Diseases

If you have symptoms that suggest kidney cancer, your doctor will try to find out what's causing the problems.You may have a physical exam. Also, you may have one or more of the following tests:

• Urine tests: The lab checks your urine for blood and other signs of disease.
• Blood tests: The lab checks your blood for several substances, such as creatinine. A high level of creatinine may mean the kidneys aren't doing their job.
• Ultrasound: An ultrasound device uses sound waves that can't be heard by humans. The sound waves make a pattern of echoes as they bounce off organs inside your abdomen. The echoes create a picture of your kidney and nearby tissues. The picture can show a kidney tumor.
• CT scan: An x-ray machine linked to a computer takes a series of detailed pictures of your abdomen. You may receive an injection of contrast material so your urinary tract and lymph nodes show up clearly in the pictures. The CT scan can show cancer in the kidneys, lymph nodes, or elsewhere in the abdomen.
• MRI: A large machine with a strong magnet linked to a computer is used to make detailed pictures of your urinary tract and lymph nodes. You may receive an injection of contrast material. MRI can show cancer in your kidneys, lymph nodes, or other tissues in the abdomen.
• IVP: You'll receive an injection of dye into a vein in your arm. The dye travels through the body and collects in your kidneys. The dye makes them show up on x-rays. A series of x-rays then tracks the dye as it moves through your kidneys to your ureters and bladder. The x-rays can show a kidney tumor or other problems. (IVP is not used as commonly as CT or MRI for the detection of kidney cancer.)
• Biopsy: The removal of tissue to look for cancer cells is a biopsy. In some cases, your doctor will do a biopsy to diagnose kidney cancer. Your doctor inserts a thin needle through your skin into the kidney to remove a small sample of tissue. Your doctor may use ultrasound or a CT scan to guide the needle. A pathologist uses a microscope to check for cancer cells in the tissue.
• Surgery: After surgery to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer cells.

StagingIf kidney cancer is diagnosed, your doctor needs to learn the extent (stage) of the disease to help you choose the best treatment. The stage is based on the size of the kidney tumor and whether the cancer has invaded nearby tissues or spread to other parts of the body.Your doctor may order one or more tests:

• Blood tests: Your doctor can check for substances in your blood. Some people with kidney cancer have high levels of calcium or LDH. A blood test can also show how well your liver is working.
• Chest x-ray: An x-ray of the chest can show a tumor in your lung.
• CT scan: CT scans of your chest and abdomen can show cancer in your lymph nodes, lungs, or elsewhere.
• MRI: MRI can show cancer in your blood vessels, lymph nodes, or other tissues in the abdomen.

When cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells. The disease is metastatic kidney cancer, not lung cancer. It's treated as kidney cancer, not as lung cancer. Doctors sometimes call the new tumor “distant” disease.These are the stages of kidney cancer:

• Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters). Cancer cells are found only in the kidney.
• Stage II: The tumor is bigger than a tennis ball. But cancer cells are found only in the kidney.
• Stage III: The tumor can be any size. It has spread to at least one nearby lymph node. Or it has grown through the kidney to reach nearby blood vessels.
• Stage IV: The tumor has grown through the layer of fatty tissue and the outer layer of fibrous tissue that surrounds the kidney. Or cancer cells have spread to nearby lymph nodes or to the lungs, liver, bones, or other tissues.

TreatmentCommon treatment options for people with kidney cancer are surgery, targeted therapy, and biological therapy. You may receive more than one type of treatment.The treatment that's right for you depends mainly on the following:

• The size of the tumor
• Whether the tumor has invaded tissues outside the kidney
• Whether the tumor has spread to other parts of the body
• Your age and general health

You may have a team of specialists to help plan your treatment. Your doctor may refer you to a specialist, or you may ask for a referral.You may want to see a urologist, a surgeon who specializes in treating problems of the urinary tract. Other specialists who treat kidney cancer include urologic oncologists (surgeons who specialize in cancers of the urinary tract), medical oncologists, and radiation oncologists. Your health care team may also include an oncology nurse and a registered dietitian.Your health care team can describe your treatment choices, the expected results of each, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities. You and your health care team can work together to develop a treatment plan that meets your needs.At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns. Information about such care is available on NCI's Web site at http://www.cancer.gov/cancertopics/coping. For example, some people with kidney cancer may need to have radiation therapy to relieve pain or certain other problems. Radiation therapy uses highenergy rays to kill cancer cells.You may want to talk with your doctor about taking part in a clinical trial. Clinical trials are research studies testing new treatments. They are an important option for people with all stages of kidney cancer.You may want to ask your doctor these questions before you begin treatment:

• How large is the tumor? What is the stage of the disease? Has the tumor grown outside the kidney or spread to other organs?
• What are my treatment choices? Which do you suggest for me? Why?
• What are the expected benefits of each kind of treatment?
• What can I do to prepare for treatment?
• Will I need to stay in the hospital? If so, for how long?
• What are the risks and possible side effects of each treatment? How can side effects be managed?
• What is the treatment likely to cost? Will my insurance cover it?
• How will treatment affect my normal activities?
• Would a research study (clinical trial) be a good choice for me?
• Can you recommend a doctor who could give me a second opinion about my treatment options?
• How often should I have checkups?

When you get a diagnosis of kidney cancer, it's natural to wonder what may have caused the disease. Doctors usually can't explain why one person gets kidney cancer and another doesn't.However, we do know that people with certain risk factors may be more likely than others to develop kidney cancer. A risk factor is something that may increase the chance of getting a disease.Studies have found the following risk factors for kidney cancer:

• Smoking: Smoking tobacco is an important risk factor for kidney cancer. People who smoke have a higher risk than nonsmokers. The risk is higher for those who smoke more cigarettes or for a long time.
• Obesity: Being obese increases the risk of kidney cancer.
• High blood pressure: Having high blood pressure may increase the risk of kidney cancer.
• Family history of kidney cancer: People with a family member who had kidney cancer have a slightly increased risk of the disease. Also, certain conditions that run in families can increase the risk of kidney cancer.
  • Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It's caused by changes in the VHL gene. People with a changed VHL gene have an increased risk of kidney cancer. They may also have cysts or tumors in the eyes, brain, or other parts of the body. Family members of those with VHL can have a test to check for a changed VHL gene.

Many people who get kidney cancer have none of these risk factors, and many people who have known risk factors don't develop the disease.

Common symptoms of kidney cancer include:

• Blood in the urine (making the urine slightly rusty to deep red)
• Pain in your side that doesn't go away
• A lump or mass in the side or the abdomen
• Weight loss for no known reason
• Fever
• Feeling very tired

These symptoms may be caused by kidney cancer or by other health problems, such as an infection or a kidney cyst. People with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible.

SurgerySurgery is the most common treatment for people with kidney cancer. The type of surgery depends on the size and stage of the cancer, whether you have two kidneys, and whether cancer was found in both kidneys.You and your surgeon can talk about the types of surgery and which may be right for you:

• Removing all of the kidney (radical nephrectomy): The surgeon removes the entire kidney along with the adrenal gland and some tissue around the kidney. Some lymph nodes in the area may also be removed.
• Removing part of the kidney (partial nephrectomy): The surgeon removes only the part of the kidney that contains the tumor. People with a kidney tumor that is smaller than a tennis ball may choose this type of surgery.

There are two approaches for removing the kidney. The surgeon may remove the tumor by making a large incision into your body (open surgery). Or the surgeon may remove the tumor by making small incisions (laparoscopic surgery). The surgeon sees inside your abdomen with a thin, lighted tube (a laparoscope) placed inside a small incision. Sometimes a robot is used. The surgeon uses handles below a computer display to control the robot's arms.The surgeon may use other methods of destroying the cancer in the kidney. For people who have a tumor smaller than 4 centimeters and who can't have surgery to remove part of the kidney because of other health problems, the surgeon may suggest:

• Cryosurgery: The surgeon inserts a tool through a small incision or directly through the skin into the tumor. The tool freezes and kills the kidney tumor.
• Radiofrequency ablation: The surgeon inserts a special probe directly through the skin or through a small incision into the tumor. The probe contains tiny electrodes that kill the kidney cancer cells with heat.

It takes time to heal after surgery, and the time needed to recover is different for each person. It's common to feel weak or tired for a while.Also, you may have pain or discomfort for the first few days. Medicine can help control your pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more pain control.Your health care team will watch you for signs of bleeding, infection, or other problems. They will keep track of how much fluid you take in and how much urine passes out of your body.If one kidney is removed, the remaining kidney is usually able to do the work of both kidneys. However, if your remaining kidney isn't doing a good job cleaning your blood, you may need dialysis. Some people may need a transplant with a healthy kidney from a donor.You may want to ask your doctor these questions before having surgery:

• What type of surgery do you suggest for me? Do you recommend surgery that is through a large incision? Or through small incisions with a laparoscope? Do you recommend surgery with a robot?
• Will lymph nodes and other tissues be removed? Why?
• How will I feel after surgery? If I have pain, how can it be controlled?
• How long will I be in the hospital?
• When will I be able to return to normal activities?
• What are the long-term effects of the surgery? Will I need dialysis?

Your kidneys are a pair of organs in your abdomen. Each kidney is about the size of a fist.Your kidneys are part of the urinary tract. They make urine by removing wastes and extra water from your blood.Urine collects in a hollow space (renal pelvis) in the middle of each kidney. Urine passes from your renal pelvis into your bladder through a long tube called a ureter. Urine leaves your bladder through a shorter tube (the urethra).Your kidneys also make substances to help control blood pressure and to make red blood cells.Attached to the top of each kidney is an adrenal gland. A layer of fatty tissue and an outer layer of fibrous tissue surround the kidney and adrenal gland.

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the kidneys and the other organs of the body.Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place.Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor.Tumors in the kidney can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors:

• Benign tumors (such as cysts):
  • are usually not a threat to life
  • can be treated or removed and usually don't grow back
  • don't invade the tissues around them
  • don't spread to other parts of the body
• Malignant growths:
  • may be a threat to life
  • usually can be removed but can grow back
  • can invade and damage nearby tissues and organs
  • can spread to other parts of the body

Kidney cancer cells can spread by breaking away from the kidney tumor. They can travel through lymph vessels to nearby lymph nodes. They can also spread through blood vessels to the lungs, bones, or liver. After spreading, kidney cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.