You have one kidney on each side of your back, just below the rib cage. They help clean your blood of waste, which then leaves your body as urine when you pee. Kidney cancer is when faulty cells grow out of control and form growths called tumors in one or both of them.
There are two main types:
Renal cell carcinoma: This is the most common type. It forms in the lining of the tiny tubes inside your kidneys. It’s usually a single tumor within a kidney, but some people get 2 or more tumors in one kidney or both kidneys at the same time.
Transitional cell carcinoma: This type doesn’t start in the kidney itself, but in a place called the renal pelvis. This is where the ureters, tubes that carry urine to your bladder, meet the kidney.
Men are more likely to get kidney cancer than women.
What Are the Symptoms of Kidney Cancer?
Though renal and transitional cancer types affect the kidney in slightly different ways, the signs and symptoms are largely the same. In addition, kidney cancer often doesn’t show any obvious signs, especially in the early stages. Plus, many possible kidney cancer symptoms, like blood in the urine, can also result from less serious illnesses, like a bladder infection or kidney stones.
But it’s a good idea to talk to your doctor if you notice:
- Blood in your pee (the doctor will call this hematuria)
- Lower back or belly pain with no clear cause
- A fever that doesn’t go away and has no obvious cause
- You’re more tired than normal
- You aren’t as hungry or don’t eat as much
- You’ve lost weight without trying
- A lump on your lower back, side, or belly
Because kidney cancer sometimes has no early symptoms, the first sign might not show up until after the cancer has spread. (The doctor will say it has metastasized.)
It can go almost anywhere in your body, and symptoms depend on the location. It might show up as a skin lesion. Or, if it spreads to a lung, you might cough up blood. If it reaches your brain, you might have balance or vision problems, among other symptoms in your nervous system.
Regular checkups can help catch early warning signs so that you and your doctor can create a treatment plan.
How Is Kidney Cancer Treated?
The treatment you choose depends on things like your overall health, how old you are, the stage of your disease, and the kind of kidney cancer you have -- renal or transitional cell carcinoma.
Watchful waiting
If your tumor is less than 1.5 inches, your doctor might suggest watchful waiting, sometimes called "active surveillance." This is more likely if your body is already weakened by age or illness.
While you do watchful waiting, you'll need to get regular checkups. Your doctor will ask you to get imaging tests, such as MRIs or CT scans, to see if the tumor has grown.
Treatment typically changes quickly to surgery or another more active treatment once the tumor gets larger than 1.5 inches.
Surgery
It's the most common and effective treatment for most kidney cancer. Your surgeon will try to cut out as much of the tumor as possible while at the same time keeping as much of your kidney as they can.
The surgeon may also remove some or all of your lymph nodes -- small, bean-shaped organs that are part of the immune system, your body's defense against germs.
Standard surgery starts with a 10-inch cut in your belly area. Laparoscopic surgery uses tube-like instruments that go in through small holes to cut into the same area.
There are several types of kidney cancer surgery:
Radical nephrectomy. The surgeon removes your whole kidney and surrounding fatty tissue, usually along with the attached adrenal gland and lymph nodes in the area. If you lose both kidneys, you'll need to go on a dialysis machine several times a week to clean your blood.
Partial nephrectomy. It's common surgery for people with early-stage kidney cancer. Your doctor may recommend it to remove tumors as big as 2.75 inches.
Long-term results seem to be about equal to the radical nephrectomy, with the added benefit that you keep more of your kidney function.
A partial nephrectomy may not be the best choice if your tumor is very large or if it's growing in the center of your kidney. It also may not be useful if your cancer has already spread to the lymph nodes and other parts of your body.
Regional lymphadenectomy. Your doctor removes lymph nodes in this surgery. They may do this simply to check for cancer cells, or as part of a radical nephrectomy, especially if the tumor looks like the type that spreads easily or the lymph nodes look enlarged. Sometimes your doctor won't know if there's a problem with the lymph nodes until they can see and feel inside your body during surgery.
Targeted therapy
In targeted therapy, you take drugs that are specifically made to block the proteins and blood vessels that your kidney cancer needs to grow.
In some cases, these medications may seem to shrink tumors or slow their growth. Your doctor will likely try one at a time to see which drug, or combination of drugs, works best.
Doctors typically use targeted therapy if the cancer has spread to other parts of your body.
Immunotherapy
Immunotherapy, sometimes called biologic therapy, boosts your immune system to fight your particular cancer type.
For kidney cancer, you may get immune checkpoint inhibitors. One type targets proteins called PD-1 on T cells in the immune system. These proteins normally help keep these cells from attacking other cells in the body. Another type of immune checkpoint inhibitor targets a protein called PD-L1 which can help boost the immune response against cancer cells. It may shrink the tumor or slow its growth. Older types of immune therapy called cytokines (interleukin-2 or interferon-alpha) activate the immune system in a more general way. Though it can shrink kidney tumors in some people, it so far only works in a small percentage of cases.
Chemotherapy
Chemotherapy puts powerful drugs into your bloodstream through pills or shots. The goal is to slow or stop cancer cell growth.
It's a less common treatment since kidney cancer typically resists chemotherapy. If your doctor does recommend it, ask about possible side effects and how to manage them.
Radiation therapy
A specialist called a radiation oncologist puts high-energy radiation into your body from machines that send radioactive particles through the air, a shot, or an implant. The goal is to shrink tumors.
Radiation therapy isn't typically very effective on kidney cancers, though your medical team may suggest it if other treatments have failed. More often your team might suggest it to ease symptoms after the cancer has spread to bones or nearby organs where it can cause quite a bit of pain.
