Kidney cancer often begins as a tumor within one kidney and may be discovered during imaging performed for another reason. At Providence Saint John’s Health Center and Saint John’s Cancer Institute, our specialists provide personalized evaluation and treatment with an emphasis on controlling the cancer while preserving healthy kidney function whenever appropriate. Treatment may include active surveillance, minimally invasive or robotic surgery, ablation, histotripsy and advanced systemic therapies depending on the tumor and stage of disease.
About the Kidneys and Kidney Cancer
The kidneys are two organs located toward the back of the abdomen that filter the blood, remove waste and excess water, and produce urine. They also help regulate blood pressure and support other important functions. Because most people have two kidneys, treatment planning considers both cancer control and preservation of healthy kidney function whenever possible.
What Is Kidney Cancer?
Kidney cancer develops when abnormal cells within the kidney begin growing uncontrollably and form a tumor. Most kidney cancers diagnosed in adults are renal cell carcinomas (RCC). Some remain confined to the kidney for a long period, while others can grow into nearby structures or spread through the bloodstream or lymphatic system to other parts of the body.
Kidney cancer is also called renal cancer. Although it becomes more common with age and occurs more frequently in men, it can affect adults of different ages and backgrounds. The behavior of an individual kidney tumor depends on its type, size, location and other characteristics.
Renal Cell Carcinoma (RCC)
Renal cell carcinoma is by far the most common type of kidney cancer in adults. RCC develops within the kidney’s filtering structures and includes several subtypes that can behave differently and respond to different treatments. Identifying the type of kidney cancer can therefore become important when planning treatment, particularly for advanced disease.
Jennifer Linehan, MD, discusses renal cell carcinoma (kidney cancer) and research involving microRNA diagnostic testing.
Kidney Cancer and Upper Tract Urothelial Carcinoma
Not every cancer found near the kidney is renal cell carcinoma. Upper Tract Urothelial Carcinoma (UTUC) develops from the urothelial cells lining the renal pelvis or ureter and is biologically different from RCC. Distinguishing between these cancers is important because their evaluation and treatment can differ substantially.
Are Kidney Cysts Cancerous?
Kidney cysts are fluid-filled structures that commonly develop in or on the kidneys. Simple kidney cysts are usually benign and may require no treatment when they are not causing symptoms or affecting kidney function.
Complex cysts have different imaging characteristics and may require additional imaging, surveillance or treatment because some complex cystic masses can contain cancerous tissue. Kidney cysts associated with inherited conditions such as polycystic kidney disease are also different from common simple cysts.
What Are the Symptoms of Kidney Cancer?
Kidney cancer may not cause noticeable symptoms during its early stages, and some tumors are discovered incidentally during CT, MRI or ultrasound imaging performed for another medical reason. As a kidney tumor grows or the disease becomes more advanced, symptoms may become more noticeable.
- Blood in the urine (hematuria)
- Persistent pain in the side or back
- A lump or mass in the side or abdomen
- Unexplained weight loss
- Loss of appetite
- Persistent fever not caused by an infection
- Fatigue or weakness
- Anemia in some patients
These symptoms can be caused by many conditions other than kidney cancer. Blood in the urine, persistent unexplained pain or other ongoing changes should be evaluated so the cause can be identified.
What Increases the Risk of Kidney Cancer?
Having a risk factor does not mean that someone will develop kidney cancer, and some people diagnosed with kidney cancer have no known risk factors. Some factors cannot be changed, such as age or inherited genetic conditions, while others involve health or environmental exposures that may be modified.
Smoking
Smoking increases the risk of kidney cancer, and risk generally increases with the amount and duration of tobacco exposure. Stopping smoking can reduce future cancer and cardiovascular risk while providing many other health benefits.
Excess Body Weight and High Blood Pressure
Obesity and high blood pressure are both associated with an increased risk of kidney cancer. Managing weight, blood pressure and cardiovascular health can therefore support overall health in addition to potentially reducing modifiable cancer risk.
Family History and Inherited Conditions
A family history of kidney cancer can increase risk, particularly when multiple relatives are affected or kidney cancer occurs at an unusually young age. Certain inherited genetic conditions, including von Hippel-Lindau (VHL) disease and other hereditary kidney cancer syndromes, can substantially increase the likelihood of developing renal tumors.
Kidney Disease and Other Exposures
Advanced kidney disease, particularly long-term dialysis, is associated with an increased risk of kidney cancer. Certain workplace or environmental exposures may also contribute to risk depending on the substance, amount and duration of exposure.
How Is Kidney Cancer Diagnosed?
Evaluation begins with a medical history, assessment of symptoms and review of imaging or other findings that led to concern about the kidney. Imaging plays a central role in determining whether a renal mass is present and characterizing its size, location, relationship to surrounding structures and other features that can help guide treatment.
CT and MRI
CT and MRI can provide detailed images of the kidneys and surrounding structures. These studies can help determine the size and location of a tumor, whether important blood vessels or nearby tissues are involved, and whether there are findings elsewhere in the body that require further evaluation.
Ultrasound
Ultrasound uses sound waves to create images of the kidney and can help distinguish some fluid-filled cysts from solid renal masses. It may be the study that first identifies an abnormality, although CT or MRI is often needed for more detailed characterization.
Blood and Urine Testing
Blood tests can help evaluate kidney function, blood cell counts and other aspects of overall health that may influence treatment planning. Urine testing can identify blood or other abnormalities, but blood and urine tests alone generally cannot determine whether a renal mass is cancerous.
Kidney Tumor Biopsy
A biopsy uses a needle to obtain a small sample of tissue for examination under a microscope. Unlike many other cancers, not every suspicious kidney mass requires a biopsy before treatment. A renal mass biopsy may be recommended when the result could help distinguish between different conditions or meaningfully change the treatment plan.
Determining the Extent of Disease
When kidney cancer is suspected or confirmed, additional imaging may be used to determine whether the cancer remains confined to the kidney or has involved nearby structures, lymph nodes or distant areas of the body. This information helps establish the stage and guides treatment decisions.
Understanding Kidney Cancer Stage
Kidney cancer stage describes how large the cancer has grown, whether it has extended beyond the kidney and whether it has spread to lymph nodes or distant parts of the body. Stage is considered together with tumor size, location, cancer subtype and grade, kidney function, overall health and other individual factors when determining treatment.
Stage I Kidney Cancer
Stage I kidney cancer is confined to the kidney and measures 7 centimeters or smaller. Many cancers diagnosed at this stage can be treated while preserving part of the affected kidney, depending on the tumor’s size and location and the patient’s overall health.
Stage II Kidney Cancer
Stage II kidney cancer remains confined to the kidney but is larger than 7 centimeters. Surgery is commonly considered, with the specific approach determined by the tumor’s size, location, complexity and the amount of healthy kidney tissue that can safely be preserved.
Stage III Kidney Cancer
Stage III kidney cancer has extended beyond the kidney in specific ways, such as into certain nearby blood vessels or tissues, and may involve regional lymph nodes. Treatment planning becomes more complex and may involve surgery along with consideration of additional therapy based on the characteristics and recurrence risk of the cancer.
Stage IV Kidney Cancer
Stage IV kidney cancer has grown beyond nearby tissues or spread to distant parts of the body, such as the lungs, bones, liver or distant lymph nodes. Treatment frequently relies on systemic therapies that work throughout the body, while surgery, radiation or other local treatments may also be appropriate for selected patients.
Stage provides an important framework, but it does not determine treatment by itself. Two patients with kidney cancer at the same stage may receive different recommendations based on the biology and location of the tumor, kidney function, other medical conditions, previous treatment and personal goals.
How Is Kidney Cancer Treated?
Treatment for kidney cancer is personalized according to the size, location and characteristics of the tumor, whether the cancer has spread, kidney function and the patient’s overall health. Whenever it is oncologically safe and technically possible, an important goal is to control the cancer while preserving as much healthy kidney function as possible.
Kidney cancer treatment is not simply about removing a tumor. The goal is to choose the approach that provides effective cancer treatment while protecting healthy kidney function whenever possible.
Active Surveillance
Not every small kidney tumor requires immediate treatment. For selected patients with small renal masses that appear unlikely to pose an immediate threat, active surveillance uses scheduled imaging and clinical follow-up to monitor the tumor for meaningful changes. Treatment can be reconsidered if the tumor grows, its characteristics change or other concerns develop.
Partial Nephrectomy
A partial nephrectomy removes the kidney tumor along with a small margin of surrounding tissue while leaving the remainder of the kidney in place. Kidney-preserving surgery is often preferred for appropriately selected localized tumors when it can provide effective cancer control while maintaining healthy kidney tissue.
Partial nephrectomy may be performed through an open, laparoscopic or robotic-assisted approach depending on tumor complexity and individual circumstances. Robotic-assisted surgery gives the surgeon magnified visualization and precise instrument control within a minimally invasive surgical approach.
Radical Nephrectomy
A radical nephrectomy removes the affected kidney and may be recommended when the tumor is too large, complex or extensive for a partial nephrectomy to provide appropriate cancer treatment. Nearby tissues, lymph nodes or the adrenal gland are removed only when their involvement or other clinical circumstances make additional surgery appropriate.
Many people can live normally with one healthy kidney. Kidney function is evaluated before and after treatment, and long-term recommendations are individualized according to the health of the remaining kidney and other medical conditions.
Ablation for Kidney Tumors
Ablation destroys tumor tissue without surgically removing the kidney mass and can be an option for selected small kidney tumors. These techniques may be particularly useful when surgery would carry greater risk because of age, other medical conditions, previous surgery or the need to preserve kidney function.
Cryoablation
Cryoablation uses one or more thin probes placed into the kidney tumor with imaging guidance. Extremely cold temperatures are then used to freeze and destroy the targeted tissue while limiting injury to surrounding structures.
Thermal Ablation
Thermal ablation uses heat to destroy tumor tissue. Depending on the individual tumor and available approach, heat-based techniques can provide another minimally invasive treatment option for selected patients who may not require or be candidates for surgical removal.
Histotripsy for Kidney Tumors
Histotripsy is a noninvasive technology that uses focused ultrasound energy to mechanically disrupt targeted tissue without an incision or surgical probe. At Saint John’s, histotripsy is available as a treatment option for selected kidney tumors, with candidacy determined by tumor characteristics, location and the patient’s individual clinical circumstances.
Because histotripsy represents a newer approach to kidney tumor treatment, it is considered within the full range of established surgical and ablative options rather than as a replacement for treatments such as partial nephrectomy. A urologic specialist can determine whether the technology is appropriate for a particular tumor.
Jennifer Linehan, MD, discusses modern kidney cancer treatments, including minimally invasive surgery, ablation and histotripsy.
Advanced 3D Planning for Kidney Cancer Surgery
Kidney tumors can develop close to important blood vessels, the urinary collecting system and healthy kidney tissue that surgeons want to preserve. Advanced three-dimensional visualization can help the surgical team better understand these anatomical relationships before an operation and plan an approach tailored to the individual patient.
Ceevra 3D Visualization
Ceevra technology can transform a patient’s CT or MRI imaging into an interactive three-dimensional model of the kidney, tumor and surrounding anatomy. Surgeons can examine the model from different perspectives to better visualize structures that may be difficult to appreciate on conventional two-dimensional imaging alone.
This additional perspective can be particularly useful when planning complex kidney-preserving surgery. The 3D model can help the surgeon evaluate the relationship between the tumor, healthy kidney tissue and nearby structures before entering the operating room and can also help patients better understand the planned procedure.
Dr. Jennifer Linehan Explains 3D Imaging for Kidney Cancer Surgery
Jennifer Linehan, MD, discusses how advanced 3D visualization can enhance surgical planning for kidney cancer.
Treatment for Advanced Kidney Cancer
When kidney cancer has spread beyond the kidney, treatment increasingly focuses on therapies that work throughout the body. Advances in immunotherapy and targeted therapy have significantly expanded treatment options for advanced renal cell carcinoma, and treatment is selected according to the cancer subtype, extent of disease, previous treatment, overall health and genetic and molecular characteristics when relevant.
Immunotherapy
Immunotherapy helps the immune system recognize and attack cancer cells. For advanced kidney cancer, immune checkpoint inhibitors may be used together or combined with targeted therapy. The specific treatment and sequence are individualized according to the type of kidney cancer and the patient’s clinical circumstances.
Targeted Therapy
Targeted therapies interfere with specific pathways that kidney cancers use to grow, form blood vessels and survive. These medications can be used alone in certain situations or in combination with immunotherapy as part of treatment for advanced disease.
Surgery and Treatment of Metastatic Sites
Surgery can still have a role for selected patients with advanced kidney cancer, but its use depends on the extent and location of disease and the overall treatment strategy. Local treatments may also be considered for particular metastatic sites when controlling an individual area could relieve symptoms or contribute to the broader treatment plan.
Radiation Therapy
Radiation therapy is not usually the primary treatment for a localized kidney tumor, but it can play an important role in advanced disease. Highly focused radiation techniques may be used to control selected tumors or metastatic sites and can also help relieve symptoms such as pain caused by cancer that has spread to bone or other areas.
Clinical Trials and Research
Clinical trials help evaluate new therapies, combinations and treatment strategies for kidney cancer. At Saint John’s Cancer Institute, clinical and translational research complement multidisciplinary care and can provide eligible patients with opportunities to consider emerging approaches while helping advance future kidney cancer treatment.
Can the Risk of Kidney Cancer Be Reduced?
There is no guaranteed way to prevent kidney cancer, and many people who develop the disease have no clearly identifiable cause. However, addressing certain modifiable risk factors can reduce kidney cancer risk while also improving cardiovascular, kidney and overall health.
- Do not smoke or use tobacco products
- Maintain a healthy weight
- Manage high blood pressure
- Follow recommended care for chronic kidney disease
- Use appropriate workplace protections to reduce exposure to potentially harmful substances
Personalized Kidney Cancer Care at Saint John’s
At Providence Saint John’s Health Center and Saint John’s Cancer Institute, kidney cancer care brings together expertise in urologic oncology, minimally invasive and robotic surgery, medical oncology, radiation oncology, imaging and research. This multidisciplinary approach allows treatment to be tailored not only to the cancer but also to kidney function, overall health and the patient’s individual priorities.
For localized kidney tumors, our specialists emphasize kidney preservation whenever it can be achieved safely, with options that may include active surveillance, robotic partial nephrectomy, ablation and histotripsy. For more advanced disease, surgical expertise is integrated with modern immunotherapy, targeted therapy, radiation treatment and clinical research as appropriate.
If you have been diagnosed with a kidney tumor or kidney cancer, or are seeking another opinion, our specialists can help you understand the diagnosis and determine which treatment approach is appropriate for you.
If you have questions regarding kidney cancer treatment, or diagnosis, please call today. Click here to request an appointment.
