Listed below are some frequently asked questions about kidney cancer.
Q: What are the kidneys, and what do they do?
A: The kidneys are two bean-shaped organs, each about the size of a fist. You have one on either side of your spine in the middle of your back. They have three main roles:
Filter waste from the blood and make urine
Make the hormone erythropoietin that controls the production of red blood cells in the bone marrow
Help regulate blood pressure
While most people are born with two kidneys, it is possible to survive with one, or none. People with no kidneys or with kidneys that do not work right survive with the help of dialysis. With dialysis, a special machine does the kidneys' job of filtering the blood.
Q: What is kidney cancer?
A: This is cancer that starts in the kidney. The most common type of kidney cancer is called renal cell carcinoma (RCC). The term renal is derived from the Latin word for kidney. About 90 percent of all kidney cancers are renal cell carcinomas. The other 10 percent are made up of transitional cell carcinomas, Wilms tumors (found in children), and other rare tumors.
Q: Are there different types of renal cell carcinoma?
A: These are the five RCC. A pathologist can identify them under a microscope based on how they look:
Clear cell, which is the most common type of RCC
Papillary, which is the second most common type
Q: Who gets kidney cancer?
A: About 65,000 people in the United States are told they have kidney cancer each year. Men get kidney cancer more often than women. People who smoke have almost twice the risk of getting kidney cancer as nonsmokers. Here are some other risk factors:
Von Hippel-Lindau disease
Family history of kidney cancer
Exposure to workplace chemicals, such as cadmium, benzene, and asbestos
However, many people with kidney cancer have no known risk factors. On the other hand, people who have one or more known risk factors may never get the disease.
Q: What are the symptoms of kidney cancer?
A: In the early stages, kidney cancer often causes no symptoms. As the cancer grows, symptoms may develop. These are the most common symptoms in people with kidney cancer:
Blood in the urine
Side or back pain
A mass or lump in the side or lower back
Fatigue, which is a chronic, unexplained tiredness
Rapid weight loss without making an effort to lose weight
Other symptoms, such as fever with no known cause, leg or ankle swelling, and high blood pressure
People with renal cancer may have any combination of these symptoms. If you have any of these symptoms, see a doctor as soon as possible.
Q: How is kidney cancer diagnosed?
A: If a doctor thinks a person has kidney cancer, there are many ways to find out for sure. These are the tests a doctor may do, and they are usually done in about this order:
Medical history and physical exam. The doctor asks all about the person's medical history. He or she also asks about the person's family history of kidney cancer and other conditions that may be related to kidney cancer. This includes assessing any risk factors. The doctor will also do an exam.
Urinalysis. For this test, the person collects a small amount of his or her urine. It is then tested to see if blood, protein, or bacteria is present. The doctor may do a special urine test called urine cytology. This test checks for cancer cells in the urine.
Blood tests. A complete set of blood tests is usually done when a doctor suspects kidney cancer. There is no specific blood test that can diagnose kidney cancer, but tests can show problems associated with kidney cancer.
Imaging tests. These are some of the tests used to take pictures of the inside of a person's body:
Intravenous pyelogram (IVP)
Biopsy. During a biopsy, the doctor removes a small amount of the tumor. A pathologist then examines this sample under a microscope. For kidney cancer, the type of biopsy used is called fine needle aspiration (FNA). In most cases of suspected kidney cancer, no biopsy is taken. When a CT scan or an MRI suggests kidney cancer, people usually go directly to surgery to have the tumor and maybe the entire kidney removed. The pathologist examines the specimen removed during surgery to confirm the diagnosis.
Q: How is kidney cancer treated?
A: Someone with kidney cancer may have only one of the following treatments. Or they may have more than one:
Surgery. This is done to remove the tumor from the kidney. The whole kidney may be taken out, or only the part of the kidney with the tumor may be removed. Surgery is the standard of care for cancer that is confined to the kidney and has not spread to other organs.
Targeted therapy. These drugs attack specific areas in the cancer cells or target the tumor's blood supply. This is the most common treatment for more advanced kidney cancers.
Biological therapy. This is used to treat the cancer and reduce the chance that the cancer will spread to other parts of the body. This treatment uses drugs that may help stimulate the body's immune system to fight cancer cells.
Radiation therapy. This is used to kill cancer cells using high energy X-rays.
Chemotherapy. This is used to try to kill the cancer cells in the kidney and those that have spread to other organs.
Doctors are always finding new ways to treat kidney cancer. New treatments are tested in clinical trials. Before beginning treatment, it's a good idea to ask your doctor if there are any clinical trials that may be helpful to you.
Q: Should everyone with kidney cancer get a second opinion?
A: Many people with cancer get a second opinion from another doctor before deciding on treatment. Here are some of the many reasons to get a second opinion:
You are not comfortable with the treatment decision.
You have a rare type of cancer.
There are different ways to treat the cancer.
You are not able to see a cancer expert.
Your health insurance requires a second opinion before treatment is started.
Q: How can someone get a second opinion about a diagnosis of kidney cancer?
A: Here are ways to find someone to give a second opinion:
Ask the doctor for the name of a specialist.
Call the Cancer Information Service. The number is 800-4-CANCER (800-422-6237). Callers can learn about centers and programs supported by the National Cancer Institute (NCI) or visit the NCI website.
Call the Kidney Cancer Association. The number is 800-850-9132, or check their website.
Get the names of doctors from a hospital, medical school or society, or cancer advocacy group.
Ask people who have had kidney cancer for doctors' names.
Q: If I have one kidney removed, can I live normally?
A: After a surgeon takes out a kidney, the remaining kidney takes on the work of both. Most people left with only one kidney experience no long-term health problems. However, they should avoid anything that could harm the remaining kidney. It is very important to talk with your doctor whenever you start taking new medications or if you have bladder infections or other problems that could affect your kidney. If the remaining kidney is damaged, you may eventually need dialysis. With dialysis, a special machine does the kidneys' job of filtering the blood.
Q: What's new in kidney cancer research?
A: Researchers are looking for ways to treat and cure kidney cancer in these ways:
Genetic therapy. Genetics is the study of genes, which are the "instructions" that direct our cells to make people what they are. Scientists are looking at several genes that may be related to the reason normal kidney cells change into cancerous cells. Their hope is to be able to put normal genes back into the cancerous kidney cells to reverse their change into cancer. This treatment is still very experimental.
Biological therapy. Biological therapy includes new drugs that are being tested in clinical trials. Combining drugs with other types of treatment is also being tested.
Chemotherapy. Chemotherapy is not very effective in fighting kidney cancer. But researchers are testing new types of drugs. They believe that understanding why kidney cancer cells are so resistant to chemotherapy will provide answers that can help make new and better chemotherapy and other treatment strategies.
Other new treatment methods
Q: What are clinical trials?
A: Clinical trials are studies of new kinds of cancer treatments. Doctors do clinical trials to learn about how well new treatments work and what their side effects are. If new treatments look promising, they are compared to the current treatment to see if they work better or have fewer side effects. People who participate in these studies may benefit from access to new treatments before the FDA approves them. Participants also help further our understanding of cancer and help people who may develop cancer in the future.