Kidney cancer

Tuesday 1 November, 2016

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On this page: The kidneys | What is the main type of kidney cancer? | Are there other types? | How common is kidney cancer? | What are the symptoms of kidney cancer? | What are the risk factors? | Which health professionals will I see?

The kidneys

The kidneys are two bean-shaped organs, each about the size of a fist. They are deep inside your abdomen, positioned near the middle of your back, on either side of the spine.

Blood filtering

The main role of the kidneys is to filter and clean the blood. Blood goes into each kidney through the renal artery and is filtered through millions of tiny sieves called nephrons. It then goes back into the rest of the body through the renal vein.

The urinary system

The kidneys are part of the body’s urinary system. When they filter the blood, they remove excess water and waste products and turn these into urine. Urine travels from each kidney into a funnel called the renal pelvis, then through a tube called the ureter, and into the bladder.

Urine is stored in the bladder until urination, when it leaves the body through a tube called the urethra. In women, the urethra is a short tube in front of the vagina. In men, the tube is longer and passes through the prostate and penis.

Hormone production

The kidneys’ main function is to cleanse the blood, but they also help your body control how much blood it needs. They do this by producing hormones that trigger the production of red blood cells and help regulate blood pressure.

Adrenal glands

An adrenal gland sits above each kidney (‘ad’ means above, and ‘renal’ means kidney). The adrenal glands produce a number of hormones. Although these glands are not part of the urinary system, kidney cancer can sometimes spread to them.

The urinary system

What is the main type of kidney cancer?

Kidney cancer is cancer that starts in the cells of the kidney. About 9 out of 10 kidney cancers are renal cell carcinoma (RCC), sometimes called renal adenocarcinoma. The information in this section is about RCC.

In the early stages of RCC, the primary cancer forms a tumour that is confined to the kidney. In almost all cases, only a single kidney is affected, but in rare cases, both can be affected. As the cancer grows, it may invade structures near the kidney, such as the surrounding fatty tissue, veins, adrenal glands, ureters or the liver. It might also spread to other parts of the body, such as the lungs or bones.

Types of renal cell carcinoma (RCC)

There are several types of renal cell carcinoma, based on the way the cells look under the microscope. The most common RCC is clear cell carcinoma.

Clear cell carcinoma
  • makes up about 75% of RCC cases
  • cancer cells look empty or clear
Papillary renal cell carcinoma
  • makes up about 10–15% of RCC cases
  • cancer cells are arranged in finger-like fronds
Chromophobe renal cell carcinoma
  • makes up about 5% of RCC cases
  • cancer cells are large and pale
Other types of RCC
  • include renal medullary carcinoma, collecting duct carcinoma, XP11 translocation RCC, sarcomatoid RCC and other very rare types
  • together make up about 5–10% of RCC cases

Are there other types?

RCC is the most common type of kidney cancer, but there are other types. An uncommon type is urothelial carcinoma (or transitional cell carcinoma). This can begin in the ureter or in the renal pelvis, where the kidney and ureter meet. Urothelial carcinoma of the kidney or ureter behaves and is treated like bladder cancer (another type of urothelial cancer), rather than like RCC. For more information, see Understanding Bladder Cancer or call Cancer Council  13 11 20.

Very rarely, cancer in the kidney can be a secondary cancer (metastasis) from a primary cancer located in another part of the body. However, this type of cancer is not kidney cancer and it behaves more like the original cancer.

The most common type of kidney cancer in younger children is called Wilms tumour (or nephroblastoma), but this is still a rare cancer. Visit Cancer Australia’s website for more information.

How common is kidney cancer?

More than 3000 Australians are diagnosed with kidney cancer each year. It makes up about 2.5% of all cancers and is the 10th most common cancer in Australia. The risk of kidney cancer increases with age, and it is rare in people under 40. Men are almost twice as likely to be diagnosed with kidney cancer as women are.

What are the symptoms of kidney cancer?

Most people with kidney cancer have no symptoms and many are diagnosed with the disease when they see a doctor for an unrelated reason. Symptoms can, however, include:

  • blood in the urine (haematuria) – this may be obvious or the urine may just look dark, rusty or brown
  • pain in the lower back or side not caused by injury
  • a lump in the abdomen
  • constant tiredness
  • unexplained weight loss
  • fever (not caused by a cold or flu).

Cancer can affect the kidneys’ production of hormones (see above), and this may lead to a low red blood cell count (anaemia), a high red blood cell count (polycythaemia) or high levels of blood calcium (hypercalcaemia). Sometimes these problems can cause symptoms such as fatigue, dizziness, headaches, constipation, abdominal pain, and depression.

The symptoms listed above can also occur with other illnesses, so they don’t necessarily mean you have kidney cancer – only tests can confirm the diagnosis. If you are concerned, make an appointment with your general practitioner (GP).

"Kidney cancer can be a silent cancer until it is quite advanced, so I do feel thankful that it was discovered incidentally, when it was small and easier to treat." – Chris

What are the risk factors?

Several factors may increase the risk of a person developing kidney cancer:

  • Smoking – People who smoke have almost twice the risk of developing kidney cancer as nonsmokers. Up to one-third of all kidney cancers are thought to be related to smoking.
  • Obesity – Excess body fat may cause changes in certain hormones that can lead to kidney cancer.
  • High blood pressure – Whether it is caused by being overweight or another medical condition, high blood pressure increases the risk of kidney cancer.
  • Kidney failure – People with end-stage kidney disease have a higher risk of developing kidney cancer.
  • Family history – People who have family members with kidney cancer, especially a sibling, are at increased risk.
  • Inherited conditions – About 3–5% of kidney cancers occur in people with particular inherited syndromes, including von Hippel-Lindau disease, hereditary papillary RCC and Birt-Hogg-Dubé syndrome.
  • Exposure to toxic substances at work – The risk may be higher after regular exposure to certain chemicals, such as some metal degreasers, arsenic or cadmium.

Which health professionals will I see?

Your general practitioner (GP) will arrange the first tests to assess your symptoms. If these tests do not rule out cancer, you will usually be referred to a specialist, such as a urologist. The specialist will arrange further tests.

If kidney cancer is diagnosed, the specialist will advise you about treatment options. You will then be cared for by a range of other health professionals who specialise in different aspects of your treatment. This is called a multidisciplinary team (MDT) and it may include some or all of the health professionals listed below.

MDT health professionals
GP assists you with treatment decisions and works in partnership with your specialists in providing ongoing care
urologist* specialises in treating diseases of the male and female urinary system and the male reproductive system; performs surgery
nephrologist* specialises in caring for people with conditions that cause kidney (renal) failure or impairment; may be consulted by your urologist when planning surgery
medicol oncologist* specialises in treating cancer with drug therapies such as targeted therapy, immunotherapy and chemotherapy
radiation oncologist* prescribes and coordinates the course of radiotherapy
interventional radiologist* uses imaging scans to diagnose cancer, may perform a biopsy under ultrasound or CT, and delivers some treatments
cancer care coordinator or clinical nurse consultant (CNC) coordinates your care, liaises with other members of the MDT and supports you and your family throughout treatment
nurses administer drugs and provide care, information and support throughout your treatment
physiotherapist, occupational therapist assist with physical and practical problems, including restoring a range of movement after surgery
dietitian recommends an eating plan to follow while you are in treatment and recovery
social worker links you to support services and helps you with emotional or practical issues
psychologist, counsellor provide emotional support and help manage any feelings of depression and anxiety

*Specialist doctor

Reviewed by: Dr Craig Gedye, Medical Oncologist, Calvary Mater Hospital, Newcastle, and Senior Conjoint Lecturer, School of Biomedical Sciences and Pharmacy, The University of Newcastle, NSW; Gregory Bock, Urology Cancer Nurse Coordinator, WA Cancer and Palliative Care Network, WA; A/Prof Declan Murphy, Urologist, Chair of Uro-Oncology and Director of Robotic Surgery, Peter MacCallum Cancer Centre, VIC; Caitriona Nienaber, 13 11 20 Consultant, Cancer Council WA, WA; Jodie Turpin, Consumer.

Diagnosing kidney cancer

Tuesday 1 November 2016

Treatment for early kidney cancer

Tuesday 1 November 2016

Treatment for advanced kidney cancer

Tuesday 1 November 2016

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