will recommend a treatment plan for each individual. 
  
  
• hormone therapy - in some cases, hormones can kill cancer cells, slow the growth of cancer cells, or stop cancer cells from growing. Hormone therapy as a cancer treatment involves taking substances to interfere with the activity of hormones or to stop the production of hormones. Hormone therapy is used in a small number of patients with advanced kidney cancer to try to control the growth of cancer cells. 
  
  
• arterial embolization -  a procedure in which small pieces of a special gelatin sponge, or other material, are injected through a catheter to clog the main renal blood vessel. This procedure shrinks the tumor by depriving it of the oxygen-carrying blood and other substances it needs to grow. It may also be used before an operation to make surgery easier, or to provide relief from pain when removal of the tumor is not possible.

New chemotherapy drugs and targeted therapies including thalidomide, Avastin, and Tarceva are being studied in kidney cancer. A vaccine for treatment also is under study.