Cancer of the kidney is a relatively common type of cancer. Symptoms of kidney cancer include:
- blood in your urine
- constant pain below your ribs
- a lump in your abdomen (tummy)
However, in around half of cases there are no symptoms and the cancer is detected during tests for other unrelated conditions.
The kidneys are two bean-shaped organs located on either side of the body, just underneath the ribcage. The main role of the kidneys is to filter out waste products from the blood and produce urine. Usually, only one of the kidneys is affected by cancer.
Types of kidney cancer
There are a number of different types of cancer than can affect the kidneys. The most common type is known as renal cell carcinoma (RCC), which accounts for about 90% of all kidney cancers.
Rarer types of kidney cancer include:
- transitional cell cancer: develops in the lining of the kidneys and usually affects older men who are 50 years of age or over
- Wilms' tumour: a rare type of kidney cancer that affects children
This article focuses on renal cell carcinoma and the term 'kidney cancer' will be used to refer to RCC. See the Cancer Research UK website for more information about transitional cell cancer and Wilms' tumour.
How common is kidney cancer?
Kidney cancer accounts for about 2-3% of all adult cancers, making it the seventh most common cancer in men and the ninth most common cancer in woman.
Cancer of the kidney most commonly affects adults aged 50-80 years, with 64 being the average age of diagnosis. Men are more likely to be affected by kidney cancer than women.
Risk factors for kidney cancer include:
- high blood pressure (hypertension)
- certain genetic conditions, such as tuberous sclerosis
See causes of kidney cancer for more information about these risk factors.
Over the last 40 years, the number of cases of kidney cancer has doubled in men and risen by 130% in women. The main reason for this rise is thought to be the corresponding increase in the number of people who are obese.
There were 3638 new cases diagnosed in men and 2118 new cases diagnosed in woman during 2007 in England.
The outlook for kidney cancer is usually good if the condition is diagnosed in its early stages, when the cancer is still contained inside the kidney. This is because it is usually possible to completely cure the cancer by removing some or all of the kidney (it is possible to live a healthy life with only one kidney). About one in three cases of kidney cancer are diagnosed at an early stage.
Depending on how aggressive the cancer is, 70-94% of people will live at least five years after receiving a diagnosis of kidney cancer, with many people living much longer.
The outlook for kidney cancer that has spread outside the kidney is less favourable. An estimated 40-70% of people with this type of kidney cancer will live at least five years after receiving a diagnosis.
The outlook for advanced kidney cancer, where the cancer has spread to other parts of the body is poor. In this situation, only 1 in 10 people will live for at least five years after receiving a diagnosis.
Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Symptoms of kidney cancer
Most cases of kidney cancer do not cause any symptoms in the early stages.
The most common symptoms of mid- to advanced-stage kidney cancer are:
- blood in your urine - the amount of blood is usually high enough to change the colour of your urine to a reddish or dark brown colour
- a constant pain below your ribs
- a lump in your abdomen (stomach)
However, in around half of all cases the cancer causes no symptoms and is only detected during a routine ultrasound scan.
Less common symptoms of kidney cancer include:
- unexplained weight loss
- a high temperature (fever) of 38C (100.4F) or above
- night sweats
- a general sense of feeling unwell
- swelling of the veins in the testicles (in men)
When to seek medical advice
See your GP if you notice blood in your urine. It is highly unlikely to be the result of kidney cancer. It will usually be a symptom of a less serious condition that still requires treatment, such as a kidney stone or bladder stone.
- Red blood cells
- Red blood cells transport oxygen around the body and remove carbon dioxide.
- Pain is an unpleasant physical or emotional feeling that your body produces as a warning sign that it has been damaged.
- High temperature
- A high temperature, also known as a fever, is when someone's body temperature goes above the normal 37°C (98.6°F).
- Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Causes of kidney cancer
Cancer begins with an alteration to the structure of the deoxyribonucleic acid (DNA) that is found in all human cells. This is known as a genetic mutation. The DNA provides the cells with a basic set of instructions, such as when to grow and reproduce.
The mutation in the DNA changes these instructions so that the cells carry on growing. This causes the cells to reproduce in an uncontrollable manner, producing a lump of tissue that is known as a tumour.
Most cancers grow and spread to other parts of the body through the lymphatic system. The lymphatic system is a series of glands (or nodes) that are spread throughout your body in a similar way to your blood circulation system. The lymph glands produce many of the specialised cells that are needed by your immune system.
Kidney cancer usually spreads into blood vessels that are located near to the kidney or the adrenal gland. The adrenal gland is an organ that releases adrenaline, which is a naturally produced hormone that the body uses during stressful situations.
The cancerous cells are spread through the lymphatic system into other organs of the body. The most common places for kidney cancer to spread are:
- the lungs
- muscles, ligaments and tendons
- central nervous system
Common risk factors
The three leading risk factors for kidney cancer are:
Each risk factor is discussed in more detail below.
Smoking is a significant risk factor for developing kidney cancer, and the more you smoke the greater the risk.
For example, research has shown that if you regularly smoke 10 cigarettes a day, you are 150% more likely to develop kidney cancer compared to a non-smoker. This is increased to 200% if you smoke 20 or more cigarettes a day.
It is not clear why smoking increases your chances of developing kidney cancer.
Obesity is another important risk factor for cancer of the kidney, particularly in women.
One way of assessing a person's weight is to measure their Body Mass Index (BMI). See the common health question called How can I work out my body mass index (BMI)? to work out what your BMI is. Alternatively, you can use the healthy weight calculator.
Research has found that there is a strong link between someone's BMI and their risk of developing kidney cancer.
Men who have a BMI score of between 25 and 29.9 are overweight and have an 18% increase in their risk of developing kidney cancer.
Women with a BMI score in this category have a 32% increase in their risk of developing kidney cancer
Men who have a BMI score of 30 or above are obese and have a 55% increase in their risk of developing kidney cancer. Women with a BMI score of 30 or above have an 85% increase in their risk of developing kidney cancer.
One theory as to why being overweight or obese increases a person's risk of developing kidney cancer is that overweight or obese people, particularly women, have higher levels of a hormone called oestrogen in their body. It is thought that excess levels of oestrogen may stimulate the growth of cancerous cells.
High blood pressure
People with poorly controlled high blood pressure who need medication to help lower it are up to twice as likely to develop kidney cancer compared with the population at large. This could be due to several reasons. For example:
- high blood pressure is associated with smoking and obesity, so these two factors could be increasing the risk
- high blood pressure can be caused by kidney disease, so there may be a kidney condition that has yet to be identified that causes both high blood pressure and kidney cancer
Possible risk factors
A number of other possible risk factors for kidney cancer include:
- exposure to certain chemicals such as asbestos and cadmium: asbestos is a mineral that was widely used in the construction industry but was banned in 1999, and cadmium is a metal used to manufacture batteries
- tuberous sclerosis: a rare genetic condition that causes multiple non-cancerous tumours to grow in the body -an estimated 1 in every 100 people with tuberous sclerosis will develop kidney cancer
- Von Hippel-Lindau disease: another rare genetic condition that causes small non-cancerous tumours to develop inside the nervous system - people with the condition have about a one in three chance of developing kidney cancer
- cocaine misuse: cocaine itself does not cause kidney cancer but a chemical called phenacetin that criminals use to 'cut' cocaine (dilute it) does
kidney transplant - people who have a kidney transplant have an estimated 1 in 100 chance of developing kidney cancer in their remaining 'native' kidney
- people with kidney failure who require dialysis: dialysis is a treatment that is designed to replicate the functions of the kidneys - people who require dialysis are three times more likely to develop kidney cancer than the population at large
Diagnosing kidney cancer
See your GP if you have symptoms such as blood in your urine or a constant pain below your ribs (symptoms of kidney cancer for a full list). There are several different tests that can help to rule out or confirm kidney cancer. For example, you may have:
- blood and urine tests
- an ultrasound scan
- a computerised tomography (CT) scan
- image-guided biopsy
These are described in more detail below.
Blood and urine tests
If you visit your GP because you notice blood in your urine, he or she will usually carry out a blood test and take a urine sample. The results will help rule out other possible causes, such as infection or kidney stones.
Your GP may refer you for an ultrasound scan if the cause of the blood in your urine cannot be found.
An ultrasound scan uses high-frequency sound waves to create an image of an organ in the body. It can often detect changes in the shape of the kidney that could possibly be due to the development of a cancerous tumour.
Computerised tomography scan
You may also be referred for a computerised tomography (CT) scan. During a CT scan, a scanner takes detailed images of the inside of your body and a computer puts them together.
If you have a CT scan you may be given a special dye to drink or it may be an injected. The dye makes the results of the CT scan clearer.
An image-guided biopsy is another procedure that is occasionally carried out for some cases of kidney cancer. It is a minor surgical procedure carried out under local anaesthetic. This means that you will be awake during the procedure but the tissue surrounding the affected kidney will be numbed so that you do not feel anything.
During an image-guided biopsy a surgeon will use an ultrasound or CT scan to guide a needle through your skin and into your kidney. A small sample of tissue will be removed from your kidney so that it can be studied under a microscope to check for the presence of cancerous cells.
Staging and grading
Once the tests have been completed it should be possible to determine the grade of your kidney cancer and what stage it is at.
The stage of the kidney cancer describes how far the cancer has spread and the grade describes how aggressive the cancer is and how quickly it is likely to spread. Both the stage and grade of your kidney cancer will have important implications in terms of your recommended treatment and the likelihood of achieving a cure.
Healthcare professionals use the TNM system to stage kidney cancer:
- T: indicates how large the tumour has grown (a tumour is a lump of cancerous tissue)
- N: indicates whether nearby lymph nodes are affected (lymph nodes are small oval-shaped glands of tissue that are found throughout the body and help protect it against infection)
- M: indicates whether the cancer has spread to another part of the body - M stands for metastases, which is the medical term for cancer that has spread
The stages of tumour size are:
- T1a: where the tumour is less than 4cm in diameter
- T1b: where the tumour is 4-7cm in diameter
- T2: where the tumour is larger than 7cm in diameter but has not yet spread out of the kidney
- T3a: where the tumour has spread into the adrenal gland or into the layer of fat that surrounds the kidney
- T3b: where the tumour has spread into the renal vein (the vein that carries blood back from the kidney to the heart) or into the vena cava (the vein that carries blood back from the top half of the body)
- T3c: where the tumour has spread past the diaphragm
- T4: where the tumour has spread beyond the tough layer of tissue that surrounds and protects the kidney
There are three lymph node stages:
- N0: where no lymph nodes have been affected
- N1: where there are cancer cells in one lymph node
- N2: where there are cancer cells in two or more lymph nodes
M0 means that the cancer has not spread to another part of the body, and M1 means that the cancer has spread.
Kidney cancer is graded using a scale of one to four. The higher the number, the more aggressive the cancer.
- Ultrasound scan
- Ultrasound scans are a way of producing pictures of inside the body using sound waves.
- Blood supplies oxygen to the body and removes carbon dioxide. It is pumped around the body by the heart.
Treating kidney cancer
Cancer treatment teams
Many hospitals use multidisciplinary teams (MDTs) to treat cancer of the kidney. MDTs are teams of specialists that work together to make decisions about the best way to treat you. See the box to the left for information about the specialists who make up MDTs.
You will also be assigned a key worker, usually a specialist nurse, who will be responsible for co-ordinating your care.
Deciding what treatment is best for you can often be confusing. Your cancer team will recommend what they think is the best treatment option but the final decision will be yours.
Before visiting hospital to discuss your treatment options, you may find it useful to write a list of questions that you would like to ask the specialist. For example, you may want to find out what the advantages and disadvantages of particular treatments are.
Your treatment plan
Your recommended treatment plan will be determined by what TNM stage your kidney cancer is at.
If the cancer has not spread out of your kidney (T1 or T2 kidney cancer) it can usually be cured by removing some or all of the kidney.
If the cancer has spread out of the kidney (T3 or T4 kidney cancer) a complete cure may not be possible. However, it should be possible to slow the progression of the cancer and treat any symptoms.
There are several different surgical treatments for kidney cancer that are outlined below.
A nephrectomy is the surgical procedure to remove a kidney. If the tumour is less than 4cm (1.5 inches) in diameter, it may only be necessary to remove some of your kidney. This is known as a partial nephrectomy. A partial nephrectomy may also be required if your remaining kidney is in poor health.
If the tumour is more than 4cm in diameter, your entire kidney will need to be removed. Even if the cancer has spread beyond your kidney, you may still benefit from having your kidney removed. Removing the kidney can help to resolve the symptoms of pain, and make other types of non-surgical treatment more effective. It is possible to live a normal life with only one kidney because the other kidney will be able to compensate.
During a nephrectomy, the surgeon may also remove nearby lymph nodes to make sure that the cancer has not spread beyond the kidney.
There are two ways that both a partial and open nephrectomy can be performed:
- open nephrectomy: where the kidney is removed through a large incision in your abdomen
- laparoscopic or keyhole nephrectomy: where a series of smaller incisions is made in your abdomen (tummy) and the kidney is removed with small surgical instruments
Both techniques have their own set of advantages and disadvantages.
A laparoscopic nephrectomy has a considerably quicker recovery time than an open nephrectomy.
However, a practical disadvantage is that the procedure requires surgeons with specialised training, so you may have to wait longer to receive treatment than you would if you chose to have an open nephrectomy.
Also, some types of kidney cancer where the tumour is located in the centre of the kidney may not be suitable for a laparoscopic nephrectomy.
One of the main disadvantages of an open nephrectomy is that it is a major surgical procedure that can place a considerable amount of strain on the body. Therefore, it may not be a suitable form of treatment for people who are particularly frail or unwell.
You should discuss the pros and cons of both procedures with your surgical team.
If you are unable to have a nephrectomy, you may benefit from an alternative surgical procedure known as embolisation.
During embolisation, the surgeon will insert a small tube, known as a catheter, into your groin. They will use X-ray images to guide the catheter into the blood supply of your kidney. A special substance will then be injected through the catheter to block the blood supply to your kidney. By blocking the blood supply to the kidney, any tumours that are present will become starved of oxygen and nutrients, causing them to shrink.
Non-surgical treatments for advanced kidney cancer
Kidney cancer is one of the few types of cancer that does not respond to traditional chemotherapy (where powerful medication is used to kill cancerous cells).
However, there are a number of ongoing clinical trials that are looking at new combinations of chemotherapy medications that appear to be benefiting some people. See Kidney cancer - clinical trials for more information.
There are also a number of different non-surgical treatment methods that can slow the spread of the cancer and help control its symptoms. These are described below.
Radiotherapy cannot usually cure kidney cancer but it can help to reduce the symptoms of pain and slow down the condition's progress. You should only require a few minutes of radiotherapy every day for a number of days.
When radiotherapy is used to control the symptoms of cancer rather than cure it, the side effects tend to be mild. Possible side effects may include:
- fatigue (tiredness)
- nausea (feeling sick)
See the Health A-Z about Radiotherapy for more information.
Immunotherapy is a type of treatment that involves taking medicines that encourage the immune system to attack cancerous cells. The immune system is the body's natural defence against illness and infection. Medicines that are used to treat kidney cancer include:
- interferon alpha
Interferon alpha is given by injection and most people will require three injections a week. Your cancer nurse will be able to teach you how to administer the infections yourself.
Most people will experience flu-like symptoms when they first to start taking interferon alpha. For example, you may experience:
- a high temperature (fever) of 38C (100.4F) or over
- joint pain
Over time, these symptoms should improve as your body begins to get used to the medicine.
Aldesleukin can either be given by injection or through a drip (intravenously). It is usually only available at specialist cancer clinics or centres. Possible side effects of aldesleukin include:
- a high temperature
- low blood pressure (hypotension)
- skin rashes
- itchy skin
- loss of appetite
These side effects will resolve when you stop taking aldesleukin. The length of time that you will need to take aldesleukin for will depend on your general health and the stage of your cancer.
Six new medicines have been developed for the treatment of kidney cancer. These are:
These medicines are sometimes referred to as 'targeted therapies' because they are designed to target and interrupt the functions that are needed by cancer to grow and spread. For example, they can block the effects of certain proteins that cancerous cells need to grow and reproduce.
Of the six medicines listed above, only sunitinib has been recommended by the National Institute of Health and Clinical Excellence (NICE) and is available free of charge on the NHS for people who are still relatively healthy and have advanced kidney cancer, or kidney cancer that has spread to other parts of their body.
The use of sunitinib in people who are in poor health is not recommended because the medicine is unlikely to provide significant benefit.
NICE does not recommended sorafenib, bevacizumab or temsirolimus because it is thought that the effectiveness of these medications is too limited to justify the costs. Therefore, if you wish to take these medications you will have to pay for them. A year's course can range from £18,000 to £30,000.
NICE is still considering evidence regarding everolimus and pazopanib, and a decision is expected by December 2010. Until NICE makes a decision, whether you are prescribed everolimus and pazopanib will be at the discretion of your local primary care trust (PTC).
Sunitinib cannot cure kidney cancer but it can slow its spread, help relieve symptoms and prolong life. The medicine works by blocking the proteins inside cancer cells that are responsible for making new blood vessels.
Cancer cells require a blood supply to grow and multiply, so by stopping the production of blood vessels, sunitinib can slow down the spread of kidney cancer.
Sunitinib is available in tablet form. The usual cycle of treatment is to take one tablet a day for four weeks, followed by two weeks off before resuming treatment.
Common side effects of sunitinib include:
- redness and swelling of the hands and feet
- mouth pain
- jaundice: where the skin and whites of the eyes have a yellowish tinge
- changes in hair colour
- thinning of the hair
- skin rashes or blisters
- high blood pressure: if your blood pressure becomes too high you may be given additional medicines to lower it
Less common side effects of sunitinib include:
- nose bleeds
- bleeding gums
- joint and muscle pain
- problems sleeping
- shortness of breath
- weight loss
- hair loss
- underactive thyroid gland, which will make you feel very tired
You should contact a member of your MDT if one or more of the side effects of sunitinib become particularly troublesome. They may be able to prescribe additional treatments to help you to cope better with the side effects.
Avoid taking complementary medicines, such as St John's Wort, because they can make sunitinib less effective. Also avoid eating grapefruit and drinking grapefruit juice for the same reason.
You should not father a child or become pregnant while taking sunitinib because the medication can damage the health of an unborn child. If you are sexually active, make sure you use an effective method of contraception while you are taking the medicine and for several months afterwards. Your GP or MDT can advise you about when it is safe to father a child or become pregnant.
Avoid breastfeeding your baby while you are taking sunitinib because the medicine could be passed on to your baby through your breast milk.
Preventing kidney cancer
A combination of a healthy diet and regular exercise will help you to avoid becoming overweight or obese and developing high blood pressure. Both obesity and high blood pressure are significant risk factors for kidney cancer.
If you are overweight or obese, you can lose weight and maintain a healthy weight by combining regular exercise and a calorie-controlled diet.
See the Health A-Z for more information on treating obesity.
The Department of Health recommends a minimum of 30 minutes of vigorous exercise a day, five times a week. The exercise should be strenuous enough to leave your heart beating faster and you should feel slightly out of breath afterwards.
Examples of activities that you could incorporate into your exercise programme include:
- brisk walking
- hill climbing
If you find it difficult to do 30 minutes of exercise a day, start at a level you feel comfortable with.
For example, you could do 5-10 minutes of light exercise a day before gradually increasing the duration and intensity of your activity as your fitness level improves. You could also try the Couch to 5K challenge, which is designed to get just about anyone off the couch and running 5km in nine weeks.
However, you should visit your GP for a health check-up if you have never exercised before or you are returning to exercise after a long lay-off.
See the Live Well section for more information and advice about How to exercise.
A low-fat, high-fibre diet that includes whole grains and plenty of fresh fruit and vegetables (at least five portions a day) is recommended for a healthy heart. Limit the amount of salt in your diet to no more than 6g (0.2oz or 1 teaspoon) a day. Too much salt will increase your blood pressure.
Avoid eating foods high in saturated fat because this will increase your cholesterol level. These include:
- meat pies
- sausages and fatty cuts of meat
- ghee - a type of butter often used in Indian cooking
- hard cheese
- cakes and biscuits
- foods that contain coconut or palm oil
There is some evidence that eating a diet that has a lot oily fish may help to reduce the risk of kidney cancer. Examples of oily fish include:
If you smoke, giving up is the most effective way of preventing kidney cancer, as well as a number of other serious health conditions, such as a stroke, heart attack and lung cancer.
If you want to give up smoking, your GP can help you by providing information and advice, and prescribing medication. The NHS Smokefree website also has useful information and advice about giving up smoking or you can call the NHS Stop Smoking helpline on 0800 022 4332 (England only).
See the Health A-Z about Quitting smoking for more information about giving up.
There is evidence to suggest that drinking a moderate amount of alcohol, such as four to five glasses of wine a month, will help to reduce your risk of developing kidney cancer. The reasons for this are not fully understood.
However, you should not exceed the recommended daily amounts for alcohol because drinking an excessive amount will place you at risk of developing liver disease, liver cancer, and high blood pressure.
The recommended daily levels of alcohol consumption are between three to four units of alcohol for men, and between two to three units for women. A unit of alcohol is equal to about half a pint of normal strength lager, a small glass of wine or a pub measure (25ml) or spirits.
See the Live Well section for more information about Alcohol and advice about safe drinking.
Support for carers
There are more than five million people in England who look after an ill or disabled partner, child, relative or friend. Caring for someone can be a varied and demanding job. This is because of the broad range of medical, personal and emotional needs that a person can have.
If you're caring for a family member, you may not consider yourself a carer because you're just doing what needs to be done. You might feel that you have no other options. This can be stressful and you may feel resentful towards the person you're caring for, which can also leave you feeling guilty. You may have been forced to leave your job, give up hobbies and stop socialising, which can be very isolating.
It's important to remember that you're not alone and that there is support available. By law you're entitled to a free health and social care assessment, which you can access through your local authority. The assessment will look at the possibility of you getting practical and financial help.You can find out about assessments on Carers Direct.
Being a carer means that you may be entitled to certain financial benefits, especially if you have to give up work. Find out more about carers' benefits on Carers Direct. Carers can also get help with breaks from caring from local authorities or organisations such as Crossroads Care. You can find out about getting time off on Carers Direct.
Social care for people with cancer
If you have been diagnosed with cancer, your treatment and medical care will probably be the first thing on your mind. But there are other aspects of your life to think about and it is important to know exactly what kind of assistance is available and where you can get it.
If you are finding it hard to cope with day-to-day life, talk about your needs with your doctor or nurse, who will refer you to a social worker. Your social worker will assess exactly the kind of help you need (see below).
Social care options
Care attendants can help with housework, dressing and washing, or even just keep you company and give your carer a break. Look into this as soon as you can, as many care attendants have waiting lists.
Crossroads is an organisation in England and Wales that helps carers by visiting homes and taking over the responsibilities of care for a while. Visit the Crossroads website at www.crossroads.org.uk (links to external site), or phone 0845 450 0350.
Meals on wheels
Contact your local council about its meals on wheels service. It will usually be able to offer financial assistance to help pay for this. Go to Directgov for details of your eligibility (links to external site).
You may be eligible for income support, disability living allowance or attendance allowance. Get in touch with the Benefit Enquiry Line for more details on 0800 882200 (textphone 0800 243355) or online at www.dwp.gov.uk (links to external site).
Occupational therapists provide a detailed assessment of your needs at home, making life easier by arranging equipment and making adaptations to your home.
The aim is to create a comfortable and practical place to live during your treatment. This could mean anything from putting a shower downstairs to adding handrails around the house.
The list below is a combination of the and brand names of medicines available in the UK. Each name provides a link to a separate website (Medicine Guides) where you can find detailed information about the medicine. The information is provided as part of an on-going medicine information project between NHS Direct, Datapharm Communications Ltd and other organisations.
The medicines listed below hold a UK licence to allow their use in the treatment of this condition. medicines are not included.
The list is continually reviewed and updated but it may not be complete as the project is still in progress and guides for new medicines may still be in development.
If you are taking one of these medicines for a different condition, or your medicine for this condition is not mentioned here at all, speak to your prescriber, GP or pharmacist, or contact NHS Direct on 0845 46 47.