Kidney Tumours

This page provides answers to the most common questions asked by kidney cancer patients about the disease and its treatment. The answers provided should be taken only as a general guide and a starting-point for further discussion with Mr. Keeley.

Firstly, a few definitions:

• Tumour: A growth or a lump, from the Latin for swelling.
• Mass: A tumour.
• Renal: Having to do with the kidneys.
• Cancer: A disease involving abnormal growth that proceeds unchecked by the body’s normal functions. 
• Localised cancer: A tumour that has not spread.
• Metastatic: Cancer that has spread.
• Benign: A tumour that is not cancerous.
• Nephrectomy: Removal of the kidney.
• Partial nephrectomy: removal of a tumour from a kidney.

Where are the kidneys and what do they do?

The kidneys are two bean-shaped organs, about 3 inches (75mm) wide and 5 inches (125mm) long. They are located at the lower edge of the ribs on either side of the spine. Their main function is to filter the blood and to convert waste products into urine. Urine collects in an area of the kidney called the renal pelvis and then drains away via a long tube called the ureter into the bladder, where it is stored. When the bladder is full, the urine passes out of the body via another tube, the urethra.

It is important to note that all normal renal functions can be maintained by one kidney. For example, a person who is born with only one kidney or who donates a kidney for organ transplantation can still live a perfectly healthy life. Similarly, a kidney cancer patient who has one kidney removed by surgery will not necessarily suffer any significant impairment of overall renal function.

When kidneys fail to work properly or have to be removed, renal replacement therapy (dialysis) is required. This is a very rare consequence of kidney cancer treatment.

What are the types of Kidney Cancer?

There are several different types of kidney cancer. The most common is renal cell carcinoma (RCC), which accounts for about 85% of all kidney cancers. 

There are also different sub-types of RCC classified according to the particular characteristics of the cancer cells when examined under a microscope. These include clear cell (the most common type of RCC), papillary, chromophobic, oncocytic, collecting duct and sarcomatoid carcinoma. About 6-7% of kidney cancers originate in the renal pelvis or the ureter. These are known as transitional cell or urothelial cell carcinomas and resemble cancers of the bladder. 

Histological (microscopic) analysis of kidney tumours is carried out after surgery or a biopsy. This information provides the basis for predicting the future (prognosis). The information is categorised by stage (how advanced the tumour has grown) and grade (how aggressive the cancer cells appear to be). Stage ranges from T1a (smallest) to T4 (largest). Grade ranges from 1 (least aggressive) to 4 (most). Mr. Keeley will explain what your tumour characteristics are and what this means for your prognosis. About 10-20% of kidney tumours are benign, i.e. not cancerous, such as angiomyolipoma and oncocytoma.

How common is kidney cancer and what are the likely causes?

Kidney cancer is the eighth most common cancer in males and the fourteenth most common cancer in females in the UK and the number of cases is on the increase. The incidence of kidney cancer has risen by 68% over the past two decades and nearly 7,400 people are affected by the disease in the UK every year.

Kidney cancer is most common among people over the age of 40. The causes are not yet fully understood but certain factors have been identified as increasing a person’s risk of developing kidney cancer. Most patients, however, have no identifiable risk factor.

• Smoking
• Exposure to certain chemicals in the workplace
• Obesity
• Patients undergoing kidney dialysis
• People affected by rare inherited diseases have an increased risk of developing kidney cancer. These include: Von Hippel-Lindau (VHL) Syndrome, Birt-Hogg-Dube Syndrome, Hereditary Non-VHL Clear Cell Renal Cell Cancer and Hereditary Papillary Renal Cell Cancer.

In the early stages of kidney cancer, there are often no obvious symptoms or they are so mild that they are overlooked. Unfortunately, this means that by the time symptoms are evident, the disease may have progressed and be more difficult to treat.

What are the symptoms of kidney cancer?

Symptoms to watch out for include:

• Blood in the urine
• Any lump or swelling in the area of the kidney
• Low back pain that is not related to an injury
• Other more general symptoms such as tiredness, loss of appetite, weight loss or persistent fever.

If your doctor suspects that you might have a kidney problem, you may undergo some of the initial tests outlined below you may be referred to a urologist like Mr. Keeley for further tests. Kidney cancer is a complex disease and can be diagnosed at different stages, so the range of tests undertaken and the order in which they are carried out will vary.

Detection & diagnosis

Initial tests and diagnostic procedures

• Medical history and physical examination
  • You will be asked questions about your medical history and symptoms and a physical examination will be carried out to detect any lumps or swellings.
• Urinalysis
  • Urine samples will be analysed for traces of blood and other substances such as proteins.
• Blood tests
  • Your blood will be checked to see whether you have anaemia and whether your overall kidney function is normal
• Ultrasound scan
  • An ultrasound scan is carried out using sound waves using a probe and jelly (‘Jelly on the belly’). No radiation is used. This is a common way that tumours are diagnosed initially but further imaging tests (usually CT scans) are required to confirm.
• Cystoscopy
  • A cystoscopy is a procedure usually performed under local anaesthetic. A flexible telescope is passed into the bladder to investigate whether symptoms are associated with the bladder rather than the kidneys.
• Flexible ureterorenoscopy
  • If an upper urinary tract urothelial carcinoma is suspected, then a fine telescope procedure may be necessary to determine if that is the case. Biopsies can be taken and, in some cases, the tumour can be treated with laser.
• CT scan
  • If kidney cancer has been detected, a CT scan is typically performed to see how far it has progressed and whether it has spread.
• MRI scan
  • MRI is used as an alternative to CT in special circumstances.

Prognosis & survival

As with all types of cancer, if it is detected at an early stage, there is usually a much greater chance of long-term survival. If your cancer has spread, then it is likely to be more difficult to treat, although in many cases treatment can keep symptoms well under control for years.

Treatment options

All patients with kidney tumours are discussed at a multidisciplinary team (MDT) meeting. Options for treatment are considered and a recommendation is made. Further discussion with the patient is then needed to determine if the recommendation is appropriate and acceptable.

Biopsy

Some tumours are best managed by getting a small sample of tissue for analysis to determine whether it is malignant or benign. The biopsy is typically carried out under local anaesthesia by a radiologist. 

Surgery

Surgery is usually the first-line treatment for localised kidney cancer and may be all that is required if the cancer is at an early stage.

In a radical nephrectomy, the whole kidney is removed along with the tumour and the surrounding fatty tissue.

If the primary tumour is small, a partial nephrectomy may be performed, whereby only the part of the kidney containing the cancer is removed.

Laparoscopic surgery to remove the diseased kidney is now standard treatment for the majority of cases. This ‘keyhole surgery’ is less invasive and can result in reduced blood loss and reduced time in hospital. Many centres also perform robotic-assisted laparoscopic surgery to remove just the diseased part of the kidney. It is possible to lead a perfectly normal life with just one kidney. If the cancer has spread, then in some cases surgery may be considered appropriate to remove secondary tumours.

Another form of treatment is renal cryoablation, which involves freezing tumours. Needles are placed into the tumour to bring the temperature of the tumour to below -40°C, thereby killing the tumour cells. This is carried out with CT scan guidance to ensure that the needles are placed accurately. 

Treatment for metastatic disease

If kidney cancer spreads (metastatic disease), treatment needs to be directed at the whole body rather than focused just on the kidney. Until recently, treatment for metastatic kidney cancer was very limited. In the last few years new drugs have become available which are much more effective. Treatment for metastatic disease is overseen by a consultant oncologist.