This page provides answers to the most common questions asked by kidney cancer patients and their carers about the disease and its treatment. Our answers are based on extensive research and discussions with leading kidney cancer experts in the UK, the United States and Europe.

It must be stressed, however, that on medical issues even experts sometimes disagree and, moreover, there is still much that is not understood about kidney cancer. The answers provided are taken from the Kidney Cancer UK Fact Pack which can be found on our website and should therefore be taken only as a general guide and a starting-point for further discussion with your own medical team.

Please select from the list of categories below

• The kidneys and their function
• Types of Kidney Cancer
• How common is kidney cancer and what are the likely causes?
• What are the symptoms of kidney cancer?
• Detection & diagnosis
• Prognosis & survival
• Surgery
• Tyrosine Kinase Inhibitors
• Radiotherapy
• Chemotherapy
• Hormone therapy
• Immunotherapy
• Clinical trials
• Regular check-ups
• Getting expert medical advice
• Access to treatment in the UK
• Complementary therapy
• Diet, nutrition & lifestyle
• Palliative care
• Emotional support
• Travel Insurance for Cancer Patients

• The kidneys and their function

  The kidneys are two bean-shaped organs, about 3 inches (75mm) wide and 5 inches (125mm) long. They are located just above the waist on either side of the spine. Their main function is to filter the blood and to convert waste products such as excess water and salt into urine. Inside the kidney, the blood is filtered through tiny networks of tubes called nephrons. Nephrons contain urine-carrying tubes called tubules. Urine collects in an area of the kidney called the renal pelvis and then drains away via a long tube called the ureter into the bladder, where it is stored. When the bladder is full, the urine passes out of the body via another tube, the urethra.

  It is important to note that all normal renal functions can be maintained by one kidney. For example, a person who is born with only one kidney or who donates a kidney for organ transplantation can still live a perfectly healthy life. Similarly, a kidney cancer patient who has one kidney removed by surgery will not necessarily suffer any significant impairment of overall renal function.

  Back to top

• Types of Kidney Cancer

  There are several different types of kidney cancer. The most common is renal cell carcinoma (RCC), also known as renal adenocarcinoma or renal hypernephroma. This accounts for about 85% of all kidney cancers. In RCC, the malignant cells originate in the lining (epithelium) of the kidney's tubules.

  There are also different sub-types of RCC classified according to the particular characteristics of the cancer cells when examined under a microscope. These include clear cell (the most common type of RCC), chromophilic or papillary, chromophobic, oncocytic, collecting duct and sarcomatoid carcinoma. About 6-7% of kidney cancers originate in the renal pelvis, at the point where the kidney joins the ureter. These are known as transitional cell carcinomas. Wilms Tumour is a rare form of kidney cancer that affects children, usually between the ages of two and five.

  Back to top

• How common is kidney cancer and what are the likely causes?

  Kidney cancer is the eighth most common cancer in males and the fourteenth most common cancer in females in the UK and the number of cases is on the increase. The incidence of kidney cancer has risen by 68% over the past two decades and nearly 7,400 people are affected by the disease in the UK every year. That's 20 new cases per day.

  Kidney cancer is most common among people over the age of 40. The causes are not yet fully understood but certain factors have been identified as increasing a person's risk of developing kidney cancer.

  • Smoking
  • Exposure to certain chemicals in the workplace
  • Obesity
  • Patients undergoing kidney dialysis
  • People affected by specific inherited diseases have an increased risk of developing kidney cancer. These include: Von Hippel-Lindau (VHL) Syndrome, Birt-Hogg-Dube Syndrome, Hereditary Non-VHL Clear Cell Renal Cell Cancer and Hereditary Papillary Renal Cell Cancer.

  In the early stages of kidney cancer, there are often no obvious symptoms or they are so mild that they are overlooked. Unfortunately, this means that by the time symptoms are evident, the disease may have progressed and be more difficult to treat.

  Back to top

• What are the symptoms of kidney cancer?

  Symptoms to watch out for include:

  • Blood in the urine
  • Any lump or swelling in the area of the kidney
  • Low back pain that is not related to an injury
  • Other more general symptoms such as tiredness, loss of appetite, weight loss or persistent fever.

  If your doctor suspects that you might have a kidney problem, he/she will arrange for some of the initial tests outlined below to be carried out or he/she may refer you to a urologist (a specialist in diseases of the urinary system) for further tests. Kidney cancer is a complex disease and can be diagnosed at different stages, so the range of tests undertaken and the order in which they are carried out will vary.

  Back to top

• Detection & diagnosis

  Initial tests and diagnostic procedures

  Medical history and physical examination

  You will be asked questions about your medical history and symptoms and a physical examination will be carried out to detect any lumps or swellings.

  Urinalysis

  Urine samples will be analysed for traces of blood and other substances such as proteins.

  Blood tests

  Your blood will be checked to see whether you have anaemia

  Ultrasound scan

  An ultrasound scan uses high-frequency sound waves to build up a picture of the inside of the abdomen.

  IVU (IVP)

  An intravenous urogram (or pyelogram) can show abnormalities in the kidneys or the urinary system.

  Cystoscopy

  A cystoscopy is a procedure usually performed under general anaesthetic. A fine tube with a light is passed into the bladder to investigate whether symptoms are associated with the bladder rather than the kidneys.

  Further tests

  If kidney cancer has been detected, further tests will be performed to see how far it has progressed and whether it has spread.

  Back to top

• Prognosis & survival

  As with all types of cancer, if it is detected at an early stage, there is usually a much greater chance of long-term survival. If your cancer has spread, then it is likely to be more difficult to treat, although in many cases treatment can keep symptoms well under control for years.

  Back to top

• Surgery

  Surgery is usually the first-line treatment for kidney cancer and may be all that is required if the cancer is at an early stage.

  In a radical nephrectomy, the whole kidney is removed along with the tumour and the surrounding fatty tissue.

  If the primary tumour is small, a partial nephrectomy may be performed, whereby only the part of the kidney containing the cancer is removed.

  Laparoscopic surgery to remove the diseased kidney is now being performed in some centres. This 'keyhole surgery' is less invasive and can result in reduced blood loss and reduced time in hospital. A few centres also perform laparoscopic surgery to remove just the diseased part of the kidney.

  This is known as a laparoscopic partial nephrectomy. It is technically a difficult procedure and is only available for selected patients in a few centres. It is possible to lead a perfectly normal life with just one kidney. If the cancer has spread, then in some cases surgery may be considered appropriate to remove secondary tumours.

  Back to top

• Tyrosine Kinase Inhibitors

  The commonest form of kidney cancer, clear cell carcinoma, contains an abnormality in its genetic make-up which means that a gene called von Hippel Lindau gene product (or VHL for short) stops working. VHL is one of the normal cells ways of controlling how cells behave, so when it stops working, kidney cancer cells develop a rich blood supply which allows them to grow and spread. In the last few years new drugs have become available which block this ability to grow a blood supply. These drugs are called anti-angiogenic drugs. There are various sorts of anti-angiogenic drugs, the most commonly used sort being tyrosine kinase inhibitors (or TKI for short) such as Sunitinib, Sorafenib and Pazopanib.

  Back to top

• Radiotherapy

  Radiotherapy uses high-energy rays to kill cancer cells while doing as little harm as possible to normal cells. It is only used occasionally in the treatment of kidney cancer, usually to shrink the tumour and so helps to control painful symptoms, particularly when the cancer has spread to the bones.

  Back to top

• Chemotherapy

  Chemotherapy is the use of special anti-cancer (cytotoxic) drugs to destroy cancer cells. It offers limited benefit in the treatment of kidney cancer because of the specific properties of kidney cancer cells. However, you may be offered chemotherapy as part of a trial of new drugs, or in combination with biological therapy (see the section on clinical trials).

  Back to top

• Hormone therapy

  A small percentage of patients respond well to hormone treatment. Side effects are few (they include water retention, weight gain, indigestion, nausea and sleeplessness) and many patients feel better while receiving this treatment and so it is offered relatively frequently.

  Back to top

• Immunotherapy

  Immunotherapy or biological therapy uses the body's own defences to fight cancer, stimulating the immune system to attack cancer cells. It is most likely to be used where cancer has already spread beyond the kidney or as adjuvant treatment (to reduce the risk of a recurrence of disease after surgery).

  Back to top

• Clinical trials

  A clinical trial is a carefully planned and supervised study of a new treatment for a particular disease. It provides medical professionals and researchers with the vital data they need to determine whether a new treatment is more effective or causes fewer side effects than the current best treatment. Without clinical trials, there can be no progress in terms of new treatments or management approaches. Trials are usually used to test new drugs although they can also be used to assess surgical techniques, different ways of giving radiotherapy and newer types of treatments such as vaccines and gene therapy.

  Many trials are randomised, which means that you are not able to choose whether you are offered a new type of treatment or the standard approach. Also, trials have strict entry requirements (eligibility criteria) in terms of your overall fitness (performance status) and extent of disease and prognosis, so you may not be suitable for a specific trial in which you are interested. Your kidney cancer specialist should be able to advise on your suitability for a specific trial.

  Back to top

• Regular check-ups

  If you have had a kidney cancer removed then your doctors will want to check that all is well periodically. The standard varies from centre to centre. A typical routine would be to see the patient every 3 months for the first 2 to 3 years before relaxing the routine to every 6 months and eventually to discharge from clinic. Most centres will also recommend CT scans every 6 months or so during the first 2 to 3 years.

  Back to top

• Getting expert medical advice

  As you would expect, patients treated at a specialist cancer centre are likely to do better than those attending clinics with limited experience of treating kidney cancer.

  Back to top

• Access to treatment in the UK

  Please see the Treatment Options Section of the Kidney Cancer UK Fact Pack.

  Back to top

• Complementary therapy

  Please see the Links Section of this website for organisations offering complimentary therapy.

  Back to top

• Diet, nutrition & lifestyle

  If you have one kidney removed you will suffer no ill-effects as long as the other kidney is working normally. For good kidney health, the following advice should be followed:

  • If you are a smoker, try to stop smoking
  • Reduce your protein intake by avoiding excessive consumption of meat and fish, eggs, dairy products, beans and lentils. A dietician can offer advice and information
  • Cut down on the amount of salt in your diet
  • Avoid excessive doses of vitamin C in supplement form
  • Keep your alcohol consumption to a moderate level
  • Drink plenty of water

  Back to top

• Palliative care

  It is important that you enjoy the best possible quality of life and that any symptoms you experience are managed effectively. You can ask your doctor about referral to a Macmillan or Marie Curie nurse, who specialises in controlling the symptoms of cancer and improving your physical well-being.

  Back to top

• Emotional support

  You may find it easier to talk openly about your feelings to somebody outside your immediate circle of family and friends. Some people find it reassuring to talk to others who have gone through a similar situation and understand how they are feeling. Kidney Cancer UK can put you in touch with other kidney cancer patients and an Internet chat room is also available. Kidney Cancer UK also administers a membership scheme whereby patients and carers can receive on-going information and support throughout the year with various events and publications.

  Please see the Join Us Section of this website. If you are finding it difficult to cope with your feelings, a trained counsellor or psychologist may be able to help. Counselling may be available at your hospital or alternatively contact an organisation such as Macmillan for advice. (Please see the Further Sources of Information Section of the Kidney Cancer UK Fact Pack).

  Back to top

• Travel Insurance for Cancer Patients

  For details of companies who provide travel insurance for cancer patients, please see the Macmillan Travel Insurance Fact Sheet via this link

  Back to top