Kidney Cancer

The two most common types of kidney cancer are renal cell carcinoma, in which malignant cells form in tubules of the kidney, and renal pelvis carcinoma, a cancer in the part of the kidney that collects urine and drains it to the ureters.

Other kinds of kidney cancer include papillary cell, chromophobe, transitional cell carcinoma, and Wilms' tumor, which is the most common type of childhood kidney cancer.

The main symptoms associated with kidney cancer are blood in the urine, abdominal or flank pain, and a mass in the abdomen. However, since this cancer often presents no symptoms, early diagnosis can be difficult and the symptoms are more often seen in advanced disease.

Smoking and misuse of certain pain medicines can affect the risk of developing kidney cancer. The chance of recovery and treatment options depend on the stage of the disease, and the patient's age and general health.

Our patients with kidney cancer are treated in the Moores Urologic Cancer Unit.

You can also review the tabs at top of this page for information on kidney cancer symptoms and risks, diagnosis, and treatment.

Symptoms

• Anemia
• Loss of appetite
• Blood in the urine
• A lump in the abdomen
• Weight loss for no known reason
• A pain in the side that doesn't go away

Risks

• Obesity
• Smoking
• High blood pressure
• Polycystic kidney disease
• Family history of kidney cancer
• A diet high in calories or fried/sauteed meats
• Chronic kidney failure and/or long-term dialysis
• Exposure to asbestos and other carcinogenic substances
• Gender: Renal cell carcinoma occurs about twice as often in males than females
• Long-term misuse of certain pain medicines, including over-the-counter pain medicines
• Certain genetic conditions, such as von Hippel Lindau disease or hereditary papillary renal cell carcinoma

Your physician may use a variety of tests to determine the presence of kidney cancer. In addition to conducting a physical examination and checking the results of urine and blood tests, the following may be used:

• Computer tomography (CT) scan uses x-rays to take detailed pictures of structures within the body. CT scanning is one of the most useful tests in detecting a mass or tumor inside the kidney.
• Magnetic resonance imaging (MRI) uses a magnetic field and radio waves to generate cross-sectional pictures of the body. Ultrasound sends and receives high-frequency sound waves that are translated into images and provide an accurate picture of the kidneys.
• Intravenous pyelogram (IVP) or renal angiography procedures require injecting contrast dye into a vein to create a series of images of the kidneys, ureters, and bladder.
• Fine-needle aspiration is a minimally invasive tissue biopsy that can confirm the presence of kidney cancer.
• Cystoscopy, in which a lighted, tubular telescope-like instrument called a cystoscope is placed into the bladder through the urethra, can determine if cancer has spread to the bladder.

Staging

Staging is a process used to determine whether your cancer has spread and, if so, to what extent. It also helps determine what treatment options to consider.

The following stages are used for kidney cancer:

• Stage I: The tumor is seven centimeters or smaller and is found only in the kidney.
• Stage II: The tumor is larger than seven centimeters and is found only in the kidney.
• Stage III: Cancer is found in:
• The kidney and in one nearby lymph node;
• An adrenal gland or in the layer of fatty tissue around the kidney, and may be found in one nearby lymph node; or
• The main blood vessels of the kidney and may be found in one nearby lymph node.
• Stage IV: Cancer has spread:
• Beyond the layer of fatty tissue around the kidney and may be found in one nearby lymph node;
• To two or more nearby lymph nodes; or
• To other organs, such as the bowel, pancreas, or lungs, and may be found in nearby lymph nodes.

Treatment of kidney cancer includes several options, depending on the extent of your cancer and your general health. The two main treatments for tumors that are confined to the kidney are tumor removal (nephrectomy) and tumor ablation.

Tumor removal (nephrectomy)

Surgical removal of the cancer traditionally was accomplished through a procedure called radical nephrectomy. It’s an open surgical procedure performed through an abdominal or flank incision during which the kidney, the fat surrounding the kidney, and the adrenal gland or lymph nodes are removed.

However, several less invasive procedures are available to patients, which offer faster recovery time, shorter hospital stays, and less scarring. UCSD specializes in these procedures, which include laparoscopic radical nephrectomy and partial nephectomy.

Read more about UCSD's surgical options for kidney cancer.

Tumor ablation

Tumor ablation, also known as targeted ablation or directed ablation, destroys the tumor without surgically removing it. By precisely targeting the tumor, cancerous tissue can be destroyed while limiting damage to normal tissue. Tumor ablation may also offer a better chance of preserving kidney function in situations when multiple tumors are present.

Ablation can be accomplished during open surgery, laparoscopy, or percutaneously (through the skin). Examples of tumor ablation techniques include:

• Cryotherapy: A cycle of freezing and thawing to destroy the tumor
• Radio frequency ablation: A special needle is inserted into the tumor and electrical impulses are used to heat and destroy the tumor
• High-intensity focused ultrasound: Sound waves are used to heat and destroy the tumor
• Laser coagulation: A targeted laser beam destroys the tumor

Since tumor ablation is less invasive than traditional surgery methods, it’s often used in patients with very small, localized tumors and in patients who aren't good candidates for surgery because of health issues or age.

Other treatment options

Embolization:: A procedure that blocks blood flow to the tumor. It’s used both to shrink the tumor by blocking its source of nutrients and to stop a tumor from bleeding. Embolization is performed by an interventional radiologist, who inserts a small tube (catheter) into an artery in the groin, and directs it to the renal artery that supplies blood to the kidney and the tumor. Special liquid agents or tiny solid particles are injected into the artery to block the flow of blood. This technique can relieve symptoms in patients with inoperable tumors. It can also be helpful in shrinking a large tumor before surgery.

Although not a standard treatment for kidney cancer, embolization can be useful in patients who can’t tolerate surgery or ablation. It can also be used as an adjunct treatment to prevent a large tumor from bleeding during surgery.

Biologic therapy (immunotherapy): This type of treatment is designed to boost the body's immune system to more effectively fight off or destroy cancer cells. Generally, the primary immunotherapy drugs used are cytokines, proteins which activate the immune system. These drugs include interleukin-2 and interferon-alpha.

New biologic therapies are highly effective oral medications, sorafinid and sunitinib, which are currently approved for the treatment of patients with advanced kidney cancer. These medications are also being tested at UCSD in the ASSURE clinical trial in the United States and Canada for adjuvant treatment of large or high grade tumors after surgery.