Kidney Cancer

What causes kidney cancer?

  • Most kidney cancers are sporadic (no obvious cause) however risks include:
    • Smoking
    • Obesity
    • High blood pressure
    • Family history
    • Genetic conditions
    • Renal cysts acquired from chronic kidney failure

How common is kidney cancer?

  • Account for 3% of adult cancers
  • Males more commonly affected than females

What are the symptoms of kidney cancer?

  • Most kidney cancers these days are detected incidentally on x-rays (ultrasound or CT scan) during investigations of other problems
  • Symptoms can include:
    • Blood in urine (haematuria)
    • Flank pain
    • Feeling a mass
    • Weight loss

How is kidney cancer diagnosed?

  • Kidney cancers are most commonly diagnosed on ultrasound and/or CT scan
  • A CT scan is necessary to provide information on size and location prior to determining treatment options
  • Routine imaging of the chest is required to ensure no spread (metastasis) of the cancer

What is the role of kidney mass biopsy?

  • Biopsy is not indicated in most cases, as approximately 80% of solid lesions in the kidney detected on CT will be kidney cancers
  • Biopsy may be indicated if:
    • There is a history of previous cancers elsewhere to rule out metastasis
    • Lymphoma is suspected
    • Tumour is small (<3cm), to help decide if treatment with surgery is required

What are the treatment options for localised kidney cancer?

  • Surgery is the most effective treatment option for attempting to cure kidney cancer.  See Urological procedures explained for details on each procedure
  • If the staging x-rays show no spread beyond the kidney, the potential options include:
    • Radical Nephrectomy (removal of the entire kidney & tumour, as well as fat surrounding kidney)
      • In most cases this will be performed laparoscopic (key hole)
    • Partial Nephrectomy: (surgical removal of just the tumour from the involved kidney, leaving the majority of healthy kidney behind)
      • Now considered the gold standard treatment option for smaller kidney tumour (usually <4cm)
      • May be performed laparoscopic or open depending on the size and location of the tumour
      • Particularly beneficial for patients with impaired baseline kidney function or medical conditions which may impair kidney function in the future (e.g. diabetes)
    • Ablative procedures:
      • RFA (radiofrequency ablation)
        • is a relative new treatment option for select patients with small localised kidney tumours not fit for surgery or who don’t want surgery but want some form of treatment
        • cancer cure rates are inferior to surgery and longer follow up data is lacking, however offers better results than observation
    • Observation:
      • May be discussed as an option if:
        • The patient is unfit for surgery due to age or other medical conditions
        • The tumour is very small and slow growing
        • The risk of a small kidney tumour (<3cm) spreading to other organs is very low (1-2%)

What are the treatment options if my kidney cancer has spread (metastasised)?

  • TKI’s – Tyrosine Kinase Inhibitors
    • Standard chemotherapy agents are not effective at treating kidney cancer
    • TKI’s are a relatively new class of drugs that result in a reduction to the blood vessel growth to the cancer
    • They can result in significant shrinkage of the tumour
    • These agents will be administered under the care of a medical oncologist
    • Survival can be improved by several months
  • Radiotherapy:
    • May be used to help control local symptoms from a bleeding kidney cancer if surgery is not possible
    • Also can be used to help control the growth of advanced kidney cancers where surgery is not an option