Overview

Cancer of the kidney
Cancer of the kidney

Kidney cancer, also called renal cancer, is one of the most common types of cancer in the UK.

It usually affects adults in their 60s or 70s. It is rare in people under 50.

It can often be cured if it's found early. But a cure will probably not be possible if it's diagnosed after it has spread beyond the kidney.

There are several types of kidney cancer. These pages focus on the most common type – renal cell carcinoma.

The Cancer Research UK website has more information about other types of kidney cancer.

Symptoms of kidney cancer

In many cases, there are no obvious symptoms at first and kidney cancer may only be found during tests for another condition or reason.

If there are symptoms, they can include:

  • blood in your pee – you may notice your pee is darker than usual or reddish in colour
  • a persistent pain in your lower back or side, just below your ribs
  • a lump or swelling in your side (although kidney cancer is often too small to feel)

When to get medical advice

See a GP if you have symptoms of kidney cancer.

Although it's unlikely you have cancer, it's important to get your symptoms checked out.

Your GP will ask about your symptoms and may test a sample of your urine to see if it contains blood or an infection.

If necessary, they may refer you to a hospital specialist for further tests to find out what the problem is.

Causes of kidney cancer

The exact cause of kidney cancer is unknown, but some things can increase your chances of getting it, including:

  • obesity – a body mass index (BMI) of 30 or more (use the healthy weight calculator to find your BMI)
  • smoking – the more you smoke, the greater the risk
  • high blood pressure (hypertension)
  • family history – you're more likely to get kidney cancer if you have a close relative with it
  • some inherited genetic conditions
  • long-term dialysis – a treatment for chronic kidney disease where a machine does some of the jobs of the kidneys

Keeping a healthy weight, a healthy blood pressure and not smoking is the best way to reduce your risk of kidney cancer.

Treatments for kidney cancer

The treatment for kidney cancer depends on the size of the cancer and whether it has spread to other parts of the body.

The main treatments are:

  • surgery to remove part or all of the affected kidney – this is the main treatment for most people
  • cryotherapy or radiofrequency ablation – where the cancerous cells are destroyed by freezing or heating
  • biological therapies – medicines that help stop the cancer growing or spreading
  • embolisation – a procedure to cut off the blood supply to the cancer
  • radiotherapy – using high-energy radiation to target cancer cells and relieve symptoms

Outlook for kidney cancer

The outlook for kidney cancer largely depends on how big the tumour is and how far it has spread by the time it's diagnosed.

If the cancer is still small and hasn't spread beyond the kidney, surgery can often cure it. Some small, slow growing cancers may not need treatment at first.

A cure isn't usually possible if the cancer has spread, although treatment can sometimes help keep it under control. Some people become unwell quickly, but others may live for several years and feel well despite having kidney cancer.

Around 7 in 10 people live at least a year after diagnosis and around 5 in 10 live at least 10 years.

Cancer Research UK has more information about survival statistics for kidney cancer.

Support groups and charities

Further information, advice and support is available from:

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Symptoms

In many cases, there are no obvious symptoms of kidney cancer at first and it may only be picked up during tests for another condition or reason.

Symptoms are often similar to those of less serious conditions, such as urinary tract infections (UTIs) or kidney stones.

Symptoms can include:

  • blood in your pee – you may notice your pee is darker than usual or reddish in colour
  • a persistent pain in your lower back or side, just below your ribs
  • a lump or swelling in your side (although kidney cancer is often too small to feel)
  • extreme tiredness
  • loss of appetite and unintentional weight loss
  • persistent high blood pressure (hypertension)
  • a high temperature
  • night sweats
  • in men, swelling of the veins in the testicles
  • swollen glands in your neck
  • bone pain
  • coughing up blood

Some of these symptoms only happen when the cancer is advanced and has spread to other parts of the body, such as the bones or lungs.

When to get medical advice

See a GP if you have symptoms of kidney cancer.

Although it's unlikely you have cancer, it's important to get your symptoms checked.

The GP may sometimes need to refer you for tests in hospital to find out what the problem is.

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Diagnosis

See a GP if you have symptoms of kidney cancer. They will do some simple checks and can refer you for further tests if necessary.

Seeing a GP

The GP may:

  • ask you about the symptoms
  • examine you to feel for any lumps or swelling
  • test a sample of your pee for infections or blood – any blood won't always be visible to the naked eye
  • arrange for a blood test to check for signs of a kidney problem

These checks may help diagnose or rule out some possible causes of your symptoms, such as a urinary tract infection (UTI).

If the GP thinks you need further assessment, they can refer you to a hospital specialist. If you need to be referred urgently, you'll usually be seen within two weeks.

Tests for kidney cancer

These tests can confirm or rule out kidney cancer. If you have cancer, they can help show whether it has spread to other parts of your body.

The tests you might have include:

  • an ultrasound scan – a scan that uses high frequency sound waves to create an image of your kidneys so your doctor can spot any problems
  • CT scan – a detailed scan where several X-rays are taken and then put together by a computer; you may be given an injection of a dye beforehand so your kidneys can be seen more clearly
  • an MRI scan – a scan that uses strong magnetic fields and radio waves to produce a detailed image of your kidneys
  • cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of your body) so your doctor can see any problems in your bladder
  • biopsy – where a needle is inserted into your kidney to remove a small tissue sample for analysis in a laboratory; local anaesthetic is used to numb the area so the procedure doesn't hurt
  • a PET scan - a detailed body scan that can be helpful for investigating confirmed cases of kidney cancer to see if the cancer has spread and how well it's responding to treatment

Stages of kidney cancer

If you're diagnosed with kidney cancer, it will usually be given a "stage". This is a number that describes how far the cancer has spread.

Doctors use the TNM system to stage kidney cancer. This consists of three numbers:

  • T (tumour) – from 1 to 4, depending on the size of the tumour
  • N (node) – from 0 to 2, depending on whether the cancer has spread to nearby lymph glands
  • M (metastases) – either 0 or 1, depending on whether the cancer has spread to another part of the body

Cancer Research UK has more detailed information about the stages of kidney cancer.

Coping with the diagnosis

Being diagnosed with cancer can be very distressing. The news can be difficult to take in and comprehend.

Talking to your friends or family may help, although you might also find it useful to speak to a counsellor, a psychiatrist or other people in a similar situation to you.

Read about coping with a cancer diagnosis for more information and advice.

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Treatment

The treatment for kidney cancer depends on the size of the cancer and whether it has spread to other parts of the body.

The main treatments are:

  • surgery to remove part or all of the affected kidney – this the main treatment for most people
  • ablation therapies – where the cancer cells are destroyed by freezing or heating them
  • targeted therapies (also called biological therapies) – medicines that help stop the cancer growing or spreading
  • embolisation – a procedure to cut off the blood supply to the cancer
  • radiotherapy – where high-energy radiation is used to target cancer cells and relieve symptoms

Cancer that hasn't spread out of the kidney can usually be cured by having an operation to remove some or all of the kidney. Sometimes cryotherapy or radiofrequency ablation may be used instead.

A complete cure may not be possible if the cancer has spread, but it may be possible to slow its progression and treat any symptoms with surgery, medication and/or radiotherapy.

Surgery

There are two main types of surgery for kidney cancer:

  • an operation to just remove the part of the kidney containing the cancer – called a partial nephrectomy
  • an operation to remove the entire affected kidney – called a radical nephrectomy

A partial nephrectomy is usually done if the cancer is small and easy for the surgeon to get to. A radical nephrectomy may be necessary for larger cancers or if the cancer has spread beyond the kidney.

It's possible to live a normal life with only one kidney. Your other kidney can usually make up for the kidney that was removed.

Surgery for kidney cancer can be done in two ways:

  • through a single large incision cut in the tummy or back – known as "open" surgery
  • using surgical tools inserted through smaller cuts – known as laparoscopic or "keyhole" surgery

Keyhole surgery tends to have a faster recovery time, but can only be done by trained surgeons and it isn't always suitable. Talk to your surgeon about the pros and cons of each method.

Ablation therapies

Ablation therapies are treatments that destroy cancer cells by either:

  • freezing them (cryotherapy)
  • heating them (radiofrequency ablation)

Either technique may be recommended in special circumstances (for example, to ensure your kidney keeps working), or if your tumour is small. Both treatments are only available in specialist centres, so you may need to travel to another hospital to have it.

Radiofreqency ablation is done by inserting a needle-like probe through your skin, so no large cuts are needed.

Cryotherapy is done using needles inserted into the tumour. This can be done through your skin (percutaneous cryotherapy) or through a small incision (laparoscopic cryotherapy).

Side effects of ablation therapies can include bleeding around the kidney and damage to the tube that carries pee from the kidney to the bladder (the ureter).

Targeted therapies

If your cancer is advanced, you may be offered targeted therapies (also called biological therapies). These are medicines, usually taken once or twice a day, that help stop the cancer growing and spreading.

There are many different biological therapies, including:

  • sunitinib 
  • pazopanib
  • cabozantinib
  • axitinib
  • everolimus
  • bevacizumab and interferon
  • nivolumab
  • tivozanib

At present, sunitinib, pazopanib, cabozantinib, axitinib, everolimus, nivolumab and tivozanib are recommended for routine use on the NHS.

Some people with advanced kidney cancer may be offered a medicine called lenvatinib, to take along with everolimus.

Side effects

Sunitinib, pazopanib, cabozantinib, axitinib and tivozanib are all taken as tablets. Possible side effects include:

Nivolumab is given by a drip directly into a vein every two weeks. It works by helping your body's immune system destroy the cancer cells. Side effects are uncommon, but can include:

Embolisation

Embolisation is a procedure to block off the blood supply to the tumour, causing it to shrink.

It's sometimes recommended if you have advanced kidney cancer and you're not in good enough health to have surgery to remove the affected kidney.

During embolisation, the surgeon will insert a small tube called a catheter into a blood vessel in your groin and then guide it to the blood vessel supplying the tumour.

A substance will be injected through the catheter to block the blood vessel.

Radiotherapy

Radiotherapy is a treatment where radiation is used to target or destroy cancerous cells. It can't usually cure kidney cancer, but it can slow down its spread and help control your symptoms.

It may be recommended if you have advanced kidney cancer that has spread to other parts of the body, such as your bones or brain.

Radiotherapy uses a large machine to carefully direct beams of radiation at the cancerous cells. It's often done for a few minutes every day, over a few weeks.

Side effects of radiotherapy can include:

  • tiredness
  • feeling and being sick
  • diarrhoea
  • reddening of the skin in the treatment area
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The information on this page has been adapted by NHS Wales from original content supplied by NHS UK NHS website nhs.uk
Last Updated: 27/10/2020 09:38:44