Kidney Cancer (Kidney Tumor): Symptoms, Diagnosis & Treatment

Kidney cancer: the most important facts in brief
Kidney Cancer Definition: What is Kidney Cancer?
Kidney cancer cause and risk factors
Typical kidney tumor symptoms
Diagnosis of kidney cancer: what is examined?
Kidney cancer: prognosis and course
How can kidney cancer be treated?
Kidney cancer: aftercare and rehabilitation
Prevention and screening of renal cell carcinoma

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Kidney cancer: the most important facts in brief

Kidney cancer is a malignant growth of individual cells in the kidney
The most common kidney tumor is renal cell carcinoma
Kidney cancer symptoms are rare and non-specific
Early diagnosis and treatment improves the chances of recovery

Kidney Cancer Definition: What is Kidney Cancer?

Kidney cancer is caused by the malignant (malignant) change and proliferation of individual cells in the kidney . These growths can originate from various kidney tissues and crowd out healthy tissue. By far the most common kidney cancer is renal cell carcinoma . This usually only affects one of the two kidneys , which is why patients rarely have problems with urination. Kidney cancer accounts for about 2% of all cancers . Most people with kidney cancer are diagnosed early and treated appropriately. With early diagnosis, the prognosis for a kidney tumor is favorable.

The kidneys are located to the left and right of the spine in the upper, rear abdominal cavity. They are bean-shaped and about the size of a fist. The main task of the kidneys is detoxification and blood purification . In this way, toxins and metabolic end products are removed from the blood and excreted in the urine. In addition, the salt-water balance is regulated.

In around 95% of cases, kidney cancer is a renal cell carcinoma , or RCC for short, which usually arises from cells in the urinary tubules. There are different types of renal cell carcinoma. Examples are the frequently occurring clear cell carcinoma, papillary carcinoma or the aggressive but rare Ductus-Bellini carcinoma.

In addition to renal cell carcinoma, the rare renal pelvis carcinoma , which develops from tissue of the urinary tract, also falls under the term kidney cancer. Other types of cancer here are lymphoma, sarcoma , nephroblastoma (Wilms tumor), embryonic carcinoma or neuroblastoma . The cancer does not necessarily have to start in the kidney tissue, but can also arise from the metastases of other types of cancer, such as lymphatic cancer, lung cancer or breast cancer.

Primary tumors arise from the kidney tissue itself. Secondary, on the other hand, is a tumor that has recurred or developed from another organ – a so-called metastasis.²

When kidney tumors spread to other organs, it is called metastatic cancer. Here, the kidney tumor is referred to as the primary tumor and the tumors in other organs as secondary tumors or metastases. Kidney cancer often spreads to the lungs, bones, lymph nodes, and liver. In 20-30% of cases, metastatic kidney cancer is already present at the time of diagnosis.

Kidney cancer is also known as renal tumor, renal carcinoma, renal CA, Grawitz tumor or renal malignancy. The most common type of kidney cancer, renal cell carcinoma, also has many names. These include RCC, hypernephroma or hypernephroid kidney tumor – just to name a few.

Epidemiology: Incidence of kidney cancer

Kidney cancer accounts for only about 2% of all cancers and is therefore a relatively rare tumor disease. In the UK, around 15,000 people are diagnosed with kidney cancer every year. ‍ Young people are rarely affected . The mean age at onset is 68 years for men and 71 years for women. Men fall ill almost twice as often as women . Robert Koch Institute estimates of incidence, mortality and survival rate in kidney cancer, 2016.⁴

Kidney cancer is often diagnosed in the early stages. The prognosis is correspondingly favourable: after 5 years, 77% of men and women are still alive. In advanced stages of the disease, the chances of recovery are poorer.

Kidney cancer cause and risk factors

An exact kidney tumor cause could not be identified so far. However, certain factors appear to increase the risk of kidney cancer. These risk factors include:

Gender, because men are almost twice as likely to have kidney cancer as women⁵
Age, because the risk of kidney cancer increases with age⁶
Smoking and passive smoking⁷
alcohol consumption⁸
lack of physical activity, overweight and obesity⁹
high blood pressure¹⁰
Regular use of certain medications, such as strong painkillers
Contact with certain substances (e.g. asbestos, cadmium or halogenated hydrocarbons), which are particularly relevant in coal gas and coke production and in metal processing¹¹
Terminal renal insufficiency (loss of function of the kidneys), e.g. due to drugs that damage the kidneys or repeated inflammation of the urinary tract¹²
Kidney Transplant¹³

In addition to these risk factors, family disposition also plays a role in renal cell carcinoma. The cancer often occurs in patients with complex hereditary diseases such as von Hippel-Lindau syndrome or tuberous sclerosis.¹⁵

Typical kidney tumor symptoms

Kidney cancer hardly causes any symptoms , especially in the early stages . Accordingly, kidney cancer is accidentally discovered in more than half of the patients , for example during an ultrasound or preventive examination carried out for other reasons. Occasionally, however, symptoms that can indicate the kidney tumor also appear in the case of a kidney carcinoma. Typical kidney tumor symptoms are: In addition to such specific kidney carcinoma symptoms, kidney tumors also show unspecific symptoms , such as:

Kidney cancer pain is rare. Occasionally, however, so-called flank pain, a dull pain in the side of the back, can occur.

Diagnosis of kidney cancer: what is examined?

Kidney carcinomas rarely show specific symptoms. This is very problematic, because with cancer the following applies: The earlier the diagnosis is made, the more promising treatment is and the higher the chances of recovery!❗️If you recognize the above symptoms in yourself, you should consult a doctor without hesitation. This is especially true if you belong to the risk group for kidney tumors (see above: risk factors). If kidney cancer is suspected, various tests are initiated. These can help make an accurate cancer diagnosis. Possible examinations are in the S3 guideline diagnostics, therapy and follow-up care of renal cell carcinoma – version 2.0summarized from 2020. In addition to the physical examination, the most important methods are the blood test, the ultrasound examination, the computed tomography and the biopsy.

If kidney cancer is suspected, the doctor first asks about symptoms and possible risk factors for kidney tumors. The kidneys are then palpated from the outside.

There are no specific tumor markers for kidney tumors. However, blood levels are often altered in kidney cancer. Anemia, altered blood proteins, an increased calcium level, increased enzymes and an altered blood sedimentation rate can indicate a kidney tumor.

The ultrasound examination, also called sonography, is probably the most important method for diagnosing renal cell carcinoma. In over 90% of cases, a tumor can be distinguished from a benign cyst by ultrasound.

Computer tomography (CT) of the chest and abdomen achieves even greater clarity than ultrasound. Here the doctor learns more about the location and extent of the growths as well as possible daughter tumors.

Taking a sample of the kidney tumor by means of a biopsy makes sense when the question arises as to whether the tumor is really malicious and is worth operating on.

If previous tests have found cancer, further tests can be used to definitively diagnose kidney cancer and to determine how far the tumor has spread. These include X-ray examination, magnetic resonance imaging and skeletal scintigraphy (bone scintigraphy).

Kidney tumors are not necessarily malignant. This can also lead to benign tissue proliferation. A common benign kidney tumor is the simple renal cyst. Oncocytoma and angiomyolipoma are also benign kidney tumors. A biopsy is usually necessary to distinguish a benign kidney tumor from a malignant one.

Kidney cancer: prognosis and course

As with other types of cancer, the earlier kidney cancer is detected and treated, the better the prognosis. Initially, renal cell carcinoma is limited to the kidney. Only when the tumor grows can the malignant growths infect nearby tissue, lymph nodes and organs and form secondary growths, so-called metastases.

Kidney Cancer Stages

Like other tumours, kidney cancer is divided into different stages according to the TNM classification . The classification is carried out depending on

the size of the tumor (T: 1-4)
the involvement of the lymph nodes (N: 0-1)
the presence of metastases (M: 0-1).

Example: T1 N0 M0 indicates a small tumor confined to the kidney with no lymph node involvement and no metastases. The exact classification of a kidney tumor into the renal carcinoma TNM stages is usually only possible after surgical removal of the tumor. Based on the renal carcinoma TNM stages, kidney cancer is divided into stages I to IV.

Kidney cancer prognosis: chances of recovery and life expectancy

If kidney cancer is detected early , the chances of a cure are good. Of course, a prerequisite is appropriate and timely treatment, because as soon as the cancer has spread and affected other organs and lymph nodes, the kidney cancer prognosis becomes worse.

Kidney cancer growth rate varies from patient to patient. In the initial phase, kidney tumors usually appear to grow very slowly. Only when the tumors are larger than 4cm do the annual growth rate and the risk of the tumors spreading to other organs or lymph nodes increase significantly.¹⁹

Spontaneous healing, i.e. healing without treatment, is very rare in cancer. However, renal cell carcinoma is one of the types of cancer that regresses more frequently than other tumors.

Since spontaneous healing of kidney cancer is possible but rare, the prognosis for untreated tumors is poor and life expectancy for kidney cancer is significantly reduced without treatment.

Kidney tumor life expectancy depends on the stage at which the tumor was discovered and treated . As long as the kidney carcinoma is localized during treatment and is in stage I or II, 77% of those affected are still alive after 5 years. If the kidney carcinoma is very small, the rate is even over 90%. In advanced stages (stages I and IV), the prognosis worsens. The life expectancy of a kidney tumor or survival rate after 5 years with metastases in the lymph nodes is 20%, in stage IV it is even only 5-10%.²⁰²¹

End-stage renal cancer life expectancy is significantly reduced. The 5-year survival rate for kidney cancer that has spread to distant organs is only 5%. In addition, terminal cancer has a very high risk of recurrence, even after initially successful treatment.²²

Aggressive, metastatic kidney cancer that is discovered too late can be fatal. Early treatment is a prerequisite for a positive kidney tumor prognosis and a long, healthy life.

How can kidney cancer be treated?

Which treatment method is used for kidney cancer depends on the tumor stage (size, location, extent and aggressiveness of the tumour) and on individual patient factors , such as their age. Depending on the findings, various surgical or drug measures are available. If the kidney tumor has not yet spread to other organs, surgery is the most promising treatment method. The aim here is complete kidney cancer cure. On the other hand, in the case of metastatic kidney cancer , systemic treatment with medication or the performance of symptom-relieving surgery is recommended.

Curative surgery for kidney cancer

If kidney cancer hasn’t spread to lymph nodes or distant organs , removing the tumor is a promising treatment. In the standard therapy for renal cell carcinoma, the entire affected kidney is removed (nephrectomy). This is often done by laparoscopy, a so-called keyhole technique. If adjacent lymph nodes are already affected, these are also removed. The tasks of the removed kidney are taken over by the healthy one. The aim of this operation is the complete cure of kidney cancer.²³In the case of small tumors, it is often sufficient if only part of the kidney is removed. Such an organ-preserving operationis particularly useful if the patient only has one kidney or the second kidney is not working properly. Because in the case of kidney loss on both sides, the patients are dependent on regular blood washing, the so-called dialysis.

Kidney surgeries are low-risk routine interventions. However, as with all other operations, there are certain risks associated with the removal of renal cell carcinoma. These range from intolerance to anesthetics and organ injuries to wound infections and postoperative bleeding.

Kidney tumor surgery duration varies depending on the procedure used and the spread of the tumor. On average, however, the operation lasts between 1.5 and 2.5 hours.

Kidney surgery hospital stays can vary from a few days to more than a week, depending on the patient’s condition.

As after any operation, the body needs time to recover and heal after kidney tumor surgery. Patients who underwent minimal-intensive surgery differ from patients who underwent open surgery.

Physical exertion should be avoided after at least 4 to 6 weeks.

The kidney does not grow back after surgical removal. However, the latest studies on mice show the first indications that the kidney can grow back through the administration of special substances.²⁴

‍

Symptom-relieving surgery for kidney cancer

The (partial) removal of the kidney does not always make sense – for example, if the renal cell carcinoma has already spread to lymph nodes or distant organs. In this so-called palliative situation , the removal of tumors is only promising in combination with systemic therapy. Alternatively, in the case of metastatic kidney cancer, the resection of metastases in other organs can be useful. Tumor embolization , which is used primarily in older patients, is also a treatment option for kidney cancer. The blood vessel that leads to the kidney is closed with a catheter so that the tumor is no longer supplied with blood and stops growing. This can produce at least short-term effects.

Kidney cancer systemic therapy

If the kidney cancer has already spread metastases to distant organs, suppressing the tumor with systemic therapy can make sense. Various medications are used here, which act throughout the body – i.e. systemically. With systemic therapy, symptoms can be alleviated and the quality of life improved.✔ Immunotherapy : In addition to foreign substances (e.g. viruses), the immune system can also fight diseased cells such as tumor cells . This is where immunotherapy comes in: The immune system is stimulated by certain substances (e.g. interferons, interleukins) to recognize and eliminate kidney cancer cells.✔ Antibody therapy: Antibody therapy is a further development of immunotherapy. In the case of metastatic kidney cancer, the so-called PD-1 inhibitor nivolumab is administered.✔ Targeted Therapy : In the case of renal cell carcinoma, a molecular, targeted therapy is also an option. This is directed against messenger substances, binding sites for messenger substances and the signaling pathways in the cells and thus influences tumor growth.✘ Chemotherapy : In cytostatic treatment (chemotherapy), fast-growing tumor cells are killed. Since chemotherapy is hardly effective in renal cell carcinoma, it is not used in renal cancer.✘ Radiation therapy: Renal cell carcinomas are not sensitive to radiation. Accordingly, radiation therapy is only used in the final stages to relieve pain.

Alternative treatment for kidney cancer

The classic treatment methods are not always the best choice for old patients or patients with severe health problems . On the other hand, active waiting can be useful here . The tumor is checked regularly (e.g. by ultrasound) and only removed from the kidney if the risk of metastasis increases and the tumor is growing very quickly. Another option for pre-stressed and old patients are ablative therapy methods . This includes the treatment and ideally the destruction of the renal cell carcinoma with cold (cryoablation) or heat (radiofrequency ablation).

Kidney cancer: aftercare and rehabilitation

After medical treatment for kidney cancer, follow-up care and rehabilitation begin . Possible consequences of the kidney tumor therapy are treated, the recurrence of the cancer is observed and the patients are supported mentally, physically and socially.

Regular follow-up examinations serve to monitor the success of the treatment and to observe a possible recurrence of tumors. The type and scope of kidney surgery aftercare vary depending on the success of the treatment and the risk profile of the patient.

Since cancer and its treatment usually place a great deal of physical and psychological strain on those affected, follow-up care for the patient is indispensable. This makes it easier to process and cope with the illness itself and the problems associated with it. Contact points are in particular psychotherapists, psycho-oncological advice centers and self-help groups.

Cancer rehabilitation, or rehab for short, aims to promote recovery from the disease and treatment and to prevent long-term consequences. Rehabilitation usually takes place over several weeks as an inpatient in specialized clinics. Possible components of rehabilitation after kidney surgery are psychotherapy, social counseling, nutritional counseling, movement therapy and physiotherapy.

Kidney cancer diagnosed late can relapse even after promising treatment. Here, the tumor can also occur in distant organs. It’s called a recurrence.

As with other types of cancer, a balanced diet is very important for kidney cancer and especially during its therapy. People with kidney problems should not consume too much protein, as a diet that is too high in protein can put a strain on the liver.

Depending on the stage and treatment, kidney tumors can lead to various sexual problems. These include erectile dysfunction, premature ejaculation, listlessness and ejaculation disorders. In addition to the various treatments, a pronounced fatigue (chronic tiredness), pain and changes in the hormone balance can be to blame. The psyche can also lead to potency problems: Many men are afraid of the disease and suffer from the feeling of being less productive.²⁷.

Prevention and screening of renal cell carcinoma

The best prevention of kidney cancer is avoidance of the (avoidable) risk factors and a healthy lifestyle . This includes not smoking and alcohol, regular exercise and a healthy and balanced diet. In addition, certain substances such as asbestos or cadmium and the regular use of painkillers should be avoided. In addition, people at particularly high risk and people in the second half of life should have regular check -ups and an ultrasound of the kidneys. In this way, kidney tumors can be detected and treated at an early stage. After all, the earlier kidney carcinomas are diagnosed, the better the chances of recovery and a healthy, long life!

The explanations and lists of possible treatment options are purely informative and do not replace consultation with your doctor or the explanations about the intake, mode of action and side effects from the product-specific leaflet.

Kidney Cancer (Kidney Tumor): Symptoms, Diagnosis & Treatment

Isabel D White

Isabel led the Royal Marsden Hospital (London) psychosexual therapy service until 2019. She works in partnership with individuals & couples to explore physical, emotional & relationship factors that contribute to sexual difficulties after cancer. These include: low desire, erection, arousal or orgasmic difficulties, sexual pain & sexual avoidance. She adopts an integrative approach to personalized therapy using psychosexual therapy (sensate focus framework), biomedical management (erectile dysfunction medication & devices, menopause & vaginal health strategies, sexual aids) & psychoeducation.