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Kidney Cancer - Introduction

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find some basic information about this disease and the parts of the body it may affect. This is the first page of Cancer.Net’s Guide to Kidney Cancer. To see other pages, use the menu. Think of that menu as a roadmap to this full guide.

About the kidneys

Every person has 2 kidneys, which are located above the waist on both sides of the spine. These reddish-brown, bean-shaped organs are each about the size of a small fist. They are located closer to the back of the body than to the front.

The kidneys filter blood to remove impurities, excess minerals and salts, and extra water. Every day, the kidneys filter about 200 quarts of blood to generate 2 quarts of urine. The kidneys also produce hormones that help control blood pressure, red blood cell production, and other bodily functions.

Although most people have 2 kidneys, each works independently. This means the body can function with less than 1 complete kidney. With dialysis, a mechanized filtering process, it is possible to live without functioning kidneys. Dialysis can be done through the blood, called hemodialysis, or by using the patient’s abdominal cavity, called peritoneal dialysis.

About kidney cancer

Kidney cancer begins when healthy cells in 1 or both kidneys change and grow out of control, forming a mass called a renal cortical tumor. A tumor can be malignant, indolent, or benign. A malignant tumor is cancerous, meaning it can grow and spread to other parts of the body. An indolent tumor is also cancerous, but this type of tumor rarely spreads to other parts of the body. A benign tumor means the tumor can grow but will not spread.

Types of kidney cancer

There are several types of kidney cancer:

  • Renal cell carcinoma. Renal cell carcinoma is the most common type of adult kidney cancer, making up about 85% of diagnoses. This type of cancer develops in the proximal renal tubules that make up the kidney’s filtration system. There are thousands of these tiny filtration units in each kidney. The treatment options for renal cell carcinoma are discussed later in this guide.

  • Transitional cell carcinoma. This is also called urothelial carcinoma. It accounts for 10% to 15% of the kidney cancers diagnosed in adults. Transitional cell carcinoma begins in the area of the kidney where urine collects before moving to the bladder, called the renal pelvis. This type of kidney cancer is treated like bladder cancer because both types of cancer start in the same cells.

  • Sarcoma. Sarcoma of the kidney is rare. This type of cancer develops in the soft tissue of the kidney; the thin layer of connective tissue surrounding the kidney, called the capsule; or surrounding fat. Sarcoma of the kidney is usually treated with surgery. However, sarcoma commonly comes back in the kidney area or spreads to other parts of the body. More surgery or chemotherapy may be recommended after the first surgery.

  • Wilms tumor. Wilms tumor is most common in children and is treated differently than kidney cancer in adults. This type of tumor is more likely to be successfully treated with radiation therapy and chemotherapy than the other types of kidney cancer when combined with surgery. This has resulted in a different approach to treatment.

  • Lymphoma. Lymphoma can enlarge both kidneys and is associated with enlarged lymph nodes, called lymphadenopathy, in other parts of the body, including the neck, chest, and abdominal cavity. In rare cases, kidney lymphoma can appear as a lone tumor mass in the kidney and may include enlarged regional lymph nodes. If lymphoma is a possibility, your doctor may perform a biopsy (see Diagnosis) and recommend chemotherapy instead of surgery.

Types of kidney cancer cells

Knowing which type of cell makes up a kidney tumor helps doctors plan treatment. Pathologists have identified as many as 20 different types of kidney cancer cells. A pathologist is a doctor who specializes in interpreting laboratory tests and evaluating cells, tissues, and organs to diagnose disease. Computed tomography (CT) scans or magnetic resonance imaging (MRI) cannot always distinguish between benign, indolent, or malignant renal cortical tumors before surgery.

The most common types of kidney cancer cells are listed below.

  • Clear cell. About 70% of kidney cancers are made up of clear cells. Clear cells range from slow growing (grade 1) to fast growing (grade 4). Clear cell kidney cancer is particularly responsive to immunotherapy and targeted therapy (see the Treatment Options section).

  • Papillary. Papillary kidney cancer develops in 10% to 15% of patients. It is divided into 2 different subtypes, called type 1 and type 2. Papillary kidney cancer is currently treated in the same way as clear cell kidney cancer. However, many doctors recommend treatment through a clinical trial because treatment with targeted therapy is often not as successful for people with papillary kidney cancer as it is for people with clear cell kidney cancer.

  • Sarcomatoid features: Each of the tumor subtypes of clear cell, chromophobe, and papillary in kidney cancer can show highly disorganized features under the microscope. These are often described by pathologists as “sarcomatoid.” This is not a distinct tumor subtype, but when these features are seen clinicians are aware that this is a very aggressive form of kidney cancer.

  • Medullary/collecting duct. This is a rare and highly aggressive cancer that is closely related to transitional cell carcinoma but is still considered a renal cortical tumor. It is more common in black people and is highly associated with having the sickle cell trait. Sickle cell trait means that a person has inherited the sickle cell gene from a parent. Collecting duct is more likely to occur in people between the ages of 20 and 30. Despite combinations of systemic chemotherapy and surgery, long term survival in this form of kidney cancer is limited.

  • Chromophobe. Chromophobe is another uncommon cancer that is different from the other types. It may form indolent tumors.

  • Oncocytoma. This is a slow-growing type of kidney cancer that rarely, if ever, spreads.

  • Angiomyolipoma. Angiomyolipoma is a benign tumor that has a unique appearance on a CT (or CAT) scan (see the Diagnosis section) and when viewed under a microscope. Usually, it is less likely to grow and spread. It is generally best treated with surgery or, if it is small, active surveillance. An aggressive form of angiomyolipoma, called epithelioid, can in rare instances spread to nearby lymph nodes or organs such as the liver.

Looking for More of an Introduction?

If you would like more of an introduction, explore these related items. Please note that these links will take you to other sections on Cancer.Net:

The next section in this guide is Statistics. It helps explain how many people are diagnosed with this disease and general survival rates. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Statistics

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find information about how many people learn are diagnosed with this type of cancer each year. You will also learn some general information on surviving the disease. Remember, survival rates depend on several factors. To see other pages, use the menu.

This year, an estimated 62,700 adults (39,650 men and 23,050 women) in the United States will be diagnosed with kidney cancer. Kidney cancer is the seventh most common cancer for men, and it is the tenth most common cause of cancer for women.

It is estimated that 14,240 deaths (9,240 men and 5,000 women) from this disease will occur this year.

The 5-year survival rate tells you what percent of people live at least 5 years after the cancer is found. Percent means how many out of 100. The 5-year survival rate for people with kidney cancer is 73%. However, survival rates depend on several factors, including the type, cell type, and stage of the cancer when it is first diagnosed.

Approximately 65% of people are diagnosed when the cancer is only located in the kidney. For this group, the 5-year survival rate is 92%. If kidney cancer has spread to surrounding tissues or organs and/or the regional lymph nodes, the 5-year survival rate is 65%. If the cancer has spread to a distant part of the body, the 5-year survival rate is 12%.

It is important to remember that statistics on how many people survive this type of cancer are an estimate. The estimate comes from data based on thousands of people with this cancer in the United States each year. So, your own risk may be different. Doctors cannot say for sure how long anyone will live with kidney cancer. Also, experts measure the survival statistics every 5 years. This means that the estimate may not show the results of better diagnosis or treatment available for less than 5 years. Learn more about understanding statistics.

Statistics adapted from the American Cancer Society's publication, Cancer Facts & Figures 2016.

The next section in this guide is Medical Illustrations. It offers drawings of body parts often affected by this disease. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Medical Illustrations

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find a basic drawing of the kidneys. To see other pages, use the menu.

For medical illustrations showing the different stages of kidney cancer, visit the Stages section.

The next section in this guide is Risk Factors and Prevention. It explains what factors may increase the chance of developing this disease and what people can do to lower their risk. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Risk Factors and Prevention

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find out more about the factors that increase the chance of developing this type of cancer and what people can do to lower their risk. To see other pages, use the menu.

A risk factor is anything that increases a person’s chance of developing cancer. Although risk factors often influence the development of cancer, most do not directly cause cancer. Some people with several risk factors never develop cancer, while others with no known risk factors do. However, knowing your risk factors and talking about them with your doctor may help you make more informed lifestyle and health care choices.

The following factors may raise a person’s risk of developing kidney cancer:

  • Smoking. Smoking tobacco doubles the risk of developing kidney cancer. It is believed to cause about 30% of kidney cancers in men and about 25% in women.

  • Gender. Men are 2 to 3 times more likely to develop kidney cancer than women.

  • Race. Black people have higher rates of kidney cancer.

  • Age. Kidney cancer is typically found in adults and is usually diagnosed between the ages of 50 and 70.

  • Nutrition and weight. Research has often shown a link between kidney cancer and obesity, which is generally caused by many years of eating a high-fat diet.

  • High blood pressure. Men with high blood pressure, also called hypertension, may be more likely to develop kidney cancer.

  • Overuse of certain medications. Painkillers containing phenacetin have been banned in the United States since 1983 because of their link to transitional cell carcinoma. Diuretics and analgesic pain pills, such as aspirin, acetaminophen, and ibuprofen, have also been linked to kidney cancer.

  • Exposure to cadmium. Some studies have shown a connection between exposure to the metallic element cadmium and kidney cancer. Working with batteries, paints, or welding materials may increase a person’s risk as well. This risk is even higher for smokers who have been exposed to cadmium.

  • Chronic kidney disease: People who have decreased kidney function but don’t yet need dialysis may be at higher risk for the development of kidney cancer.

  • Long-term dialysis. People who have been on dialysis for a long time may develop cancerous cysts in their kidneys. These growths are usually found early and can often be removed before the cancer spreads.

  • Family history of kidney cancer. People who have first-degree relatives, such as parents, brothers, sisters, or children, with kidney cancer have an increased risk of developing the disease. This risk increases if a number of extended family members have been diagnosed with kidney cancer, including grandparents, aunts, uncles, nieces, nephews, grandchildren, and cousins, and if these family members were diagnosed before the age of 50, had cancer in both kidneys, and/or had more than 1 tumor in the same kidney.

    If you are concerned kidney cancer may run in your family, it is important to get an accurate family history and to share the results with your doctor. By understanding your family history, you and your doctor can take steps to reduce your risk and be proactive about your health.

Genetic conditions and kidney cancer

Although kidney cancer can run in families, inherited kidney cancers are uncommon, occurring about 5% of the time. Only a few specific genes that increase the risk of developing kidney cancer have been found, and many are linked to specific genetic syndromes. Most of these conditions are associated with a specific type of kidney cancer (see the Introduction).

Finding a specific genetic syndrome in a family can help a person and his or her doctor develop an appropriate cancer screening plan and, in some cases, help determine the best treatment options. Only genetic testing can determine whether a person has a genetic mutation. Most experts strongly recommend that people considering genetic testing first talk with a genetic counselor. A genetic counselor is an expert trained to explain the risks and benefits of genetic testing.

Genetic conditions that increase a person's risk of developing kidney cancer include:

  • Von Hippel-Lindau syndrome (VHL). People with VHL have an increased risk of developing several types of tumors. Most of these tumors are benign. However, 40% of people with this disorder develop kidney cancer, most often clear cell kidney cancer.

  • Hereditary non-VHL clear cell renal cell carcinoma. Hereditary non-VHL clear cell renal cell carcinoma is a genetic condition that increases a person's risk of developing clear cell renal cell carcinoma (CCRCC). A family may have hereditary non-VHL CCRCC if more than 1 family member has been diagnosed with CCRCC.

  • Hereditary papillary renal cell carcinoma (HPRCC). HPRCC is a genetic condition that increases the risk of type 1 papillary renal cell carcinoma. People who have HPRCC have an increased risk of developing more than 1 kidney tumor and tumors on both kidneys. HPRCC is suspected when 2 or more close relatives have been diagnosed with type 1 papillary renal cell carcinoma.

  • Birt-Hogg-Dubé syndrome (BHD). BHD is a rare genetic condition associated with multiple noncancerous skin tumors, lung cysts, and an increased risk of noncancerous and cancerous kidney tumors, specifically chromophobe or oncocytoma. People with BHD may also develop clear cell or papillary kidney cancer.

  • Hereditary leiomyomatosis and renal cell carcinoma (HLRCC). HLRCC is associated with an increased risk of developing type 2 papillary renal cell carcinoma and skin nodules called leiomyomata that are found mainly on the arms, legs, chest, and back. Women with HLRCC often develop uterine fibroids known as leiomyomas or, less commonly, leiomyosarcoma.

  • Tuberous sclerosis complex (TSC). TSC is a genetic condition associated with changes in the skin, brain, kidney, and heart. People with TSC also have an increased risk of developing angiomyolipomas of the kidney and kidney cancer (see the Introduction).

Other genetic conditions may be associated with an increased risk of kidney cancer, and research to find other genetic causes of kidney cancer is ongoing.

Prevention

Different factors cause different types of cancer. Researchers continue to look into what factors cause this type of cancer. Although there is no proven way to completely prevent this disease, you may be able to lower your risk by:

  • Quitting smoking

  • Lowering blood pressure

  • Maintaining a healthy body weight

  • Eating a diet high in fruits and vegetables and low in fat

Talk with your doctor for more information about your personal risk of cancer.

The next section in this guide is Screening. It explains how tests may find cancer before signs or symptoms appear. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Screening

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find out more about screening for this type of cancer. You will also learn the risks and benefits of screening. To see other pages, use the menu.

Screening is used to look for cancer before you have any symptoms or signs. Scientists have developed, and continue to develop, tests that can be used to screen a person for specific types of cancer. The overall goals of cancer screening are to:

  • Lower the number of people who die from the disease, or eliminate deaths from cancer altogether

  • Lower the number of people who develop the disease

Learn more about the basics of cancer screening.

Screening information for kidney cancer

Routine screening tests to detect early kidney cancer are not available. Doctors may recommend that people with a high risk of the disease have imaging tests (see the Diagnosis section) to look inside the body. For people with a family history of kidney cancer, CT scans or renal ultrasounds are sometimes used to search for early-stage kidney cancer. However, CT scans have not been proven to be a useful screening tool for kidney cancer for most people.

The next section in this guide is Symptoms and Signs. It explains what body changes or medical problems this disease can cause. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Symptoms and Signs

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find out more about body changes and other things that can signal a problem that may need medical care. To see other pages, use the menu.

Often, kidney cancer is found when a person has an x-ray or ultrasound (see the Diagnosis section) for another reason. In its earliest stages, kidney cancer causes no pain. Therefore, symptoms of the disease usually appear when the tumor grows large and begins to affect nearby organs.

People with kidney cancer may experience the following symptoms or signs. Sometimes, people with kidney cancer do not have any of these changes. Or, the cause of a symptom may be another medical condition that is not cancer.           

  • Blood in the urine

  • Pain or pressure in the side or back

  • A mass or lump in the side or back

  • Swelling of the ankles and legs

  • High blood pressure

  • Anemia, which is a low red blood cell count

  • Fatigue

  • Loss of appetite

  • Unexplained weight loss

  • Recurrent fever that is not from a cold, flu, or other infection

  • For men, a rapid development of a cluster of enlarged veins, known as a varicocele, around a testicle, particularly the right testicle, may indicate that a large kidney tumor may be present

If you are concerned about any changes you experience, please talk with your doctor. Your doctor will ask how long and how often you’ve been experiencing the symptom(s), in addition to other questions. This is to help find out the cause of the problem, called a diagnosis.

If cancer is diagnosed, relieving symptoms remains an important part of cancer care and treatment. This may also be called symptom management, palliative care, or supportive care. Be sure to talk with your health care team about symptoms you experience, including any new symptoms or a change in symptoms.

The next section in this guide is Diagnosis. It explains what tests may be needed to learn more about the cause of the symptoms. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Diagnosis

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find a list of common tests, procedures, and scans that doctors use to find the cause of a medical problem. To see other pages, use the menu.

Doctors use many tests to find, or diagnose, cancer. They also do tests to learn if cancer has spread to another part of the body from where it started. If this happens, it is called metastasis. For example, imaging tests can show if the cancer has spread. Imaging tests show pictures of the inside of the body. Doctors may also do tests to learn which treatments could work best.

For most types of cancer, a biopsy is the only sure way for the doctor to know whether an area of the body has cancer. In a biopsy, the doctor takes a small sample of tissue for testing in a laboratory. If a biopsy is not possible, the doctor may suggest other tests that will help make a diagnosis.

This list describes options for diagnosing this type of cancer. Not all tests listed below will be used for every person. Your doctor may consider these factors when choosing a diagnostic test:

  • The type of cancer suspected

  • Your signs and symptoms

  • Your age and medical condition

  • The results of earlier medical tests

In addition to a physical examination, the following tests may be used to diagnose kidney cancer:

  • Blood and urine tests. The doctor may recommend having a blood test to check the number of red blood cells and a urine test to find blood, bacteria, or cancer cells. These tests may suggest that kidney cancer is present, but they cannot be used to make a definite diagnosis.

  • Biopsy. A biopsy is the removal of a small amount of tissue for examination under a microscope. This is usually performed as an outpatient procedure using local anesthesia by an interventional radiologist. Anesthesia is medicine that blocks the awareness of pain. Other tests can suggest that cancer is present, but only a biopsy can make a definite diagnosis. A pathologist then analyzes the sample(s) and writes a pathology report describing the results. This report becomes a permanent part of the person’s medical record.

    The pathology report identifies the type of cell involved in the kidney cancer (see the Introduction for a list), which is important in planning treatment. Medical oncologists must have a pathology report before they use systemic therapy to treat metastatic kidney cancer. Systemic therapy involves using treatment(s) that affect the entire body. In certain cases, surgeons also may request a renal tumor biopsy to assist in planning treatment. However, if imaging tests show a solid and growing mass, then surgeons may remove the tumor first and then the pathologist will later provide the definitive tumor type and stage.

    The patient should carefully discuss with their doctor whether a biopsy is needed before treatment.

Imaging Tests

  • X-ray. An x-ray is a way to create a picture of the structures inside of the body, using a small amount of radiation.

  • Bone scan. A bone scan uses a radioactive tracer to look at the inside of the bones. The tracer is injected into a patient’s vein. It collects in areas of the bone and is detected by a special camera. Healthy bone appears gray to the camera, and areas of injury, such as those caused by cancer or a fracture (break), appear dark. This test is only ordered if the patient has bone pain or the doctor believes the cancer has spread to the bone.

  • Computed tomography (CT or CAT) scan. A CT scan creates a 3-dimensional picture of the inside of the body using x-rays taken from different angles. A computer then combines these images into a detailed, cross-sectional view that shows any abnormalities or tumors. A CT scan can also be used to measure the tumor’s size. For patients being evaluated for a renal mass, a non-contrast CT scan is done before a contrast medium is injected. A contrast medium is a special dye that provides better detail on the images taken by CT scans. This dye is injected into a patient’s vein. If the renal mass is found to have the dye in it, then the diagnosis of benign angiomyolipoma can be made and nonsurgical treatment options may be recommended. Renal cysts will not take up the contrast medium, but renal tumors will. If patients have severe chronic kidney disease or kidney failure, then the contrast medium cannot be safely given. A CT scan of the urinary tract is called a CT urogram.

  • Magnetic resonance imaging (MRI). An MRI uses magnetic fields, not x-rays, to produce detailed images of the body. MRI can also be used to measure the tumor’s size. A special dye called gadolinium is given before the scan to create a clearer picture. This dye is injected into a patient’s vein.

  • Intravenous pyelogram (IVP). A dye is injected into the patient’s bloodstream to highlight the kidney, urethra, and bladder when an x-ray is taken. The picture produced can show changes in these organs and in the nearby lymph nodes. This is test is rarely performed. It has been replaced with CT scans of the urinary tract, called CT urography, which provides much clearer and in-depth imaging of the urinary system (see above).

  • Cystoscopy and nephro-ureteroscopy. Occasionally, special tests called a cystoscopy and nephro-ureteroscopy may be done for renal pelvic cancer. They are not often used for renal cell carcinoma unless imaging also finds a mass or stone in the bladder. During these procedures, the patient is sedated, while a tiny, lighted tube is inserted into the bladder through the ureter and up into the kidney. Sedation is giving medication to become more relaxed, calm, or sleepy. The procedure can be used to obtain tumor cells for examination under a microscope, to perform biopsies, and sometimes to completely destroy small tumors.

After diagnostic tests are done, your doctor will review all of the results with you. If the diagnosis is cancer, these results also help the doctor describe the cancer. This is called staging.

The next section in this guide is Stages. It explains the system doctors use to describe the extent of the disease. Or, use the menu to choose another section to continue reading this guide.  

Kidney Cancer - Stages

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn about how doctors describe a cancer’s growth or spread. This is called the stage. To see other pages, use the menu.

Staging is a way of describing where the cancer is located, if or where it has spread, and whether it is affecting other parts of the body.

Doctors use diagnostic tests to find out the cancer's stage, so staging may not be complete until all the tests are finished. Knowing the stage helps the doctor to decide what kind of treatment is best and can help predict a patient's prognosis, which is the chance of recovery. There are different stage descriptions for different types of cancer.

TNM staging system

One tool that doctors use to describe the stage is the TNM system. Doctors use the results from diagnostic tests and scans to answer these questions:

  • Tumor (T): How large is the primary tumor? Where is it located?

  • Node (N): Has the tumor spread to the lymph nodes? If so, where and how many?

  • Metastasis (M): Has the cancer metastasized to other parts of the body? If so, where and how much?

The results are combined to determine the stage of cancer for each person. There are 5 stages: stage 0 (zero) and stages I through IV (1 through 4), although stage 0 kidney cancer is extremely rare. The stage provides a common way of describing the cancer so doctors can work together to plan the best treatments.

Here are more details on each part of the TNM system for kidney cancer.

Tumor (T)

Using the TNM system, the "T" plus a letter or number (0 to 4) is used to describe the size and location of the tumor. Some stages are also divided into smaller groups that help describe the tumor in even more detail. This helps the doctor develop the best treatment plan for each patient. If there is more than 1 tumor, the lowercase letter "m" (multiple) is added to the "T" stage category. Specific tumor stage information for kidney cancer is listed below.

TX: The primary tumor cannot be evaluated.

T1: The tumor is found only in the kidney and is 7 centimeters (cm) or smaller at its largest area. There has been much discussion among doctors about whether this classification should only include a tumor that is 5 cm or smaller.

  • T1a: The tumor is found only in the kidney and is 4 cm or smaller at its largest area.

  • T1b: The tumor is found only in the kidney and is between 4 cm and 7 cm at its largest area.

T2: The tumor is found only in the kidney and is larger than 7 cm at its largest area.

  • T2a: The tumor is only in the kidney and is more than 7 cm but not more than 10 cm at its largest area.

  • T2b: The tumor is only in the kidney and is more than 10 cm at its largest area.

T3: The tumor has grown into major veins within the kidney or perinephric tissue, which is the connective, fatty tissue around the kidneys. However, it has not grown into the adrenal gland on the same side of the body as the tumor. The adrenal glands are located on top of each kidney and produce hormones and adrenaline to help control heart rate, blood pressure, and other bodily functions. In addition, the tumor has not spread beyond Gerota's fascia, an envelope of tissue that surrounds the kidney.

  • T3a: The tumor has spread to the large vein leading out of the kidney, called the renal vein; the muscular branches of the renal vein; the fat surrounding the kidney; or the fat inside the kidney. The tumor has not grown beyond Gerota's fascia.

  • T3b: The tumor has grown into the large vein that drains into the heart, called the inferior vena cava, below the diaphragm. The diaphragm is the muscle under the lungs that helps breathing.

  • T3c: The tumor has spread to the vena cava above the diaphragm and into the right atrium of the heart or to the walls of the vena cava.

T4: The tumor has spread to areas beyond Gerota's fascia and extends into the adrenal gland on the same side of the body as the tumor.

Node (N)

The “N” in the TNM staging system stands for lymph nodes. These tiny, bean-shaped organs help fight infection. Lymph nodes near the kidneys are called regional lymph nodes. Lymph nodes in other parts of the body are called distant lymph nodes.

NX: The regional lymph nodes cannot be evaluated.

N0 (N plus zero): The cancer has not spread to the regional lymph nodes.

N1: The cancer has spread to regional lymph nodes.

Metastasis (M)

The "M" in the TNM system indicates whether the cancer has spread to other parts of the body, called distant metastasis. Common areas where kidney cancer may spread include the bones, liver, lungs, brain, and distant lymph nodes.

M0 (M plus zero): The disease has not metastasized.

M1: The cancer has spread to other parts of the body beyond the kidney area.

Cancer stage grouping

Doctors assign the stage of the cancer by combining the T, N, and M classifications.

Stage I: The tumor is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T1, N0, M0).

Stage I Kidney Cancer

Stage II: The tumor is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs (T2, N0, M0).

Stage II Kidney Cancer

Stage III: Either of these conditions:

  • A tumor of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body (T1 or T2, N1, M0).

  • The tumor has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body (T3, any N, M0).

Stage III Kidney Cancer

Stage IV: Either of these conditions:

  • The tumor has spread to areas beyond Gerota's fascia and extends into the adrenal gland on the same side of the body as the tumor, possibly to lymph nodes, but not to other parts of the body (T4, any N, M0).

  • The tumor has spread to any other organ, such as the lungs, bones, or the brain (any T, any N, M1).

Stage IV Kidney Cancer

Recurrent: Recurrent cancer is cancer that has come back after treatment. It may be found in the kidney area or in another part of the body. If the cancer does return, there will be another round of tests to learn about the extent of the recurrence. These tests and scans are often similar to those done at the time of the original diagnosis.

Used with permission of the AJCC, Chicago, Illinois. The original source for this material is the AJCC Cancer Staging Manual, Seventh Edition, published by Springer-Verlag New York, www.cancerstaging.org. Please note that AJCC’s Eighth Edition (2017) has been released; related changes to the information provided above are underway. Please check back soon for updated staging definitions or talk with your doctor about whether these changes affect your diagnosis..

Prognostic factors

It is important for doctors to learn as much as possible about the tumor because this information can help them predict if the cancer will grow and spread or how it will respond to treatment. This information includes:

  • Cell type, such as clear cell or another type

  • Grade, which describes how similar the cancer cells are to healthy cells

  • Personal information, such as the person’s activity level and body weight

  • Presence or absence of fevers, sweats, and other symptoms

Information about the cancer’s stage will help the doctor recommend a specific treatment plan. The next section in this guide is Treatment Options. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Treatment Options

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn about the different ways doctors use to treat people with this type of cancer. To see other pages, use the menu.

This section tells you the treatments that are the standard of care for this type of cancer. “Standard of care” means the best treatments known. When making treatment plan decisions, patients are also encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn if it is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Your doctor can help you consider all your treatment options. To learn more about clinical trials, see the About Clinical Trials and Latest Research sections.

Treatment overview

In cancer care, different types of doctors often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. For kidney cancer, the health care team is usually led by a urologist, a doctor who specializes in the genitourinary tract, which includes the kidneys, bladder, genitals, prostate, and testicles, or a urologic oncologist, a doctor who specializes in treating cancers of the urinary tract. Cancer care teams also include a variety of other health care professionals, including physician assistants, oncology nurses, social workers, pharmacists, counselors, dietitians, and others.

Treatment options and recommendations depend on several factors, including the type, cell type, and stage of cancer, possible side effects, and the patient’s preferences and overall health. Your care plan may also include treatment for symptoms and side effects, an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Also, talk about the goals of each treatment with your doctor and what you can expect while receiving treatment. Learn more about making treatment decisions.

Kidney cancer is most often treated with surgery, targeted therapy, immunotherapy, or a combination of these treatments. Radiation therapy and chemotherapy are occasionally used. Patients with kidney cancer that has spread (metastatic cancer, see below) often receive multiple lines of therapy, which are treatments given one after another. Descriptions of these treatment options are listed below.

Active surveillance

Sometimes the doctor may recommend monitoring the tumor closely with regular diagnostic tests and clinic appointments. This is called active surveillance. Active surveillance is effective in older adults and patients who have a small renal tumor and other serious medical conditions, such as heart disease, chronic kidney disease, or severe lung disease. Active surveillance may also be used for some patients with kidney cancer, even if it has spread to other parts of the body (metastasized).

Active surveillance is not the same as watchful waiting. Watchful waiting involves regular appointments to review symptoms, but patients do not have regular diagnostic tests, such as biopsy or imaging scans. The doctor simply watches for symptoms. If symptoms suggest that action is needed, then a new treatment plan is considered.

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. If the cancer has not spread beyond the kidneys, surgery to remove the tumor, part or all of the kidney, and possibly nearby tissue and lymph nodes, may be the only treatment necessary.

The types of surgery used for kidney cancer include the following procedures:

  • Radical nephrectomy. Surgery to remove the tumor, the entire kidney, and surrounding tissue is called a radical nephrectomy. If nearby tissue and surrounding lymph nodes are also affected by the disease, a radical nephrectomy and lymph node dissection is performed. During a lymph node dissection, the lymph nodes affected by the cancer are removed. If the cancer has spread to the adrenal gland or nearby blood vessels, the surgeon may remove the adrenal gland during a procedure called an adrenalectomy and parts of the blood vessels. A radical nephrectomy is usually recommended to treat a large tumor when there is little healthy tissue remaining. Sometimes the renal tumor will grow directly inside the renal vein and enter the vena cava on its way to the heart. If this happens, complicated cardiovascular surgical techniques are needed to safely remove all disease.

  • Partial nephrectomy. A partial nephrectomy is the surgical removal of a tumor. This type of surgery preserves kidney function and lowers the risk of developing chronic kidney disease after surgery. Research has shown that partial nephrectomy is as effective for T1 tumors whenever technically possible. Newer approaches that use a smaller surgical incision, or cut, are associated with fewer side effects and a speedier recovery.

  • Laparoscopic and robotic surgery (minimally invasive surgery). During laparoscopic surgery, the surgeon makes several small incisions rather than the 1 larger incision in the abdomen used during a traditional surgical procedure. The surgeon then inserts telescoping equipment into these small keyhole incisions to completely remove the kidney or perform a partial nephrectomy. Sometimes, the surgeon may use robotic instruments to perform the operation. This surgery may take longer but may be less painful. Laparoscopic and robotic approaches require specialized training. It is important to discuss the potential benefits and risks of these types of surgery with your surgical team and to be certain that the team has experience with the procedure.

Sometimes surgery is not recommended because of characteristics of the tumor or the patient’s overall health. The following procedures may be recommended instead:

  • Radiofrequency ablation. Radiofrequency ablation (RFA) is the use of a needle inserted into the tumor to destroy the cancer with an electrical current. The procedure is performed by a radiologist or urologist. The patient is sedated and given local anesthesia to numb the area. In the past, RFA has only been used for patients who were too sick to have surgery. Today, most of these patients are managed with active surveillance (see above).

  • Cryoablation. Cryoablation, also called cryotherapy or cryosurgery, is the freezing of cancer cells with a metal probe inserted through a small incision. The metal probe is placed into the cancerous tissue. A CT scan and ultrasound are used to guide the probe. The procedure requires general anesthesia for several hours. Some surgeons combine this technique with laparoscopy to treat the tumor, but there is little long-term research evidence to know its effectiveness. Talk with your doctor before surgery about what side effects are likely based on the type of surgery you’ll have and what can be done to reduce or manage these side effects. Learn more about the basics of cancer surgery.

Targeted therapy

Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells. These drugs are becoming more important in the treatment of kidney cancer.

Recent studies show that not all tumors have the same targets. Many research studies are taking place now to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments.

  • Anti-angiogenesis therapy. This type of treatment focuses on stopping angiogenesis, which is the process of making new blood vessels. Because a tumor needs the nutrients delivered by blood vessels to grow and spread, the goal of anti-angiogenesis therapies is to “starve” the tumor. One anti-angiogenic drug called bevacizumab (Avastin) has been shown to slow tumor growth for people with metastatic renal carcinoma. Bevacizumab combined with interferon (see Immunotherapy below) slows tumor growth and spread.

  • Tyrosine kinase inhibitors (TKIs). Clear cell kidney cancer has a mutation of the VHL gene that causes the cancer to make too much of a certain protein, known as vascular endothelial growth factor (VEGF). VEGF controls the formation of new blood vessels. Drugs called TKIs help block VEGF and other chemical signals that promote the development of new blood vessels. TKIs such as cabozantinib (Cabometyx), pazopanib (Votrient), sorafenib (Nexavar), and sunitinib (Sutent) may be used during treatment for clear cell kidney cancer. Axitinib (Inlyta), another TKI, has been approved to treat later-stage renal cell carcinoma. Side effects of TKIs may include diarrhea, high blood pressure, and tenderness and sensitivity in the hands and feet.

  • mTOR inhibitors. Everolimus (Afinitor) and temsirolimus (Torisel) are drugs that target a certain protein that helps kidney cancer cells grow, called mTOR. Studies show that these drugs slow kidney cancer growth.

Talk with your doctor about possible side effects for each specific medication and how they can be managed. The medications used to treat cancer are constantly being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Immunotherapy

Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function.

Interleukin-2 (IL-2, Proleukin) is a type of immunotherapy that has been used to treat later-stage kidney cancer. It is a cellular hormone called a cytokine that is produced by white blood cells. It is important in immune system function, including the destruction of tumor cells.

High-dose IL-2 can cause severe side effects, such as low blood pressure, excess fluid in the lungs, kidney damage, heart attack, bleeding, chills, and fever. Patients may need to stay in the hospital for up to 10 days during treatment. However, some symptoms may be reversible. Only centers with expertise in high-dose IL-2 treatment for kidney cancer should recommend IL-2. High-dose IL-2 can cure a small percentage of patients with metastatic kidney cancer. Some centers use low-dose IL-2 because it has fewer side effects, although it is not as effective.

Alpha-interferon is another type of immunotherapy used to treat kidney cancer that has spread. Interferon appears to change the proteins on the surface of cancer cells and slow their growth. Although it has not proven to be as beneficial as IL-2, alpha-interferon has been shown to lengthen lives when compared with an older treatment called megestrol acetate (Megace).

Researchers have tested many combinations of IL-2 and alpha-interferon for patients with advanced kidney cancer. These treatments have also been combined with chemotherapy (see below). It has not been shown in research studies that these combinations are better than IL-2 or interferon alone.

Researchers are working to learn more about how IL-2 and interferon eliminate kidney cancer cells and which patients can benefit the most from these treatments.

A new form of immunotherapy called checkpoint inhibitors (see below) has been recently tested in kidney cancer. A drug called nivolumab (Opdivo) given through the vein every 2 weeks was shown to help certain patients who had received prior treatment live longer than patients treated with everolimus. A lot of research is being done on these types of drugs in kidney cancer (see the Latest Research section).

Talk with your doctor about the possible side effects of the type of immunotherapy recommended, including how they will be managed. Learn more about the basics of immunotherapy.

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by stopping the cancer cells’ ability to grow and divide. Chemotherapy is given by a medical oncologist, a doctor who specializes in treating cancer with medication.

Systemic chemotherapy gets into the bloodstream to reach cancer cells throughout the body. Common ways to give chemotherapy include an intravenous (IV) tube placed into a vein using a needle or in a pill or capsule that is swallowed (orally).

A chemotherapy regimen (schedule) usually consists of a specific number of cycles given over a set period of time. A patient may receive 1 drug at a time or combinations of different drugs at the same time.

Although chemotherapy is useful for treating most types of cancer, kidney cancer is often resistant to chemotherapy. However, researchers continue to study new drugs and new combinations of drugs. For some patients, the combination of gemcitabine (Gemzar) with capecitabine (Xeloda) or fluorouracil (5-FU, Adrucil) will temporarily shrink a tumor.

It is important to remember that transitional cell carcinoma, also called urothelial carcinoma, and Wilms tumor are much more likely to be successfully treated with chemotherapy.

The side effects of chemotherapy depend on the individual and the dose used, but can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, and diarrhea. These side effects usually go away once treatment is finished.

Learn more about the basics of chemotherapy and preparing for treatment. The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications. Learn more about your prescriptions by using searchable drug databases.

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.

Radiation therapy is not effective as a primary treatment for kidney cancer. It is very rarely used alone to treat kidney cancer because of the damage it causes to the healthy kidney. Radiation therapy is used only if a patient cannot have surgery and, even then, usually only on areas where the cancer has spread and not the primary kidney tumor. Most often, radiation therapy is used when the cancer has spread to help ease symptoms, such as bone pain or swelling in the brain.

The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy. For kidney cancer, internal radiation therapy is given using a hollow needle to insert radioactive seeds directly into a tumor. Another type of radiation therapy is stereotactic radiosurgery, which is designed to direct the radiation therapy to a specific area without damaging nearby tissue.

A radiation therapy regimen (schedule) usually consists of a specific number of treatments given over a set period of time.

Side effects from radiation therapy may include fatigue, mild skin reactions, upset stomach, and loose bowel movements. Internal radiation therapy may cause some bleeding, infection, and risk of injury to nearby tissue. Most side effects go away soon after treatment is finished.

Learn more about the basics of radiation therapy.

Getting care for symptoms and side effects

Cancer and its treatment often cause side effects. In addition to treatment to slow, stop, or eliminate the cancer, an important part of cancer care is relieving a person’s symptoms and side effects. This approach is called palliative or supportive care, and it includes supporting the patient with his or her physical, emotional, and social needs.

Palliative care is any treatment that focuses on reducing symptoms, improving quality of life, and supporting patients and their families. Any person, regardless of age or type and stage of cancer, may receive palliative care. It works best when palliative care is started as early as needed in the cancer treatment process.

People often receive treatment for the cancer and treatment to ease side effects at the same time. In fact, patients who receive both often have less severe symptoms, better quality of life, and report they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional support, and other therapies. You may also receive palliative treatments similar to those meant to eliminate the cancer, such as chemotherapy, surgery, or radiation therapy. Talk with your doctor about the goals of each treatment in your treatment plan.

Before treatment begins, talk with your health care team about the possible side effects of your specific treatment plan and palliative care options. And during and after treatment, be sure to tell your doctor or another health care team member if you are experiencing a problem so it can be addressed as quickly as possible. Learn more about palliative care.

Metastatic kidney cancer

If cancer spreads to another part in the body from where it started, doctors call it metastatic cancer. This is a systemic disease that requires systemic therapy, such as targeted therapy or immunotherapy. Often, doctors may ask a surgeon to remove the kidney with the tumor in an operation called a cytoreductive nephrectomy. This prevents pain and bleeding during systemic treatment and is associated with a better prognosis.

The most common place kidney cancer spreads is to the lungs, but it can also spread to the lymph nodes, bones, liver, brain, skin, and other areas in the body. For kidney cancer that has spread to 1 specific part of the body, such as a lung, surgery may be able to completely remove the cancer. If the cancer has spread to many areas beyond the kidney, it is more difficult to treat.

If the cancer has spread, it is a good idea to talk with doctors who have experience in treating it. Doctors can have different opinions about the best standard treatment plan. Also, clinical trials might be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. If cancer has spread to another location in the body, it is called metastatic cancer.

Currently, the most effective treatment for metastatic kidney cancer is targeted therapy that slows or prevents tumor growth and blood vessel formation. These drugs have been shown to lengthen life when compared with standard treatment. Palliative care is also important to help relieve symptoms and side effects.

For most patients, a diagnosis of metastatic cancer is very stressful and, at times, difficult to bear. Patients and their families are encouraged to talk about the way they are feeling with doctors, nurses, social workers, or other members of the health care team. It may also be helpful to talk with other patients, including through a support group.

Remission and the chance of recurrence

A remission is when cancer cannot be detected in the body and there are no symptoms. This may also be called having “no evidence of disease” or NED.

A remission may be temporary or permanent. This uncertainty causes many people to worry that the cancer will come back. While many remissions are permanent, it’s important to talk with your doctor about the possibility of the cancer returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the cancer does return. Learn more about coping with the fear of recurrence.

If the cancer does return after the original treatment, it is called recurrent cancer. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence). If you have had a partial nephrectomy already, a new tumor may form in that kidney. The recurrent tumor can be removed with another partial nephrectomy or with a radical nephrectomy.

When there is a recurrence, a cycle of testing will begin again to learn as much as possible about the recurrence. After testing is done, you and your doctor will talk about your treatment options. Often the treatment plan will include the treatments described above, such as surgery, targeted therapy, immunotherapy, radiation therapy, and chemotherapy, but they may be used in a different combination or given at a different pace. Your doctor may also suggest clinical trials that are studying new ways to treat this type of recurrent cancer. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects.

People with recurrent cancer often experience emotions such as disbelief or fear. Patients are encouraged to talk with their health care team about these feelings and ask about support services to help them cope. Learn more about dealing with cancer recurrence.

If treatment fails

Recovery from cancer is not always possible. If the cancer cannot be cured or controlled, the disease may be called advanced or terminal.

This diagnosis is stressful, and advanced cancer is difficult to discuss for many people. However, it is important to have open and honest conversations with your doctor and health care team to express your feelings, preferences, and concerns. The health care team is there to help, and many team members have special skills, experience, and knowledge to support patients and their families. Making sure a person is physically comfortable and free from pain is extremely important.

Patients who have advanced cancer and who are expected to live less than 6 months may want to consider a type of palliative care called hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to think about where you would be most comfortable: at home, in the hospital, or in a hospice environment. Nursing care and special equipment can make staying at home a workable alternative for many families. Learn more about advanced cancer care planning.

After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.

The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - About Clinical Trials

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn more about clinical trials, which are the main way that new medical approaches are tested to see how well they work. To see other pages, use the menu.

What are clinical trials?

Doctors and scientists are always looking for better ways to care for patients with kidney cancer. To make scientific advances, doctors create research studies involving volunteers, called clinical trials. In fact, every drug that is now approved by the U.S. Food and Drug Administration (FDA) was tested in clinical trials.

Many clinical trials focus on new treatments. Researchers want to learn if a new treatment is safe, effective, and possibly better than the treatment doctors use now. These types of studies evaluate new drugs, different combinations of existing treatments, new approaches to radiation therapy or surgery, and new methods of treatment. Patients who participate in clinical trials can be some of the first to get a treatment before it is available to the public. However, there is no guarantee that the new treatment will be safe, effective, or better than what doctors use now.

Some clinical trials study new ways to relieve symptoms and side effects during treatment. Others study ways to manage the late effects that may happen a long time after treatment. Talk with your doctor about clinical trials for symptoms and side effects. There are also clinical trials studying ways to prevent cancer.

Deciding to join a clinical trial

Patients decide to participate in clinical trials for many reasons. For some patients, a clinical trial is the best treatment option available. Because standard treatments are not perfect, patients are often willing to face the added uncertainty of a clinical trial in the hope of a better result. Other patients volunteer for clinical trials because they know that these studies are the only way to make progress in treating kidney cancer. Even if they do not benefit directly from the clinical trial, their participation may benefit future patients with kidney cancer.

Sometimes people have concerns that, in a clinical trial, they may receive no treatment by being given a placebo or a “sugar pill.” However, placebos are usually combined with standard treatment in most cancer clinical trials. When a placebo is used in a study, it is done with the full knowledge of the participants. Find out more about placebos in cancer clinical trials.

Patient safety and informed consent

To join a clinical trial, patients must participate in a process known as informed consent. During informed consent, the doctor should list all of the patient's options, so that the person understands how the new treatment differs from the standard treatment. The doctor must also list all of the risks of the new treatment, which may or may not be different than the risks of standard treatment. Finally, the doctor must explain what will be required of each patient in order to participate in the clinical trial, including the number of doctor visits, tests, and the schedule of treatment.

Patients who participate in a clinical trial may stop participating at any time for any personal or medical reason. This may include that the new treatment is not working or there are serious side effects. Clinical trials are also closely monitored by experts who watch for any problems with each study. It is important that patients participating in a clinical trial talk with their doctor and researchers about who will be providing their treatment and care during the clinical trial, after the clinical trial ends, and/or if the patient chooses to leave the clinical trial before it ends.

Finding a clinical trial

Research through clinical trials is ongoing for all types of cancer. For specific topics being studied for kidney cancer, learn more in the Latest Research section.

Cancer.Net offers a lot of information about cancer clinical trials in other areas of the website, including a complete section on clinical trials and places to search for clinical trials for a specific type of cancer.

In addition, this website offers free access to a video-based educational program about cancer clinical trials, located outside of this guide.

The next section in this guide is Latest Research. It explains areas of scientific research currently going on for this type of cancer. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Latest Research

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will read about the scientific research being done now to learn more about this type of cancer and how to treat it. To see other pages, use the menu.

Doctors are working to learn more about kidney cancer, ways to prevent it, how to best treat it, and how to provide the best care to people diagnosed with this disease. The following areas of research may include new options for patients through clinical trials. Always talk with your doctor about the diagnostic and treatment options best for you.

Because most types of kidney cancer do not respond well to traditional chemotherapy, research for kidney cancer focuses on using newer and different treatments, such as immunotherapy and targeted therapy.

  • Targeted therapy. Several recently discovered drugs that affect the process of blood vessel development and/or cancer cell growth are being tested as targeted therapies for kidney cancer. The early results from these clinical trials show that these types of drugs may be effective treatments for kidney cancer, and this is an area of rapid scientific change.

    Many targeted therapies are being studied for use as adjuvant therapies, which are treatments given after the main treatment(s) to lower the risk of recurrence and to get rid of any remaining cancer cells. Currently, there are no adjuvant therapies for kidney cancer that have shown significant benefit.

  • Cancer vaccines. Cancer vaccines are treatments that help a person’s immune system fight cancer. Doctors are testing the use of several cancer vaccines to treat kidney cancer and to prevent recurrence for people with later-stage renal cell carcinoma. One vaccine is made from a person's tumor and given after surgery, while others are made from proteins found on the surface of kidney cancer cells or blood vessel cells found in the tumor.

  • Checkpoint inhibitors. A type of immunotherapy, called checkpoint inhibitors, works by taking the brakes off the immune system so it is better able to destroy the cancer. These drugs use antibodies directed at specific molecules found on the surface of immune cells, such as programmed death-1 (PD-1) and cytotoxic T lymphocyte antigen-4 (CTLA-4). Some early results of research using these drugs to treat kidney cancer are encouraging, and more clinical trials are currently ongoing.

  • Palliative care. Clinical trials are underway to find better ways of reducing symptoms and side effects of current kidney cancer treatments to improve patients’ comfort and quality of life.

Looking for More About the Latest Research?

If you would like additional information about the latest areas of research regarding kidney cancer, explore these related items that will take you outside of this guide:

The next section in this guide is Coping with Treatment. It offers some guidance in how to cope with the physical, emotional, and social changes that cancer and its treatment can bring. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Coping with Treatment

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will learn more about coping with the physical, emotional, social, and financial effects of cancer and its treatment. This page includes several links outside of this guide to other sections of this website. To see other pages, use the menu.

Every cancer treatment can cause side effects or changes to your body and how you feel. For many reasons, people don’t experience the same side effects even when given the same treatment for the same type of cancer. This can make it hard to predict how you will feel during treatment.

As you prepare to start cancer treatment, it is normal to fear treatment-related side effects. It may help to know that your health care team will work to prevent and relieve side effects. Doctors call this part of cancer treatment “palliative care.” It is an important part of your treatment plan, regardless of your age or the stage of disease.

Coping with physical side effects

Common physical side effects from each treatment option for kidney cancer are described in the Treatment Options section. Learn more about side effects of cancer and its treatment, along with ways to prevent or control them. Changes to your physical health depend on several factors, including the cancer’s stage, the length and dose of treatment, and your general health.

Sometimes, physical side effects can last after treatment ends. Doctors call these long-term side effects. They call side effects that occur months or years after treatment late effects. Treating long-term side effects and late effects is an important part of survivorship care. Learn more by reading the Follow-up Care section of this guide or talking with your doctor.

Coping with emotional and social effects

You can have emotional and social effects as well as physical effects after a cancer diagnosis. This may include dealing with difficult emotions, such as anxiety or anger, or managing your stress level. Sometimes, patients have problems expressing how they feel to their loved ones, or people don’t know what to say in return.

Patients and their families are encouraged to share their feelings with a member of their health care team. You can also find coping strategies for emotional and social effects in a separate section of this website. This section includes many resources for finding support and information to meet your needs.

Coping with financial effects

Cancer treatment can be expensive. It is often a big source of stress and anxiety for people with cancer and their families. In addition to treatment costs, many people find they have extra, unplanned expenses related to their care. For some people, the high cost stops them from following or completing their cancer treatment plan. This can put their health at risk and may lead to higher costs in the future. Learn more about managing financial considerations, in a separate part of this website.

Caring for a loved one with cancer

Family members and friends often play an important role in taking care of a person with kidney cancer. This is called being a caregiver. Caregivers can provide physical, practical, and emotional support to the patient, even if they live far away.

Caregivers may have a range of responsibilities on a daily or as-needed basis. Below are some of the responsibilities caregivers take care of:

  • Providing support and encouragement

  • Giving medications

  • Helping manage symptoms and side effects

  • Coordinating medical appointments

  • Providing a ride to appointments

  • Assisting with meals

  • Helping with household chores

  • Handling insurance and billing issues

Learn more about caregiving.

Talking with your health care team about side effects

Before starting treatment, talk with your doctor about possible side effects. Ask:

  • Which side effects are most likely?

  • When are they are likely to happen?

  • What can we do to prevent or relieve them?

Be sure to tell your health care team about any side effects that happen during treatment and afterward, too. Tell them even if you don’t think the side effects are serious. This discussion should include physical, emotional, and social effects of cancer.

Also, ask how much care you may need at home and with daily tasks during and after treatment. This can help you make a caregiving plan.

The next section in this guide is Follow-up Care. It explains the importance of check-ups after cancer treatment is finished. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Follow-Up Care

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will read about your medical care after cancer treatment is completed, and why this follow-up care is important. To see other pages, use the menu.

Care for people diagnosed with cancer doesn’t end when active treatment has finished. Your health care team will continue to check to make sure the cancer has not returned, manage any side effects, and monitor your overall health. This is called follow-up care.

Your follow-up care may include regular physical examinations, medical tests, or both. Doctors want to keep track of your recovery in the months and years ahead. As part of this follow-up care, patients should receive regular blood tests to check kidney function, chest x-rays, CT scans of the abdomen and chest, and other imaging tests to watch for recurrence or metastasis. Patients should have a checkup every 3 months for the first year, every 4 months for the second to fifth year, and once a year after that. Learn more about the importance of follow-up care.

Watching for recurrence

One goal of follow-up care is to check for a recurrence. Cancer recurs because small areas of cancer cells may remain undetected in the body. Over time, these cells may increase in number until they show up on test results or cause signs or symptoms. During follow-up care, a doctor familiar with your medical history can give you personalized information about your risk of recurrence. Your doctor will also ask specific questions about your health. Some people may have blood tests or imaging tests done as part of regular follow-up care, but testing recommendations depend on several factors, including the type and stage of cancer originally diagnosed and the types of treatment given.

Managing long-term and late side effects

Most people expect to experience side effects when receiving treatment. However, it is often surprising to survivors that some side effects may linger beyond the treatment period. These are called long-term side effects. In addition, other side effects called late effects may develop months or even years afterwards. Long-term and late effects can include both physical and emotional changes.

Talk with your doctor about your risk of developing such side effects based on the type of cancer, your individual treatment plan, and your overall health. If you had a treatment known to cause specific late effects, you may also have certain physical examinations, scans, or blood tests to help find and manage them.

Because people treated for kidney cancer often have a single kidney, their kidney function will have to be monitored for the rest of their lives. There are few long-term side effects of surgery, although some patients may have chronic pain from the surgical scar. Also, people treated for kidney cancer have a slightly higher risk of developing colon cancer and prostate cancer.

Keeping personal health records

You and your doctor should work together to develop a personalized follow-up care plan. Be sure to ask about any concerns you have about your future physical or emotional health. ASCO offers forms to help create a treatment summary to keep track of the cancer treatment you received and develop a survivorship care plan once treatment is completed.

This is also a good time to decide who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the general care of their family doctor or another health care professional. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.

If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with him or her, as well as all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.

The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Survivorship

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will read about how to with challenges in everyday life after a cancer diagnosis. To see other pages, use the menu.

What is survivorship?

The word “survivorship” means different things to different people. Common definitions include:

  • Having no signs of cancer after finishing treatment.

  • Living with, through, and beyond cancer. According to this definition, cancer survivorship begins at diagnosis and includes people who continue to have treatment over the long term, to either reduce the risk of recurrence or to manage chronic disease.

Survivorship is one of the most complicated parts of having cancer. This is because it is different for everyone.

Survivors may experience a mixture of strong feelings, including joy, concern, relief, guilt, and fear. Some people say they appreciate life more after a cancer diagnosis and have gained a greater acceptance of themselves. Others become very anxious about their health and uncertain of how to cope with everyday life.

Survivors may feel some stress when frequent visits to the health care team end following treatment. Often, relationships built with the cancer care team provide a sense of security during treatment, and people miss this source of support. This may be especially true as new worries and challenges surface over time, such as any late effects of treatment, emotional challenges including fear of recurrence, sexuality and fertility concerns, and financial and workplace issues.

Every survivor has individual concerns and challenges. With any challenge, a good first step is being able to recognize your fears and talk about them. Effective coping requires:

  • Understanding the challenge you are facing,

  • Thinking through solutions,

  • Asking for and allowing the support of others, and

  • Feeling comfortable with the course of action you choose.

Many survivors find it helpful to join an in-person support group or an online community of survivors. This allows you to talk with people who have had similar first-hand experiences. Other options for finding support include talking with a friend or member of your health care team, individual counseling, or asking for assistance at the learning resource center of the center where you received treatment.

Changing role of caregivers

Family members and friends may also go through periods of transition. A caregiver plays a very important role in supporting a person diagnosed with cancer, providing physical, emotional, and practical care on a daily or as-needed basis. Many caregivers become focused on providing this support, especially if the treatment period lasts for many months or longer.

However, as treatment is completed, the caregiver's role often changes. Eventually, the need for caregiving related to the cancer diagnosis will become much less or come to an end. Caregivers can learn more about adjusting to life after caregiving in this article.

A new perspective on your health

For many people, survivorship serves as a strong motivator to make positive lifestyle changes.

People recovering from kidney cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

In addition, it is important to have recommended medical check-ups and tests (see Follow-up Care) to take care of your health. Cancer rehabilitation may also be recommended, and this could mean any of a wide range of services such as physical therapy, career counseling, pain management, nutritional planning, and/or emotional counseling. The goal of rehabilitation is to help people regain control over many aspects of their lives and remain as independent and productive as possible.

Talk with your doctor to develop a survivorship care plan that is best for your needs.

Looking for More Survivorship Resources?

For more information about cancer survivorship, explore these related items. Please note that these links will take you to other sections of Cancer.Net:

  • ASCO Answers Cancer Survivorship Guide: Get this 44-page booklet that helps people transition into life after treatment. It includes blank treatment summary and survivorship care plan forms. The booklet is available as a PDF, so it is easy to print out.

  • Cancer.Net Patient Education Video: View a short video led by an ASCO expert that provides information about what comes next after finishing treatment.

  • Survivorship Resources: Cancer.Net offers an entire area of this website with resources to help survivors, including for survivors in different age groups.

The next section offers Questions to Ask the Doctor to help start conversations with your cancer care team. Or, use the menu to choose another section to continue reading this guide

Kidney Cancer - Questions to Ask the Doctor

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find some questions to ask your doctor or other members of your health care team, to help you better understand your diagnosis, treatment plan, and overall care. To see other pages, use the menu.

Talking often with the doctor is important to make informed decisions about your health care. These suggested questions are a starting point to help you learn more about your cancer care and treatment. You are also encouraged to ask additional questions that are important to you. You may want to print this list and bring it to your next appointment, or download Cancer.Net’s free mobile app for an e-list and other interactive tools to manage your care.

Questions to ask after getting a diagnosis

  • What type of kidney cancer do I have?

  • What type of cell makes up the tumor?

  • Can you explain my pathology report (laboratory test results) to me?

  • What is the stage of my cancer? What does this mean?

  • What is my prognosis?

  • What are my treatment options?

Questions to ask about choosing a treatment and managing side effects

  • What treatment plan do you recommend? Why?

  • What clinical trials are available for me? Where are they located, and how do I find out more about them?

  • What is the goal of each treatment? Is it to eliminate the cancer, help me feel better, or both?

  • Who will be part of my health care team, and what does each member do?

  • Who will be leading my overall treatment?

  • How will this treatment affect my daily life? Will I be able to work, exercise, and perform my usual activities?

  • Could this treatment affect my sex life? If so, how and for how long?

  • Could this treatment affect my ability to become pregnant or have children in the future? If so, should I talk with a fertility specialist before cancer treatment begins?

  • If I’m worried about managing the costs of cancer care, who can help me?

  • What support services are available to me? To my family?

  • Whom should I call with questions or problems?

Questions to ask about having surgery

  • What type of surgery will I have? Will lymph nodes be removed?

  • Can I have a partial nephrectomy? If not, why?

  • If I first receive a type of treatment other than surgery, can surgery be done later, if necessary?

  • Who will be doing the surgery? How experienced is this surgeon with this type of cancer?

  • How long will the operation take?

  • How long will I be in the hospital?

  • Can you describe what my recovery from surgery will be like?

  • What are the possible long-term effects of having this surgery?

  • Will I need treatment after surgery? What type of treatment?

Questions to ask about having targeted therapy or immunotherapy

  • What role, if any, will targeted therapy or immunotherapy play in my treatment plan?

  • What is the goal of this treatment?

  • Does this center have expertise in using high-dose IL-2, if it is recommended for me? If not, what is the nearest center with that expertise?

  • How long will it take to give this treatment?

  • What side effects can I expect during treatment?

  • What are the possible long-term effects of having this treatment?

  • What can be done to relieve the side effects?

  • How can I keep myself as healthy as possible during treatment?

  • What is the chance that the cancer will come back? Should I watch for specific signs or symptoms?

Questions to ask about planning follow-up care

  • What long-term side effects or late effects are possible based on the cancer treatment I received?

  • What follow-up tests will I need, and how often will I need them?

  • How do I get a treatment summary and survivorship care plan to keep in my personal records?

  • Who will be leading my follow-up care?

  • What survivorship support services are available to me? To my family?

The next section in this guide is Additional Resources. It offers some more resources on this website beyond this guide that may be helpful to you. Or, use the menu to choose another section to continue reading this guide.

Kidney Cancer - Additional Resources

This section has been reviewed and approved by the Cancer.Net Editorial Board, 08/2016

ON THIS PAGE: You will find some helpful links to other areas of Cancer.Net that provide information about cancer care and treatment. This is the final page of Cancer.Net’s Guide to Kidney Cancer. To go back and review other pages, use the menu.

Cancer.Net includes many other sections about the medical and emotional aspects of cancer, both for the person diagnosed and their family members and friends. This website is meant to be a resource for you and your loved ones from the time of diagnosis, through treatment, and beyond.

Beyond this guide, here are a few links to help you explore other parts of Cancer.Net:

This is the end of Cancer.Net’s Guide to Kidney Cancer. Use the menu to select another section to continue reading this guide.