Kidney Cancer

If found early, the survival rate for patients with kidney cancer ranges from 79 to 100 percent. More than 100,000 survivors of kidney cancer are alive in the United States today. The following information addresses the most common questions about kidney tumors and serves as a supplement to the discussion that you have with your physician.

Most people have two functional kidneys. The kidneys produce urine that drains through narrow tubes (called ureters) into the bladder. The kidneys are usually located in each flank protected by muscles of the back and rib cage. The kidneys are contained within a fibrous sheath called the Gerota's fascia and surrounded by a layer of fat. The kidney capsule is a thin layer that covers the outer surface of the kidney (similar to the red peel of an apple). The primary vein that drains the kidney (renal vein) merges with the vein that takes blood to the heart (vena cava). An adrenal gland is located above each kidney within Gerota's fascia.

The adrenal glands, which are not part of the kidney, are located near the top of each kidney. The adrenal glands regulate blood sugar, potassium, body fluids and sex hormones. They also control the body's response to stress by producing a hormone called adrenaline.

The kidney is the main filter of the body and thus performs many bodily functions, such as controlling fluid balance, regulating electrolytes (e.g., sodium, potassium, calcium, magnesium), preventing acid buildup, eliminating waste products, producing urine, and regulating blood pressure. The kidney also manufactures a hormone called erythropoietin that stimulates the production of red blood cells.

When the kidneys are damaged or a significant portion of kidney tissue is removed, the normal processes listed above may be impaired. In most cases, mild to moderate impairment causes very minor problems. In cases when kidney function is severely impaired, dialysis may be required.

Risk Factors:

The following associations may increase the risk of developing kidney cancer:

  • Smoking
  • Hypertension
  • Obesity
  • Family history of kidney cancer
  • Chronic kidney failure and/or dialysis 
  • Diet with high caloric intake or fried/sauteed meat
  • Von Hippel-Lindau syndrome 
  • Tuberous sclerosis

Symptoms:

Many kidney tumors do not produce symptoms, but may be detected incidentally during the evaluation of an unrelated problem or during routine screenings for people who are in high-risk categories (e.g. Von Hippel-Lindau disease, tuberous sclerosis). Compression, stretching and invasion of structures near the kidney may cause pain (in the flank, abdomen or back), palpable mass, and blood in the urine (microscopic or grossly visible). If cancer spreads (metastasizes) beyond the kidney, symptoms depend upon the involved organ. Shortness of breath or coughing up blood may occur when cancer is in the lung; bone pain or fracture may occur when cancer is in the bone; and neurological symptoms may occur when cancer is in the brain. In some cases, the cancer causes associated clinical or laboratory abnormalities called paraneoplastic syndromes. These syndromes are observed in approximately 20 percent of patients with kidney cancer and can occur in any stage (including cancers confined to the kidney). Symptoms from paraneoplastic syndromes include weight loss, loss of appetite, fever, sweats and high blood pressure. Laboratory findings include elevated red blood cell sedimentation rate, low blood count (anemia), high calcium level in the blood, abnormal liver function tests, elevated alkaline phosphatase in the blood, and high blood count. In many cases, the paraneoplastic syndrome resolves after the cancer is removed.

Diagnosis:

Unfortunately, there are no blood or urine tests that directly detect the presence of kidney tumors. When a kidney tumor is suspected, a kidney imaging study is obtained. The initial imaging study is usually an ultrasound or CT scan. In some cases, a combination of imaging studies may be required to completely evaluate the tumor. If cancer is suspected, the patient should be evaluated to see if the cancer has spread beyond the kidney (metastasis). An evaluation for metastasis includes an abdominal CT scan or MRI, chest X-ray and blood tests. A bone scan is also recommended if the patient has bone pain, recent bone fractures, or certain abnormalities on their blood tests. Additional tests may be obtained when indicated. Kidney cancer has the tendency to grow into the renal vein and vena cava. The portion of the cancer that extends into these veins is called "tumor thrombus." Imaging studies, particularly CT or MRI, can help determine if tumor thrombus is present.

Stages:

The most commonly used staging system for kidney cancer was developed by the American Joint Committee on Cancer (AJCC). The most current version is the 2009 AJCC Staging System. This staging system includes the extent of the primary kidney tumor (T stage), the status of lymph nodes near the kidney (N stage) and the presence or absence of metastases (M stage). With kidney cancer, the lymph nodes near the kidney are referred to as regional lymph nodes. Clinical stage is based on radiographic imaging before surgery, whereas pathologic stage is based on the analysis of surgically removed tissue. Staging the cancer helps predict prognosis and survival. In general, cancers with higher T stage, lymph node metastasis, or distant metastasis have a worse prognosis and shorter survival rates, and these patients need to consider more aggressive treatments.


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