Kidney Cancer

The UofL Brown Cancer Center’s method of delivering personalized care for kidney cancer can make a crucial difference in your outcome and recovery.

Overview

The UofL Brown Cancer Center’s method of delivering personalized care for kidney cancer can make a crucial difference in your outcome and recovery.

You are the focus of a team of experts who specialize in kidney cancer and strive to provide the most advanced treatment with the least impact on your body.

Working together, our team of surgical and medical oncologists, as well as specially trained support staff, utilizes leading-edge technology and techniques from diagnosis through treatment. Your kidney cancer treatment options may include:

  • Kidney-sparing surgery
  • Laparoscopic and robotic surgery
  • Targeted therapies
  • Immunotherapy, including interferon and interleukin-2, nivolumab
  • Cryoablation, radiofrequency ablation and active surveillance

At the UofL Brown Cancer Center, your care will be under the direction of a multidisciplinary team that combines the expertise from multiple disciplines to formulate the best, most individualized treatment plan for your cancer.

There are also clinical trials available for advanced kidney cancer to ensure the most cutting-edge treatments are available to our patients.

Understanding a disease is the first step toward finding the right care. Get the facts about kidney cancer, including the different types, how it starts and who’s at risk.

The American Cancer Society estimates that more than 58,240 people were diagnosed with kidney cancer in 2010. In the 1980s, up to 80 percent of kidney cancers were in advanced stages when they were diagnosed. Today, thanks to more advanced detection methods, only about 40 percent of cases are advanced at diagnosis.

You have two kidneys, one on each side of the back above the waist. Kidneys filter blood, and the waste is carried in the urine, which is produced by microscopic tubules. Urine flows into the ureter tubes and down into the bladder. Cancer arises from the microscopic tubules inside the kidney. Although kidney cancer usually grows as a single mass within the kidney, a kidney may contain more than one tumor, or tumors may be found in both kidneys.

Surgery offers the highest chance for successful treatment when kidney cancer has not spread. Once the cancer has spread beyond the kidney, the chance for successful treatment becomes much lower. Since 2006, new-generation drugs called targeted therapies have become available to control the cancer more successfully than prior medications.

Kidney cancer types

Renal cell carcinoma (cancer) (RCC) is the most prevalent form of kidney cancer. Types of RCC include clear cell, papillary, chromophobe and collecting duct carcinomas. Clear cell carcinoma accounts for 80 percent of all RCC cases, and most treatments are focused on this type.

Wilms’ tumor is a childhood cancer, responsible for 95 percent of pediatric kidney cancer cases.

Urothelial cancer of the kidney pelvis and ureter: Cancer of the urinary tract that occurs in the kidney or ureter is called urothelial carcinoma. It is not considered kidney cancer, although it is frequently called that in error.

Some cases of kidney cancer can be passed down from one generation to the next. Genetic counseling may be right for you.

Risk factors

Anything that increases your chance of getting kidney cancer is called a risk factor. The biggest risk for kidney cancer is smoking. 

Other kidney cancer risk factors include:

  • Age: Most cases occur after age 50
  • Gender: Men are more than twice as likely to get kidney cancer as women
  • Obesity
  • High blood pressure
  • Exposure to asbestos, cadmium, and coke (used in making steel), benzene, herbicides and organic solvents
  • Advanced kidney disease and long-term kidney dialysis
  • Race: African-Americans have a slightly higher rate of kidney cancer
  • Rare inherited conditions including von Hippel-Lindau disease or hereditary papillary renal cell carcinoma
  • Family history of kidney disease

Not everyone with risk factors gets kidney cancer. However, if you have risk factors, it’s a good idea to discuss them with your doctor.

Most cancers have the same symptoms as other, less serious conditions. Still, it’s important to know the signs.

Due to the location of the kidneys, many people with kidney cancer don't have symptoms until the tumor has grown quite large. If there are symptoms, they vary from person to person.

The most common kidney cancer symptom is blood in the urine (hematuria), but hematuria can be caused by a variety of conditions so it doesn't necessarily mean you have cancer.

Other kidney cancer symptoms may include:

  • A lump or mass on the side or lower back
  • Unexplained fever for a few weeks
  • Rapid weight loss
  • Lingering dull ache or pain in the side, abdomen or lower back
  • Feeling fatigued or in poor health
  • Swelling of ankles and legs

These symptoms do not always mean you have kidney cancer and may be caused by other conditions. However, it is important to discuss any symptoms with your doctor, since they may signal other health problems.

Blood tests, imaging exams and even surgical procedures are used to check for cancer.

At UofL Brown Cancer Center, our experts specialize in kidney cancer and use the very latest technology to pinpoint the exact extent and location of each kidney cancer tumor.

If you have been diagnosed with a kidney tumor or kidney cancer, it’s important to be treated as early as possible. This helps improve your chances for successful treatment. Most tumors of the kidney are malignant (cancer), but some are benign (not cancer). There is no imaging test that can tell if a kidney tumor is benign or cancerous.

If you have symptoms that may signal kidney cancer, your doctor will ask you questions about your health; your lifestyle, including smoking and drinking habits; and your family medical history.

One or more of the following tests may be used to find out if you have kidney cancer and if it has spread. These tests also may be used to find out if treatment is working.

Blood and urine tests

Imaging tests, which may include:

  • CT or CAT (computed axial tomography) scans
  • MRI (magnetic resonance imaging) scans
  • Ultrasound
  • Chest X-Ray
  • Bone Scan

Biopsy and fine needle aspiration (FNA) are sometimes used to obtain a biopsy of the kidney. This involves the insertion of a long, thin needle into the kidney to take a tiny sample of tissue for examination under a microscope. With modern biopsy methods, there is virtually no risk of ‘spreading cancer.’ Our team of radiologists is highly experienced in safe biopsy methods.

Kidney cancer staging

If you are diagnosed with kidney cancer, your doctor will determine the stage of the disease. Staging is a way of classifying cancer by how much disease is in the body and where it has spread when it is diagnosed. This helps the doctor plan the best way to treat the cancer.

After a biopsy or surgery for removal of the tumor, a grade or nuclear grade is assigned to kidney cancer. The cancer grade is a measure of how likely the cancer is to spread. The pathologist assigns the grade after looking at the tumor cells under the microscope.

Once the staging classification is determined, it stays the same even if treatment is successful or the cancer spreads

Stage I: The tumor is 7 centimeters or smaller and is only in the kidney

Stage II: The tumor is larger than 7 centimeters and is only in the kidney

Stage III: Cancer is found in one of the following:

  • The kidney and one nearby lymph node
  • An adrenal gland or the layer of fatty tissue around the kidney, also may be in one nearby lymph node
  • The main blood vessels of the kidney, also may be in one nearby lymph node

Stage IV: Cancer has spread to one of the following:

  • Beyond the layer of fatty tissue around the kidney and possibly to one nearby lymph node
  • To two or more nearby lymph nodes
  • To other organs, such as the bowel, pancreas or lungs and possibly to nearby lymph nod

Common cancer treatments include chemotherapy, radiation treatment and surgery. Doctors select a treatment plan based on your diagnosis and disease stage.

At UofL Brown Cancer Center, your kidney cancer treatment is personalized to include the most-advanced therapies with the fewest possible side effects. Our experts work together – and with you – to give you the highest chance for successful treatment and recovery.

UofL Brown Cancer Center offers some of the most advanced therapies for kidney cancer. These include minimally invasive surgeries that can mean less pain and quicker recovery.

In addition to treating the cancer itself, treatment options are available for cancer patients dealing with sexual problems. Talk to your doctor about any concerns.

If you are diagnosed with kidney cancer, your doctor will discuss the best options to treat it. This depends on several factors, including the stage of the cancer and your general health. Your treatment for kidney cancer at UofL Brown Cancer Center will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.

Surgery

Tumors that are confined to the kidney or to the area around the kidney usually are surgically removed. It’s important for the surgeon to leave as much of the kidney as possible. When your surgeon has a high level of experience in this type of surgery, your outcomes are likely to be better.

At UofL Brown Cancer Center, these surgeries sometimes can be minimally invasive (done with a laparoscope and robotic technology).

You can usually live with one kidney, but if both kidneys are removed or not working you will need kidney dialysis (a way to clean the blood with a machine). A kidney transplant may be an option for some patients.

The main types of surgery for kidney cancer include:

Radical nephrectomy is removal of the entire kidney along with the surrounding fatty tissue. Sometimes the adrenal gland and nearby lymph nodes are removed too. One of the following methods will be used, depending on the size of the tumor and other factors that your surgeon will consider.

Standard or "open" surgery: A four- to eight-inch incision (cut) is made in the front of the abdomen. The surgeon removes the entire kidney through the incision.

Laparoscopic radical nephrectomy (LRN): A small incision is made to insert a laparoscope. Other tiny incisions are made for miniature surgical instruments to remove the kidney. Benefits of this procedure include a shorter hospital stay (one to two days vs. five to seven days), shorter recovery time and less blood loss than with open surgery. Surgeon experience is important for this procedure.

Partial nephrectomy (or kidney-sparing surgery): Only the cancerous portion of the kidney is removed, along with a margin of healthy tissue around it. High quality pre-treatment imaging is used to determine what will be removed, and ultrasound can be used to look for additional tumors during surgery.

Candidates for partial nephrectomy are chosen based on favorable tumor location, co-existing health problems that may affect the treatment outcome, the condition of the kidneys and the patient's desire to save the kidney. Partial nephrectomy is best for kidney cancer tumors that are 4 centimeters or less in size. They can be done for larger tumors when necessary. Recurrence rates for stage 1 cancers removed by either radical or partial nephrectomy are about 5 percent.

Partial nephrectomy can be done by traditional or laparoscopic robotic methods. Robotic partial nephrectomy (RPN) offers a shorter hospital stay (one to two days instead of four to five days) and quicker recovery.

Energy ablative techniques

Other minimally invasive surgery techniques use either heat or cold to treat tumors in place, without having to remove the kidney. RFA and cryoablation are ideal for smaller kidney tumors in patients considered at high risk for surgery.

Cryoablation freezes the tumor to -140 degrees Centigrade with a long, thin probe inserted into the tumor. Intensive follow-up with X-rays or other imaging procedures is required to ensure that the tumor has been destroyed.

Radiofrequency ablation (RFA) is similar to cryoablation, but heat is used to destroy the tumor instead of cold. 

Radiation therapy

Radiation has a limited role in the treatment of kidney cancer. Kidney tumors are not very sensitive to radiation, but healthy kidneys are, so radiation as a frontline treatment is not advisable. In some cases, radiation may be used to help relieve pain and other symptoms when kidney cancer has spread to the bone, brain, or other parts of the body. 

Another Radiation therapy option is the Cyberknife radiosurgery; which is not really surgery. The CyberKnife’s robotic arm will position itself around your body, delivering radiation with pinpoint precision.

Targeted therapies

Kidney tumors are very vascular, meaning they have a large number of blood vessels. The tumors use a process called angiogenesis to create their own network of blood vessels, enabling the cancer to thrive and grow.

These blood vessels are vulnerable to anti-angiogenic drugs, which are developed to take advantage of this process. This new generation of drugs targets the blood vessels leading to the tumor without harming normal blood vessels.

A number of agents have been developed, including Sutent® (sunitinib), Nexavar® (sorafenib), Votrient® (pazopanib) and Avastin® (bevacizumab). Another drug, Torisel® (temsirolimus), has shown promise in patients with more aggressive kidney disease.

Chemotherapy

Most traditional chemotherapy is generally ineffective against kidney tumors, with a few exceptions. A combination of gemcitabine and capecitabine is sometimes used to treat metastatic renal cell cancer.

Immunotherapy

Renal cell carcinoma is occasionally responsive to immunotherapy, and is one option for kidney cancer that has metastasized (spread). These therapies have only a general, non-targeted effect on the immune system, and their side effects are not well tolerated by many patients.

Two types of immunotherapy are used to treat renal cell cancer:

Interferon-alpha (IFN) is a protein produced by white blood cells in response to a viral infection. It increases antigens on the surface of cancer cells, making them more susceptible to attack by the immune system. IFN is rarely used today. 

Interleukin-2 (IL-2) is a protein that stimulates the growth of immune cells and activates them to destroy tumor cells. High-dose IL-2 therapy is given by IV, and treatment requires a five-day hospital stay. Side effects include hypotension (low blood pressure), flu-like symptoms (fever, muscle aches, headache and nasal congestion), decreased urine production, nausea and diarrhea. IL-2 can cause a complete shrinkage of disease in 5 to 10 percent of patients with clear cell tumors. For that reason, it is still offered as an option to patients with appropriate tumor characteristics who are in excellent overall physical condition.

Our doctors at UofL Brown Cancer Center are proudly part of UofL Physicians and the UofL School of Medicine.

We believe knowledge comes from questioning the status quo, discovering more about disease and using that knowledge to improve the health of our community. Our physicians are the teachers and researchers at the UofL School of Medicine, involved in the research and development of new treatments and cures for cancer. This means you receive the most advanced and appropriate treatment, even for complex or rare conditions.

To learn more about the physicians who make the academic difference in kidney cancer treatment, visit the UofL Physicians website here.