Kidney Cancer


Estimates for kidney cancer based on the American Cancer Society report for 2012:

  • total estimated new cases: 64,770 ( 40,250 men, 24,520 women)
  • total estimated deaths: 13,570 (8,650 men, 4,920 women)

Risk Factors

  • Tobacco use
  • Obesity
  • Hypertension
  • Familial Renal Cell Carcinoma Syndromes (i.e. von Hippel-Lindau, Hereditary Papillary RCC, Familial Leiomyomatosis and RCC, Birt-Hogg-Dube)
  • Possible risk factors: lead compounds, various chemicals (i.e. aromatic hydrocarbons), trichloroethylene exposure, Occupational exposure (i.e. metal, chemical, rubber, and printing industries), asbestos or cadmium exposure, radiation therapy, dietary factors (i.e. high fat/protein and low fruits/vegetables)

Anatomy and Physiology of the Kidney

The kidneys lie in the back portion of the abdominal compartment in an area known as the retroperitoneum. There is one kidney on each side of the body. The kidneys are surrounded by fat (i.e. perinephric fat) and a fascial layer (i.e. Gerota’s fascia). While there is typically only one artery and vein supplying each kidney, there can be some variability in the vascularity to the kidney with at times multiple vessels supplying the kidney. The kidneys typically filter the blood to create urine which is drained from the kidney into the bladder via a long tube called the ureter. The kidneys have multiple functions:

  • Regulation of electrolytes
  • Maintenance of acid-base balance in the body
  • Regulation of blood pressure
  • Filtration of the blood (i.e. removal of waste products)
  • Reabsorption of water, glucose, and amino acids
  • Production of hormones (i.e. calcitriol, erythropoietin, renin)


Types of lesions:

  • Clear Cell RCC (70-80%)
  • Papillary RCC (10-15%)
  • Chromophobe RCC (3-5%)
  • Collecting Duct Carcinoma (less than 1%)
  • Renal Medullary Carcinoma (rare)
  • Sarcoma
  • Lymphoma/Leukemia
  • Metastasis from a different primary cancer originating from another part of the body
  • Other

Route of Spread

Kidney Cancer spreads by:

  • Local invasion
  • Hematogenous spread (i.e. to metastatic sites through the blood by way of vascular channels)
  • Lymphatic spread (i.e. by way of lymphatic channels to lymph nodes)

Clinical Features

  • Typically asymptomatic and nonpalpable until they are advanced (>50% of tumors are picked up incidentally on imaging
  • Hematuria (i.e. blood in the urine)
  • Flank pain
  • Abdominal mass
  • Paraneoplastic syndromes (i.e. hypercalcemia, hypertension, increased amount and concentration of blood cells in the blood, liver dysfunction)
  • Metastatic symptoms (i.e. persistent cough, bone pain, lymph node enlargement, weight loss, fever, malaise)
  • Symptoms resulting from vena cava blockage (lower extremity swelling or congestion of lower extremity or scrotal veins)

Usual Work-up

  • General examination (i.e. history and physical)
  • Laboratory tests (i.e. blood count, kidney function, electrolytes, liver function)
  • Radiographic images for staging (i.e. CT scan, MRI, bone scan)

Staging (TNM)

Primary Tumor (T):

  • TX-primary tumor cannot be assessed
  • T0-No evidence of primary tumor
  • T1-tumor≤7.0cm and confined to the kidney (T1a=Tumor ≤4.0cm and confined to the kidney, T1b=tumor >4.0cm and ≤7.0cm and confined to the kidney)
  • T2-Tumor>7.0cm and confined to the kidney (T2a=tumor>7.0cm and ≤10cm and confined to the kidney, T2b=tumor >10.0cm and confined to the kidney)
  • T3-Tumor extends into major veins or perinephric tissues but not into the ipsilateral adrenal gland and not beyond the Gerota fascia (T3a=tumor grossly extends into the renal vein or its segmental (muscle containing) branches or tumor invades perirenal and/or renal sinus fat but not beyond the Gerota fascia, T3b=Tumor grossly extends into the vena cava below the diaphragm, T3c=Tumor grossly extends into the vena cava above the diaphragm or invades the wall of the vena cava)
  • T4-Tumor invades beyond the Gerota fascia (including contiguous extension into the ipsilateral adrenal gland)

Regional Lymph Nodes (N):

  • Nx-Lymph nodes cannot be assessed
  • N0-no lymph node metastasis
  • N1-Metastasis in regional lymph node(s)

Distant Metastasis (M):

  • Mx-Distant metastasis cannot be assessed
  • M0-No distant metastasis
  • M1-Distant metastasis

Treatment Options

Tumors confined to the kidney:

  • Treatment depends on many factors such as tumor characteristics, health and past medical/surgical history of a patient, and kidney function, but typically include:
    • Radical Nephrectomy (Removal of the entire kidney)
    • Partial Nephrectomy (Removal of only the abnormal portion of the kidney)
    • Thermal Ablative Therapy (i.e. cryotherapy or radiofrequency ablation)
    • Active surveillance

Tumors that are involving surrounding structures (i.e. vena cava, pancreas, liver, intestine)

  • Aggressive surgical management is typically recommended in patients whose health and tumor characteristics allow for surgical management and may require extensive vascular surgery and/or surgery to remove portions or all of any involved, adjacent organs.
  • Any medical management of locally advanced tumors after surgery is currently limited to clinical trials

Tumors that have traveled to other parts of the body (i.e. metastatic)

  • Medical management (i.e. systemic treatment to the whole body) with targeted agents, immunologic agents, or chemotherapy agents to treat cancer throughout the body with or without surgery to remove the primary kidney lesion and potentially any other lesions outside of the kidney with the intent of removing tumor volume.

Prognostic Factors

  • Pathologic stage
  • Tumor size
  • Nuclear grade
  • Histologic subtype
  • Symptoms present at time of presentation
  • Performance status (i.e. how healthy a patient is)
  • Molecular markers
  • Abnormalities in certain labs (i.e. low blood count, increased platelets, elevated calcium, elevated alkaline phosphatase, elevated lactate dehydrogenase, elevated erythrocyte sedimentation rate)
  • Invasion of the fat surrounding the kidney
  • Invasion into the upper portion of the ureter
  • Invasion into the venous drainage system of the kidney
  • Disease that has spread to other parts of the body (i.e. lymph nodes, liver, lung, bone, brain)


Survival is very much dependent upon removal of the cancer. Patients who have kidney tumors confined to the kidney allowing for complete removal of the tumor either by complete removal of the kidney, partial removal of the kidney, or ablation tend to have the best survival. Patients who have disease that has grown into surrounding structures or has traveled to other parts of the body have the worst survival.

Recommended Follow-up

Follow-up is very much dependent upon treatment offered, but typically includes regular clinic follow-up for general examination as well as monitoring of laboratory tests and follow-up imaging (i.e. CT scan, ultrasound, MRI) to evaluate for recurrence or progression of disease.