Overview

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

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

It can often be cured if it's caught early. But a cure probably won't be possible if it's not diagnosed until 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

Title
Kidney cancer

Symptoms

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

If symptoms do occur, they can include:

  • blood in your pee – you may notice your pee is darker than normal 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)
Causes

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

These include:

  • obesity – a body mass index (BMI) of 30 or more; use the healthy weight calculator to work out 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
  • genetic conditions – some inherited genetic conditions increase the risk of kidney cancer, such as Von Hippel-Lindau syndrome
  • long-term dialysis – a treatment for kidney disease where a machine replicates some of the jobs of the kidneys

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

Diagnosis

The tests you might need may 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
  • a computerised tomography (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 special dye beforehand so your kidneys show up more clearly
  • a magnetic resonance imaging (MRI) scan – a scan that uses strong magnetic fields and radio waves to produce a detailed image of your kidneys
  • a cystoscopy – where a thin tube is passed up your urethra (the tube that carries urine out of the body) so your doctor can spot any problems in your bladder
  • a 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

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.

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

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

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 cancerous cells are destroyed by freezing or heating them
  • biological therapies – medications 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 removing some or all of the kidney, although 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 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 access. 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 carried out in one of two ways:

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

Keyhole surgery tends to have a faster recovery time, but can only be done by surgeons with special training 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 involve either:

  • destroying cancer cells by freezing them (cryotherapy)
  • destroying cancer cells by 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 carried out by inserting a needle-like probe through your skin, so no large incisions are needed.

Cryotherapy is carried out 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 urine from the kidney to the bladder (the ureter).

Biological therapies

If your cancer is advanced, treatment with biological therapies may be offered. These are medications, usually taken once or twice a day, that help stop the cancer growing and spreading.

There are many different biological therapies, including:

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

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

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

Side effects

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

  • feeling and being sick
  • indigestion
  • diarrhoea
  • high blood pressure
  • a sore mouth
  • loss of appetite and weight loss
  • tiredness
  • infertility

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

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 progress 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.

The treatment involves a large machine directing a carefully aimed beam of radiation at the cancerous cells. It's often carried out 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

Self-help

If you're diagnosed with cancer, your treatment and medical care will be of utmost importance.

But other aspects of your life are also important. You'll need to think about the kind of support you need, and know what assistance is available and where you can get it.

Support is also available for people who care for ill partners, children, relatives or friends.