Kidney cancer

What is kidney cancer?

Kidney cancer is cancer that starts in the cells of the kidney. The most common type of kidney cancer is renal cell carcinoma, accounting for about 90% of all cases. Usually only one kidney is affected, but in rare cases the cancer may develop in both kidneys.

Other less common types include:

• Uroethelial carcinoma which can begin in the ureter or renal pelvis where the kidney and ureter meet. It is generally treated like bladder cancer.
• Wilms tumour, which is the most common type of kidney cancer in younger children.

There were 3382 new cases of kidney cancer diagnosed in Australia in 2015. Kidney cancer is more common in men - the risk of being diagnosed by age 85 is 1 in 47 for men compared to 1 in 100 for women.

In 2016, there were 953 deaths resulting from kidney cancer in Australia. 

The five year survival rate for kidney cancer is 76%.

Kidney cancer symptoms

In its early stages, kidney cancer often does not produce any symptoms.

Symptoms may include:

• blood in the urine (haematuria)
• pain or a dull ache in the side or lower back that is not due to an injury
• a lump in the abdomen
• constant tiredness
• rapid, unexplained weight loss
• fever not caused by a cold or flu.

Causes of kidney cancer

The causes of kidney cancer are not known, but factors that put some people at higher risk are:

• smoking
• overuse of pain relievers containing phenacetin (this chemical is now banned)
• workplace exposure to asbestos or cadmium (construction workers, dock workers, painters and printers)
• a family history of kidney cancer
• being overweight or obese
• high blood pressure
• having advanced kidney disease
• being male: men are more likely to develop kidney cancer than women.

Diagnosis for kidney cancer

Tests to diagnose kidney cancer include:

Urine test

A urine test will look for traces of blood or other abnormalities in your urine.

Blood tests

A blood sample may be taken to check for changes that could be caused by kidney cancer. It will also identify the number of different types of blood cells present.

Imaging tests

If kidney cancer is detected, you may have scans to see if the cancer has spread to other parts of your body, such as an ultrasound, chest X-ray, CT scan, MRI, or radioisotopebone scan.

Biopsy

A core needle biopsy is used to check for kidney cancer. This will provide a tissue sample which will be examined under a microscope to check for any changes in your cells.

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Treatment for kidney cancer

The main treatment for kidney cancer is surgery, alone or with radiotherapy and will depend on the extent of the cancer.

Staging

A CT scan, bone (radioisotope) scan and chest x-ray are done to determine the extent of the cancer.

The most common staging system used for kidney cancer is the TNM system, which describes the stage of the cancer from stage I to stage IV.

Active surveillance

If small tumours are found in your kidney your doctor may recommend active surveillance or observation as it is likely that the tumours will not be aggressive and may not grow in your lifetime. You will have regular ultrasounds or CT scans to monitor the tumours.

Surgery

A radical nephrectomy (removal of the affected kidney) is the most common type of surgery for renal cell carcinoma.

A partial nephrectomy (removal of part of the kidney) may be an option for people who have a small tumour in one kidney (less than 4cm), people with cancer in both kidneys and those who have only one working kidney.

Radiofrequency ablation

Radiofrequency ablation heats the tumour with high energy waves in order to kill the cancer cells. Your doctor will insert a needle into the tumour and an electrical current is passed into the tumour.

Immunotherapy

Immunotherapy works to enhance your body's own immune system. Immunotherapy is an option for people with advanced kidney cancer. Cytokines (proteins that activate the immune system) can be given intravenously or orally, and may shrink the cancer.

Targeted therapies

Targeted therapies may be recommended by your doctor if you have advanced kidney cancer or your cancer is growing quickly. Targeted therapies target specific molecules in cells to block cell growth. Targeted therapy drugs are usually given in the form of tablets or intraveneously.

Tyrosine kinase inhibitors (TKIs) have been trialled in people with advanced kidney cancer and found to cause fewer side-effects than chemotherapy drugs.

Radiotherapy

Standard radiotherapy is not effective in treating primary kidney cancer but it may be used in advanced kidney cancer to shrink tumours and relieve symptoms.

Palliative care

In some cases of kidney cancer, your medical team may talk to you about palliative care. Palliative care aims to improve your quality of life by alleviating symptoms of cancer.

As well as slowing the spread of kidney cancer, palliative treatment can relieve pain and help manage other symptoms. Treatment may include radiotherapy, chemotherapy or other drug therapies.

Treatment team

Depending on your treatment, your treatment team may consist of a number of different specialist staff, such as:

• GP who works with your specialists and can help with treatment decisions
• urologist
• nephrologist
• a medical oncologist
• a radiation oncologist
• a radiologist
• nurses
• cancer care coordinator
• dietition
• other allied health professionals, such as counsellor and physiotherapists.

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Screening for kidney cancer

There is currently no screening for kidney cancer available in Australia.

Prognosis for kidney cancer

It is not possible for a doctor to predict the exact course of a disease, as it will depend on each person's individual circumstances. However, your doctor may give you a prognosis, the likely outcome of the disease, based on the type of kidney cancer you have, the test results, the rate of tumour growth, as well as your age, fitness and medical history.

In most cases, the earlier that kidney cancer is diagnosed, the better the prognosis. 

Preventing kidney cancer

Not smoking or quitting smoking. Up to one third of kidney cancers are thought to be due to smoking.

Source

Understanding Kidney Cancer, Cancer Council Australia, 2019. Last medical review of this booklet: January 2019.

Australian Institute of Health and Welfare 2015. ACIM (Australian Cancer Incidence and Mortality) Books. Canberra: AIHW.

Australian Institute of Health and Welfare (AIHW) 2017. Cancer in Australia 2017. Cancer series no. 101. Cat. no. CAN 100. Canberra: AIHW.

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