Revised November 2007

Kidney Cancer

This information should not be used to self-diagnose, or be used in place of a qualified physician’s care. 

• Kidney cancers are treated by members of the BC Cancer Agency’s Genitourinary (GU) Tumour Group. 
• Other names/types of kidney cancers: renal cell carcinoma, transitional cell carcinoma, hypernephroma, chromophobe and papillary renal cell carcinoma, and Wilms’ Tumour. 
• The kidneys are two bean-shaped organs 4.5 inches long (11.4 cm) situated against the back abdominal wall, one on each side of the spine. 
• The kidneys filter the body’s blood to remove salt, toxins and water. The end result of the filtering is the creation of urine (pee). 
• The kidneys also return water to the body to maintain the balance of water that body tissues need. 
• Hormones produced by the pituitary gland control the function of the kidneys in balancing the body’s water content. 
• Having only one kidney does not create a medical problem. If one kidney is removed, the remaining kidney grows larger over the next few months to handle the extra load. 
• 90% of tumours arise in the parenchyma and are commonly called renal cell cancers. 
• Survival rate for patients with early stage cancer is up to 75%. 

What causes it and who gets it?
Listed below are some of the known risk factors for this cancer. Not all of the risk factors below may cause this cancer, but they may be contributing factors. 

• Kidney cancer constitutes approximately 4% of all cancers. 
• This cancer affects more men than women (2 or 3 times as many men as women). 
• Black people are more vulnerable to kidney cancer. 
• This cancer occurs mostly in people between the ages of 30 – 70, but especially in men aged 40-75. 
• Exposure to tobacco smoke is a known factor. The risk is about double (2x) in cigarette smokers versus non-smokers. 
• The use of drugs containing phenacetin. The use of phenacetin in prescription or over-the-counter drugs was discontinued in Canada in 1973, so this risk factor is diminishing in the general population. However, the illegal drug cocaine is often ‘cut’ with phenacetin. 
• Long-term use of diuretic drugs may increase risk. 
• Long-term dialysis. 
• Long-term use of pain medications, including over-the-counter medications. 
• Exposure to cadmium – batteries, paint, welding materials contain cadmium. This is especially true for smokers who are exposed to cadmium. 
• A specific gene mutation known as Von Hippel-Lindau may be responsible over 40% of clear cell kidney cancers. 
• Coke oven workers appear to have an above average rate of kidney cancer. (coke ovens are used primarily in the aluminum, steel, graphite, electrical, and construction industries)
• Statistics 
• BC: approximately 500 new cases in 2007. 
• Canada: approximately 4600 new cases in 2007 and 1650 patients dying from kidney cancer.
• More B.C. statistics

Can I help to prevent it? 

• Stop the use of and exposure to tobacco and cigarette smoke. 
• Being overweight and having high blood pressure can cause people to be more likely to get kidney cancer. Maintain a healthy weight and blood pressure. 
• If your brother or sister has had kidney cancer, you may be more likely to get it.

Screening for this cancer 

• No valid screening test or process is currently available for kidney cancer 
• If you have a family history of kidney cancer or of if a member of your family has developed kidney cancer at young age (< 45 years), you should discuss it with your doctor.

Signs and Symptoms 

• Often there are no symptoms. 
• Detection of kidney tumours at an early stage is difficult. 
• Blood in the urine (hematuria) The blood may be invisible, but can be detected by a urine test. 
• A dull persistent pain in the flank region, around the back and side of the abdomen. 
• Fullness in the upper abdomen or a distinct lump in this area. 
• In 15% - 20% of patients all three of the above symptoms are present and disappear upon removal of the tumour. 
• High blood pressure is reported in about 25% of patients and disappears upon removal of the tumour. 
• Fever might be present. Recurrent fevers might be a sign. 
• Loss of appetite, with or without nausea and vomiting. 
• Constipation, weakness and fatigue are occasionally seen. 
• Anemia or polycythemia. (low or high red blood cell count) 
• Unexplained weight loss without dieting.

Diagnosis 
This is a list of some or all of the tests used to diagnose this type of cancer.  For more information on diagnostic tests, please see our Recommended Links, Diagnosis section.

• Urine tests. 
• Blood tests. 
• X-ray examinations are extensively used. 
• IVP - Intravenous Pyelogram – also known as ‘excretory urogram’ – this is an X-ray mapping of the kidneys and area. A dye, called a contrast medium, is injected into the bloodstream and a series of x-rays are taken. As the dye moves through the kidneys, ureters and bladder, the x-rays provide a picture of any blockages, which shows where the tumour is located. 
• Arteriogram - a dye is injected that enters the kidney through the arteries, enabling the biggest arteries to be seen. This test is rarely used today. 
• Ultrasound. 
• CT scans.

Types & Stages

• Staging describes the extent of a cancer. The TNM classification system is used as the standard around the world. In general a lower number in each category means a better prognosis. The stage of the cancer is used to plan the treatment. 
• T describes the site and size of the main tumour (primary); 
• N describes involvement of lymph nodes; 
• M relates to whether the cancer has spread (presence or absence of distant metastases). 
• Types 
•  Renal cell carcinomas (also called adenocarcinomas) are the most common (85%) of all kidney cancers. 
• The peak incidence is between age 50 - 70. 
• Men are affected twice as much as women. 
• Transitional cell carcinomas 
• These tumours occur in the renal pelvis. 
• They affect the kidney's collecting systems and behave like cancers of the bladder or ureter, so the BC Cancer Agency treats these cancer the same way we treat transitional cell carcinomas of the bladder. 
• Constitutes 8% of kidney tumours. 
• 50% of patients have invasion of underlying muscle at diagnosis. 
• Usually affects people aged 60 - 80. 
• Wilms' Tumour 
• Found mostly in children. 
• Accounts for 5% of all kidney cancers. 
• Stages

Treatment
Cancer therapies can be highly individualized – your treatment may differ from what is described below. 

• Surgery is the preferred treatment for renal cell carcinomas because it offers the best chance for cure. 
• Nephrectomy is the removal of the affected kidney, possibly large portions of the surrounding tissues, and tying off the renal vein and artery. Some lymph nodes might also be taken, to see if the cancer has spread. 
• Removal of the kidney will relieve any pain or discomfort. 
• Renal pelvis tumours are usually also treated surgically and in most of these cases the kidney and the ureter are removed. 
• Interferon-alpha, a form of immune system therapy (also called immunotherapy or biological therapy), shrinks tumours in 10% -15% of patients and was used as the standard therapy for a long time, but is rarely used today. 
• Radiation therapy is not useful as a primary treatment, but may be used to relieve pain, or as palliative treatment for advanced cancer. 
• Chemotherapy is usually not effective against kidney cancer, except renal pelvis tumours (transitional cell). 
• Spontaneous remission (temporary or permanent cure without treatment) is more common in kidney cancer than in most other types of cancer, but is still very rare. 
• Standard therapy for patients with tumour spread (metastases) are anti-angiogenesis inhibitors (drugs which interfere with the formation of blood vessels which could feed the tumour), such Sutent® or Nexavar®. Sutent® shrinks tumours in 40% of patients and stabilizes tumour growth in another 35% of patients. 
• Children – Kidney cancers in children, including Wilms’ Tumours, are treated at BC Children’s Hospital.

Followup after Treatment 

• Guidelines for followup after treatment has ended have been developed by the BC Cancer Agency and are listed on our website. 
• You will be returned to the care of your family doctor for regular follow-up. 
• Follow-up testing is based on your type of cancer and your particular individual circumstances.

Coping with Cancer

• BC Cancer Agency staff can help with quality of life issues for those living with or affected by cancer. This includes the physical, emotional, psychological and practical aspects of care. Each cancer experience is different, but in one way or another, many cancer patients share the same needs.
• The effects of cancer and its treatment can present unique challenges: from practical concerns like money and housing, to emotional concerns like anxiety and grief. If you need support with the practical and emotional impacts of cancer, or in managing symptoms and side effects you can use the information in Coping with Cancer to connect to these resources.

Search our library catalogue 

• Automatically get a bibliography of books, videos and other items available through our library.

Recommended websites
The following websites have been selected and evaluated by the BC Cancer Agency.

1. NCI http://www.cancer.gov/  
2. CCS http://www.cancer.ca/  
3. ASCO http://cancer.net/  
BC Cancer Agency Recommended Links

Can I help with research at BCCA?
BCCA cancer patients are very helpful when it comes to the fight against cancer. Here are a few ways that you can help. 

• Clinical Trials – join our treatment-based research. Ask your oncologist if you qualify for a clinical trial. 
• What are the pros and cons of joining a clinical trial? 
• Tumour Tissue Bank – support our research by donating some of your cancer tissue. 
• BC Cancer Foundation – support our research with a donation of money.