What is kidney cancer?
Kidney cancer is the eighth most common cancer in adults in the UK. About 9,300 people are diagnosed with kidney cancer each year.
Signs and symptoms of kidney cancer can include:
- blood in your urine
- a constant pain below your ribs
- a lump in your abdomen (tummy)
If you notice any of these symptoms, see a doctor as soon as possible. Your doctor can examine you for signs of kidney cancer and may refer you to a specialist clinic for further tests.
However, in around half of cases there are no symptoms and the cancer is detected during tests for other unrelated conditions
The kidneys are two bean-shaped organs located on either side of the body, just underneath the ribcage. The main role of the kidneys is to filter out waste products from the blood and to produce urine. Usually, only one of the kidneys is affected by cancer.
Our bodies are made up of billions of tiny cells. Normally, cells grow and multiply in an orderly way. New cells are only made when and where they are needed. In cancer, this orderly process goes wrong and cells begin to grow and multiply uncontrollably.
Although the exact cause of kidney cancer is unknown, there are certain risk factors that can increase the chances of the condition developing, such as smoking and obesity.
Kidney cancer most frequently affects people over 50 years of age and is more common among men.
Read more about the causes of kidney cancer.
Types of kidney cancer
There are a number of different types of cancer than can affect the kidneys. The most common type is known as renal cell carcinoma (RCC), which accounts for more than 80% of all kidney cancers.
Rarer types of kidney cancer include:
- transitional cell cancer: develops in the lining of the kidneys and usually affects men who are 50 years of age or over
- Wilms’ tumour: a rare type of kidney cancer that affects children
This article focuses on renal cell carcinoma. See the Cancer Research UK website for more information about transitional cell cancer and Wilms’ tumour.
How is kidney cancer treated?
The treatment of kidney cancer depends on the size and spread of the cancer. Most commonly, surgery is the first course of action, with the aim of removing the cancer cells.
Unlike most other cancers, chemotherapy is not very effective in treating kidney cancer. There are, however, non-surgical treatments available, such as radiotherapy or targeted drug therapies. These are most commonly used when the kidney cancer is advanced, so has spread beyond the kidney.
Read more about treating kidney cancer.
The outlook for kidney cancer is usually good if the condition is diagnosed in its early stages, when the cancer is still contained inside the kidney. This is because it is usually possible to completely cure the cancer by removing some or all of the kidney, as it is possible to live a healthy life with only one kidney. About one in three cases of kidney cancer are diagnosed at an early stage.
Depending on how aggressive the cancer is, 65-90% of people will live at least five years after receiving an early diagnosis of kidney cancer, with many people living much longer.
The outlook for kidney cancer that has spread outside the kidney is less favourable. An estimated 40-70% of people with this type of kidney cancer will live at least five years after receiving a diagnosis.
If the kidney cancer is advanced and has spread to other parts of the body, only 1 in 10 people will live for at least five years after receiving a diagnosis.
Kidney cancer symptoms
Most cases of kidney cancer do not cause any symptoms in the early stages.
The most common symptoms of mid- to advanced-stage kidney cancer are:
- blood in your urine – the amount of blood is usually high enough to change the colour of your urine to a reddish or dark brown colour
- a constant pain below your ribs
- a lump in your abdomen (stomach)
However, in around half of all cases the cancer causes no symptoms and is only detected during a routine ultrasound scan.
Less common symptoms of kidney cancer include:
- unexplained weight loss
- a high temperature of 38C (100.4F) or above
- night sweats
- a general sense of feeling unwell
- swelling of the veins in the testicles (in men)
- fatigue or anaemia
- loss of appetite
- high blood pressure
When to seek medical advice
See your doctor if you notice blood in your urine. Although it is highly unlikely to be the result of kidney cancer, it could be a symptom of a less serious condition that still requires treatment, such as a kidney stone or bladder stone.
Kidney cancer causes
The exact cause of kidney cancer is unknown, although there are risk factors that can increase the chances of the condition developing.
The main risk factors for kidney cancer are:
- family history
Obesity is a particularly important risk factor for kidney cancer in women.
Research has found that there is a strong link between someone’s Body Mass IndexBMI (BMI) and their risk of developing kidney cancer.
A BMI score of 25 or above has been shown to increase the chances of developing kidney cancer.
A BMI score of 30 or above has been shown to signficantly increase the chances of developing kidney cancer.
This may be because overweight or obese people, particularly women, have higher levels of a hormone called oestrogen in their body. It is thought that excess levels of oestrogen may stimulate the growth of cancerous cells.
Cases of kidney cancer have been increasing over the last 40 years, which has been linked to rising obesity levels.
Smoking is a significant risk factor for developing kidney cancer, and the more you smoke the greater the risk.
For example, research has shown that if you regularly smoke 10 cigarettes a day, you are one and a half times more likely to develop kidney cancer compared to a non-smoker. This is increased to twice as likely if you smoke 20 or more cigarettes a day.
It is not clear why smoking increases your chances of developing kidney cancer.
People with close family members that have been diagnosed with kidney cancer are about twice as likely to develop kidney cancer themselves.
Other conditions and risks
A number of other possible risk factors for kidney cancer include:
- exposure to certain chemicals, such as asbestos and cadmium
- cocaine misuse: a chemical called phenacetin used by criminals to ‘cut’ cocaine (dilute it) can cause kidney cancer
- kidney transplant – people who have had a kidney transplant have an estimated 1 in 100 chance of developing kidney cancer in their remaining ‘native’ kidney
- dialysis – dialysis is a treatment that is designed to replicate the functions of the kidneys, people who require dialysis are three times more likely to develop kidney cancer than the population at large
- tuberous sclerosis – a rare genetic condition that causes multiple non-cancerous tumours to grow in the body, an estimated 1 in every 100 people with tuberous sclerosis will develop kidney cancer
- Von Hippel-Lindau disease – another rare genetic condition that causes small non-cancerous tumours to develop inside the nervous system, people with the condition have about a one in three chance of developing kidney cancer
- high blood pressure (hypertension) – people with high blood pressure are up to twice as likely to develop kidney cancer.
Diagnosing kidney cancer
In many cases, kidney cancer is diagnosed after routine check ups and scans, as the condition does not always have obvious symptoms.
Seeing your doctor
You should see a doctor if you do have any symptoms of kidney cancer, such as blood in your urine or a constant pain below your ribs.
Your doctor will examine you and, if they think your symptoms need further assessment, refer you to a specialist urologist.
If you notice blood in your urine, your doctor will usually carry out a blood test and take a urine sample. The results will help rule out other possible causes, such as infection or kidney stones.
If your doctor refers you to a hospital specialist, further tests will help determine whether you have kidney cancer.
An ultrasound scan uses high-frequency sound waves to create an image of an organ in the body. It can often detect changes in the shape of the kidney that could possibly be due to the development of a cancerous tumour.
An ultrasound scan may be required if the cause of the blood in your urine cannot be found.
Computerised tomography scan
You may also be referred for a computerised tomography (CT) scan. During a CT scan, a scanner takes detailed images of the inside of your body and a computer puts them together.
If you have a CT scan you may be given a special dye to drink or it may be injected. The dye makes the results of the CT scan clearer.
An image-guided biopsy is occasionally carried out for some cases of kidney cancer. It is a minor surgical procedure carried out under local anaesthetic. This means you will be awake during the procedure, but the area surrounding the affected kidney will be numbed, so that you do not feel anything.
During an image-guided biopsy a radiologist or surgeon will use an ultrasound or CT scan to guide a needle through your skin and into your kidney. A small sample of tissue is removed from your kidney and studied under a microscope to check for the presence of cancerous cells.
Magnetic Resonance Imaging scan
A Magnetic Resonance Imaging (MRI) scan may be ordered to produce detailed images of your kidneys. These images can determine the existence of a tumour, as well as its size.
A cystoscopy looks inside your bladder and urinary system. This procedure does not inspect the kidneys, but can rule out or confirm whether any bleeding is coming from problems in the bladder.
Intravenous pyelogram (IVP)
An intravenous pyelogram (IVP) test involves the injection of a dye into your bloodstream. X-rays are taken after a short time, with the dye highlighting any growths present in the kidneys.
Staging and grading
If kidney cancer is confirmed, it is usually possible to determine its grade and stage.
The stage of the kidney cancer describes how far the cancer has spread, while the grade describes how aggressive the cancer is and how quickly it is likely to spread.
Both the stage and grade of your kidney cancer will help determine your recommended treatment and the likelihood of achieving a cure.
Healthcare professionals use the TNM system to stage kidney cancer:
- T: indicates how large the tumour has grown (a tumour is a lump of cancerous tissue)
- N: indicates whether nearby lymph nodes are affected (lymph nodes are small, oval-shaped glands of tissue found throughout the body and they help protect it against infection)
- M: indicates whether the cancer has spread to another part of the body – M stands for metastases, which is the medical term for cancer that has spread
The stages of tumour size are:
- T1a: where the tumour is less than 4cm in diameter
- T1b: where the tumour is 4-7cm in diameter
- T2: where the tumour is larger than 7cm in diameter but has not yet spread out of the kidney
- T3a: where the tumour has spread into the adrenal gland or into the layer of fat that surrounds the kidney
- T3b: where the tumour has spread into the renal vein (the vein that carries blood back from the kidney to the heart) or into the vena cava (the vein that carries blood back from the top half of the body)
- T3c: where the tumour has spread past the diaphragm
- T4: where the tumour has spread beyond the tough layer of tissue that surrounds and protects the kidney
There are three lymph node stages:
- N0: where no lymph nodes have been affected
- N1: where there are cancer cells in one lymph node
- N2: where there are cancer cells in two or more lymph nodes
M0 means that the cancer has not spread to another part of the body, and M1 means that the cancer has spread.
Kidney cancer is graded using a scale of one to four. The higher the number, the more aggressive the cancer.
Coping with cancer
If you have been diagnosed with cancer, talking to a counsellor or a psychiatrist may help you combat feelings of depression](yourmd:/condition/depression) and [anxiety, antidepressants may also be used to help you through this process.
You may also find the information and advice about living with kidney cancer from some of the UK’s leading cancer charities useful. For example:
- Cancer Research UK: kidney cancer
- Macmillan Cancer Support: kidney cancer
- Kidney Cancer UK
- Kidney Research UK
Treatment for kidney cancer
People with cancer should be cared for by a team of specialists who work together to provide the best treatment and care, this is known as a multidisciplinary team (MDT).
The MDT often consists of:
- a specialist cancer surgeon
- an oncologist (a radiotherapy and chemotherapy specialist)
- a radiologist
- a pathologist
- a nephrologist (a kidney specialist)
- a specialist nurse.
Other members may include a physiotherapist, a dietitian, and an occupational therapist, you may also have access to clinical psychology support.
You will be assigned a key worker, usually a specialist nurse, who will be responsible for co-ordinating your care.
Your treatment plan
Your cancer team will recommend what they think is the best treatment option, but the final decision will be yours.
When deciding what treatment is best for you, your doctors will consider:
- the stage and grade of your cancer (how big it is and how far it has spread)
- your age and general health
If the cancer has not spread out of your kidney (T1 or T2 kidney cancer) it can usually be cured by removing some or all of the kidney.
If the cancer has spread out of the kidney (T3 or T4 kidney cancer) a complete cure may not be possible. However, it should be possible to slow the progression of the cancer and treat any symptoms.
The main treatments for kidney cancer are:
- targeted therapies
- immunotherapy These treatment options are outlined in more detail below.
A nephrectomy is an operation to remove a kidney. If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health.
If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed. Removing the kidney can help to resolve the symptoms of pain, and make other types of non-surgical treatment more effective. It is possible to live a normal life with only one kidney because the other kidney will be able to compensate.
During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure that the cancer has not spread beyond the kidney.
There are two ways that both a partial and open nephrectomy can be performed:
- open nephrectomy: where the kidney is removed through a large incision in your abdomen (tummy)
- laparoscopic or keyhole nephrectomy: where a series of smaller incisions are made in your abdomen and the kidney is removed with small surgical instruments
Both techniques have their own set of advantages and disadvantages.
A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy.
However, a practical disadvantage is that the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if you chose to have an open nephrectomy.
Also, some types of kidney cancer, where the tumour is located in the centre of the kidney, may not be suitable for a laparoscopic nephrectomy.
One of the main disadvantages of an open nephrectomy is that it is a major surgical procedure that can place a considerable amount of strain on the body. Therefore, it may not be a suitable form of treatment for people who are particularly frail or unwell.
You should discuss the pros and cons of both procedures with your surgical team.
If you are unable to have a nephrectomy, you may benefit from an alternative operation known as embolisation.
During embolisation, the surgeon will insert a small tube, known as a catheter, into your groin. They will use X-ray images to guide the catheter into the blood supply of your kidney. A substance will then be injected through the catheter to block the blood supply to your kidney. By blocking the blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink.
Non-surgical treatments for advanced kidney cancer
Kidney cancer is one of the few types of cancer that is less responsive to chemotherapy (where powerful medication is used to kill cancerous cells).
However, there are a number of ongoing clinical trials looking at new combinations of chemotherapy medications that appear to be benefiting some people.
Read more about [kidney cancer clinical trials].
There are also a number of different non-surgical treatments that can slow the spread of the cancer and help control its symptoms.
Radiotherapy cannot usually cure kidney cancer, but it can help to reduce the symptoms of pain and slow down its progress. You should only require a few minutes of radiotherapy every day for a number of days.
When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include:
- fatigue (tiredness)
- nausea (feeling sick)
Cryotherapy involves killing cancer cells by freezing them. This treatment is usually used if you are not fit enough for surgery or if your tumour is small.
Cryotherapy is usually classed as either percutaneous (using needles that pass through the skin) or laparoscopic (needles are placed directly into the kidney through a small incision).
Side effects include bleeding around the kidney and injury to the tube that carries urine from the kidney to the bladder (the ureter).
Radiofrequency ablation (RFA) use heat generated by radiowaves to kill cancer cells. This is a percutaneous treatment, meaning no incision is needed.
This treatment is only available at specialist centres. It is mainly used if you are not strong enough for surgery or your kidney cancer is in the early stages.
This treatment cannot be used if the cancer is too close to other organs, such as the bowel.
Side effects include bleeding in the treatment area, a collection of blood (haematoma) near the kidney and problems passing urine due to the narrowing of the tube that joins the kidney to the bladder (the ureter).
Seven new medicines have been developed for the treatment of kidney cancer. These are:
These medicines are sometimes referred to as ‘targeted therapies’ because they are designed to target and interrupt the functions needed by cancer to grow and spread.
Sunitinib cannot cure kidney cancer, but it can slow its spread, help relieve symptoms, and prolong life.
Common side effects of sunitinib include:
- redness and swelling of the hands and feet
- mouth pain
- jaundice: where the skin and whites of the eyes have a yellowish tinge
- changes in hair colour
- skin rashes or blisters
You should contact a member of your MDT if the side effects of sunitinib become particularly troublesome. They may be able to prescribe additional treatments to help you to cope better with the side effects.
Avoid taking complementary medicines, such as St John’s Wort, because they can make sunitinib less effective. Also avoid eating grapefruit and drinking grapefruit juice for the same reason.
You should not father a child or become pregnant while taking sunitinib because the medication can damage the health of an unborn child. If you are sexually active, make sure you use an effective method of contraception while you are taking the medicine and for several months afterwards. Your doctor or MDT can advise you about when it is safe to father a child or become pregnant.
Avoid breastfeeding your baby while you are taking sunitinib because the medicine could be passed on to your baby through your breast milk.
Pazopanib hydrochloride can slow or stop the growth of cancer cells in the kidneys.
Common side effects of pazopanib include:
- high blood pressure
- nausea or vomiting
- stomach pain
- loss of appetite
- changes in hair colour
Like sunitinib, you should not father a child or become pregnant while taking pazopanib. The effects of this have not yet been established, but there is a potential danger to an unborn child.
Breastfeeding should also be avoided, as it has not been shown that there is no risk to a breastfed child.
Pazopanib may also have an impact on fertility.
Immunotherapy treatment involves taking medicines that encourage the immune system to attack cancerous cells. The immune system is the body’s natural defence against illness and infection. Medicines that are used to treat kidney cancer include:
- interferon alpha
- aldesleukin (Proleukin)
Interferon alpha is given by injection and most people will require three injections a week. Your cancer nurse will be able to teach you how to administer the injections yourself.
Most people will experience flu-like symptoms when they first start taking interferon alpha. This should improve as your body begins to get used to the medicine.
Aldesleukin can either be given by injection or through a drip (intravenously). It is usually only available at specialist cancer clinics or centres.
Possible side effects of aldesleukin include:
- a high temperature
- low blood pressure (hypotension)
- skin rashes
Immunotherapy treatments are rarely used now because targeted therapies have proved to be more effective in controlling advanced kidney cancer, and because immunotherapy can sometimes have serious side effects.
If you have been diagnosed with cancer, your treatment and medical care will probably be the first thing on your mind.
But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it.
If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need.
Caring for someone can be a varied and demanding job because of the broad range of medical, personal and emotional needs that a person can have.
If you're caring for a family member, you may not consider yourself a carer because you're just doing what needs to be done. You might feel that you have no other options. This can be stressful and you may feel resentful towards the person you're caring for, which can also leave you feeling guilty. You may have been forced to leave your job, give up hobbies and stop socialising, which can be very isolating.
It's important to remember that you're not alone and that there is support available. By law you're entitled to a free health and social care assessment, which you can access through your local authority. The assessment will look at the possibility of you getting practical and financial help.
Read more out about assessments on Carers Direct.
Being a carer means that you may be entitled to certain financial benefits, especially if you have to give up work.
Preventing kidney cancer
As the causes of kidney cancer are not fully understood, it is not possible to completely prevent it.
However, a healthy lifestyle may reduce the chances of developing the condition.
Read about the causes of kidney cancer.
A combination of a healthy diet and regular exercise will help you to avoid becoming overweight or obese, which is a significant risk factor for kidney cancer.
If you are overweight or obese, you can lose weight and maintain a healthy weight by combining regular exercise and a calorie-controlled diet.
Read more about treating obesity.
It is recommended that adults should do at least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity (for example, cycling or fast walking) every week. The exercise should be strenuous enough to leave your heart beating faster and you should feel slightly out of breath afterwards.
Examples of activities that you could incorporate into your exercise programme include:
- brisk walking
- hill climbing
If you find it difficult to do 150 minutes of exercise a week, start at a level you feel comfortable with.
However, you should visit your doctor for a health check-up if you have never exercised before or you are returning to exercise after a long lay-off.
A low-fat, high-fibre diet that includes whole grains and plenty of fresh fruit and vegetables (at least five portions a day) is recommended for a healthy heart. Limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day. Too much salt will increase your blood pressure.
Avoid eating foods high in saturated fat because this will increase your cholesterol level. These include:
- meat pies
- sausages and fatty cuts of meat
- ghee - a type of clarified butter often used in Indian cooking
- hard cheese
- cakes and biscuits
- foods that contain coconut or palm oil
There is some evidence that eating a diet that has a lot of oily fish may help to reduce the risk of kidney cancer. Examples of oily fish include:
Oily fish also contain vitamin D, which can reduce the risk of some cancers. You can also get vitamin D by exposing your skin to the sun or by taking supplements.
If you smoke, giving up is the most effective way of preventing kidney cancer, as well as a number of other serious health conditions, such as a stroke, heart attack and lung cancer.
If you want to give up smoking, your doctor can help you by providing information and advice, and prescribing medication.
Read more about quitting smoking.
There is evidence to suggest that drinking a moderate amount of alcohol, such as four to five glasses of wine a month, will help to reduce your risk of developing kidney cancer. The reasons for this are not fully understood.
However, you should not exceed the recommended daily amounts for alcohol because drinking an excessive amount will place you at risk of developing liver disease, liver cancer, and high blood pressure.
The recommended daily levels of alcohol consumption are between three to four units of alcohol for men, and between two to three units for women. A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) of spirits.