Overview
Almost 50,000 new cases of kidney cancer are diagnosed in the United States each year. Advances in treatment for kidney cancer have given many cancer patients an improved outlook.
If you have been diagnosed with kidney cancer, you probably have many questions about your disease, how it is likely to be treated, and what happens when treatment is completed. The treatment summaries, which are based on the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines™), will help you understand the best available treatments for kidney cancer. Talk to your doctors about these therapies so that together you can decide on a plan that is right for you.
Background
The kidneys are a pair of organs on either side of your spine a bit above your waist; they are responsible for clearing waste products out of your blood. The kidneys are most efficient when both are in good working order, but a person can live with just one kidney, even if that one is not functioning with 100% efficiency. The kidneys are made up of tiny tubes (ducts) that filter the blood, remove waste, and make urine. Kidney cancer most often develops in these ducts.
Smoking, obesity, and overuse of over-the-counter pain medications are some risk factors for kidney cancer, but people with no risk factors also get this type of cancer.
Kidney cancer is divided into two large groups, each of which represents different types of cells and has different treatment requirements. Separate treatment summaries are available for each of these types:
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Renal cell cancer: Approximately 90% of kidney cancers are renal cell cancers. This treatment summary concerns renal cell cancer.
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Transitional cell cancer of the renal pelvis: A less common type of kidney cancer is transitional cell cancer, which originates from cells lining the kidney. It will be discussed in the bladder cancer summary later this year.
Renal cell cancer is further classified by the type of normal cell that has become cancerous. Knowing the subtype is important because it determines how aggressive the cancer is and how easily it can be treated.
Clear cell is the most common subtype and accounts for about 85% of all cases. All other subtypes (such as papillary or sarcomatoid) are less common, accounting for 15% of all cases, and are referred to as non-clear cell.
This summary describes the tests and treatments for renal cell cancer only. Treatment of transitional cell cancer will be discussed in the bladder cancer summary, which will be available in late 2009.
Diagnosis
Many kidney cancers are found accidentally when a patient has a chest x-ray or CT scan for another reason. Some patients have blood in their urine or pain in their side that does not go away. Others have unexplained weight loss or fatigue. If kidney cancer is suspected, your doctor will take a complete medical history and perform a physical exam. Your doctor will arrange for tests, including a urinalysis to look for blood or cancer cells in your urine and imaging tests such as ultrasound and/or computerized tomography (CT) to look for a mass on your kidney.
Most patients with kidney cancer do not require a biopsy. If imaging tests (CT and ultrasound) show that the tumor is confined to the kidney, then surgery is performed to remove the entire tumor. The tumor mass that has been surgically removed is then sent to a pathologist to determine whether the cancer started in the kidney ; the type and subtype of kidney cancer and whether cancer has spread outsidethe kidney to the lymph nodes and other organs. If tumor has spread outside the kidney, biopsy may be performed in sites where the tumor has spread outside the kidney.
The Pathology Report
The pathology report from the tumor sample obtained during surgery or in some cases biopsy, helps in knowing the type and subtype of kidney cancer you may have. The most common type of kidney cancer is the renal cell cancer. In addition, there are different subtypes of renal cell cancer that are determined by the type of cell from which the tumor originates. The most common subtype is the clear cell or and the less common is the non-clear cell. Knowing the subtype is important because it determines how aggressive the cancer is and how easily it can be treated. In addition to the pathology report, your general health other than the cancer is also important in selecting a treatment.
Staging
A formal system called staging is used to identify how localized or widespread your cancer is. Stages range from I (most localized) to IV (spread to distant organs in your body). Staging is an important part of developing the best treatment plan for you. For a more-detailed explanation of staging, see the Cancer Staging Guide.
Kidney cancer is divided into four stages that describe whether the cancer is confined to the kidney (early stage) or has spread to other organs (late or advanced stage). Doctors determine the stage using the tumor obtained during surgery and/or lymph nodes and from imaging studies that show whether cancer has (or has not) spread to other organs.
- People with stage I kidney cancer have tumors lesser than 7 cm confined to the kidney. There is no evidence of spread to the lymph nodes or any other organs.
- People with stage II kidney cancer have tumors larger than 7 cm across (about 2 ¾ inches) but confined to the kidney; in addition there is no cancer spread to lymph nodes or to distant organs.
- People with stage III kidney cancer have tumors that have spread to the adrenal gland and tissues around the kidney, or the nearby veins such as the vena cava. Stage III patients may also have enlarged or abnormal lymph nodes.
- People with stage IV kidney cancer have tumors that have spread to other organs regardless of the size of the tumor or whether cancer is found in the lymph nodes.
In general, the lower the stage of disease, the better the chance that your cancer can be cured. The higher the stage, the less likely it is that your cancer can be cured; however, newer treatments have made it possible for people with advanced stage disease to live longer, high-quality lives.
Staging is used both to help your doctors make treatment decisions and to provide you and your doctors with information about what typically happens to patients with cancers most like yours.
Treatment
Depending on the stage of disease, the characteristics of the tumor, and your general health, your treatment will include surgery and/or systemic therapy with targeted therapy, biologic agents, or chemotherapy.
Surgery is used to remove the tumor and provides the best chance of cure. The more localized the cancer, the better the chance that the surgeon can remove it completely.
For disease that has spread to other organs, targeted therapy, biological agents, and chemotherapy are used to kill tumor cells, slow the growth of the tumor, and control the disease.
Your doctor should provide you with a written care plan explaining what treatments you will have, when they will occur, how often (if you will have targeted therapy or biologic therapy), and what side effects you may experience.
Each of these treatments has side effects. Some side effects can be anticipated and you can have treatment to reduce their severity. Talk with your doctor about what to expect from your treatment and how these side effects can be prevented, reduced, managed, or eliminated. Generally, reducing side effects does not affect the effectiveness of treatment.
You will be asked to sign an informed consent document indicating that you have been told about your treatment and what to expect. It is very important that you ask your doctor or nurse every question you have. Cancer and its treatment are complicated, and most patients have questions.
Clinical Trials
New therapies and combinations of therapies are enabling people with cancer to live longer, better-quality lives than ever before. You may want to find out whether you are eligible to participate in a clinical trial, in which new and experimental therapies are compared with standard treatments. More information is available in the Guide to Clinical Trials and Demystifying Common Clinical Trials Myths.
Prognosis
In determining a prognosis—the likely course or outcome of a disease and its treatment—a doctor may look at kidney cancer survival statistics taken from studies of large groups of patients. However, these statistics:
- Are estimates only
- Can vary widely with each cancer stage
- Are sometimes based on older data that do not reflect recent advances in early detection and treatment
- Cannot be used to precisely predict your survival
Your individual prognosis will be affected by many factors, including:
- Your age
- Your overall health
- The stage of your cancer
- Your response to the treatment(s) being used
Life After Treatment
After completion of your treatment, you will begin a period called follow-up. During this period you will visit your doctor at regular intervals. The doctor will perform a physical exam, ask you about how you are feeling, and order tests to ensure your continued good health. In the event that your cancer recurs (comes back), these visits will help your doctor find the recurrence so that you can begin treatment.