Kidney cancer is sometimes referred to as renal cell carcinoma, which is its medical name. Renal derives from the Latin word “renalis”, which are the kidneys.

Kidney cancer is considered one of ten most commonly diagnosed forms of cancers in both women and men, with over 60,000 diagnosed cases occurring each year. The average age of people who are diagnosed with this disease is 64.

About Kidneys and How They Function
The kidneys are pair of bean-shaped organs located in the upper back wall of the abdomen. A primary job of the kidneys is to act as a filter to help remove any excess water, salt and waste products from the blood that comes in via the renal arteries. The substances they remove become urine, which leaves the kidneys through long slender tubes (ureters), which connect to the bladder, where the urine is stored until a person urinates. (On average, the kidneys filter roughly 200 quarts of blood to generate two quarts of urine.)

Topics Discussed:

– Clinical Trials

– Targeted Therapy

– Immunotherapy

– New Cancer Drug Treatments

Another function of the kidneys involves helping to control blood pressure by creating a hormone called renin. Kidneys also ensure that the body has enough red blood cells by making another hormone called erythropoietin, which signals the bone marrow to create more red blood cells.

While kidneys provide important functions, humans need less than one to function. In fact, there are many people who live healthy, normal lives with just one kidney.

Some people do not have any functioning kidneys, but are still able to survive with the assistance of dialysis, which helps to filter the blood much like a kidney would.

Types of Kidney Cancers
As with most cancers, kidney cancer begins when healthy cells in one or both of the kidneys rapidly grow, or change, creating a mass referred to as a tumor.

  • Renal Cell Carcinoma – About 85% of all diagnosed kidney cancers are renal cell carcinoma (RCC). This type of cancer usually produces a single tumor within a kidney, but sometimes may produce 2 or more tumors in one kidney, or even tumors in both kidneys.There are several sub-types of RCC, which can be determined by how the cancer cells look under a microscope. A defining a sub-type cancer may factor into determining a particular treatment plan and may also help determine whether the cancer is due to an inherited genetic syndrome.Among the possible types of diagnosed RCC, clear cell renal cell carcinoma is the most common, followed by papillary renal cell carcinoma, then chromophobe renal cell carcinoma, as well as other more rare types.

  • Transitional Cell Carcinoma – This type of kidney cancer is less common, occurring in about 10-15% of all diagnosed kidney cancers. This cancer begins in the area of the kidney that collects the urine before it moves to the bladder, called the renal pelvis.

  • Renal Sarcoma – A more rare form of kidney cancer, sarcoma of the kidney originates in the soft tissue of the kidney or the surrounding fat.

  • Wilms Tumor – This type of kidney cancer is most common in children, usually between the ages of 3 and 4, becoming less common after the age of 5.

Risk Factors
While these risk factors may make a person more likely to develop kidney cancer, this does not necessarily mean a person will get this disease. In fact, some people who are diagnosed with kidney cancer may have no known risk factors or very few. The following are some risk factors that scientists have found to increase a person’s chances of getting this cancer. These risk factors are typically lifestyle or genetic related.

  • Smoking – Smokers have an increased risk of developing RCC, but the risk appears to be related to how much a person smokes. This risk drops when a person stops smoking, but it may take many years to be at the same level of someone who never smoked.

  • Obesity – Obesity may affect some hormones that can lead to RCC.

  • Workplace Exposures – Some studies have shown that over exposure to certain workplace substances can increase the risk for RCC. These substances may include herbicides, organic solvents and cadmium, which is a particular type of metal.

  • Genetic and Hereditary Risk Factors – Some people may be predisposed to kidney cancer because the DNA they inherit from their parents causes genetic mutations or they inherit health conditions that can lead to this cancer.

  • High Blood Pressure – Some studies have shown that certain medicines used to treat high blood pressure may increase the risk of kidney cancer. It is still, however, difficult to determine whether it’s the condition, the medicine, or both, that may increase the risk.

  • Gender – RCC is almost twice as commonly diagnosed in men as in women. This may be related to more men being smokers and having been exposed to certain chemicals at work.

  • Race – African Americans and Native Americans have a slightly higher rate of RCC than do whites.

Symptoms
While early kidney cancers do not generally cause any symptoms, there are several possible symptoms to be mindful of which could indicate kidney cancer.

  • Lower back pain on one side that is not related to an injury.

  • A lump on the lower back or side.

  • Loss of appetite

  • Fatigue

  • Weight loss that is not related to dieting.

  • Having low red blood cell counts, like with Anemia.

  • Blood found in the urine.

Even though many of these symptoms may be linked to kidney cancer, or other types of cancer, they may often be related to other diseases that are more benign, such as a urinary tract infection that may cause blood in the urine. Do not postpone seeing your doctor if any of these symptoms appear.

Diagnosing
While kidney cancer might be found because of certain symptoms a person experiences, it might be diagnosed because of lab tests or imaging tests a person receives for other reasons. If kidney cancer is suspected.

Most people who are diagnosed with kidney cancer are diagnosed later in their life, with the average age around 64. In general, kidney cancer is very uncommon is people younger than 45.

For people who have a higher risk of kidney cancer, physicians may recommend regular imaging tests to look for any signs of kidney tumors. These diagnostic tests may include CT, MRI or ultrasound scans.

A physician may also recommend genetic counseling or testing to see if there are any inherited gene mutations. This would be for people who have family members, who have had kidney cancer, particularly at a young age, or have been diagnosed with an inherited condition that is linked to kidney cancer.

If a person has any symptoms that suggest kidney cancer, a physician will want to take a complete medical examination, which will include covering the person’s medical history to check for possible risk factors. Following this exam, the doctor may suggest more tests if they suspect kidney cancer. These tests may include the following:

  • Complete blood count test to measure the amounts of different cells in the blood, such as red blood cells.

  • Urinalysis

  • Imaging Tests – Using x-rays, magnetic fields, sound waves or radioactive substances, these tests will help to determine whether a suspicious area might be cancer. (CT, PET, Ultrasound, MRI)

  • Biopsy – Biopsies are generally not used to diagnose kidney tumors, since imaging tests generally offer enough information to determine whether an operation is needed. Sometimes, however, a biopsy is used to take a sample of cells from a suspected cancerous area, especially when the imaging results are not clear enough to suggest surgery.

Treatment
If kidney cancer is diagnosed, your medical team will discuss all treatment options with you to determine a plan that takes into account various factors such as the type of cancer, it’s stage (whether the cancer has spread), as well as the patient’s overall health and the types of side effects that may occur.

  • Surgery – This is the main treatment for most types of kidney cancers (including metastatic kidney cancer, where the cancer has spread to other organs. Depending upon the stage and location of the cancer, surgery may remove either the cancer with any surrounding kidney tissue, or the entire kidney.

  • Radiation Therapy – While kidney cancers are usually not very sensitive to radiation, radiation therapy may sometimes be used to treat the cancer if the patient is not healthy enough to have surgery. Usually radiation therapy is used to help ease some of the symptoms of kidney cancer, such as bleeding or pain.

  • Targeted Therapy – New cancer research is helping to develop newer cancer drugs that target specific cells. These drugs are different from standard chemotherapy drugs, as they seek the cancer while minimizing any damage to the patient’s healthy cells. Where standard chemotherapy is often not as effective, targeted drug therapies are showing a lot more promise and often cause less severe side effects.  Avastin (Bevacizumab) is an example of an FDA approved targeted therapy for kidney cancer.

  • Immunotherapy – This relatively new treatment seeks to boost the patient’s immune system to help it recognize the cancer and fight it off or destroy the cancer cells. One FDA approved immunotherapy for kidney cancer is Opdivo (Nivolumab).

  • Chemotherapy – Given intravenously or in pill form, chemotherapy treatment uses anti-cancer drugs, which enter the patient’s blood and then reach all areas of their body. This type of treatment is useful for treating cancer that has spread from its original location to other organs. In general, chemo is no longer a standard treatment for kidney cancer as the kidney cancer cells tend to resist the chemo. While some chemo drugs have shown to help a small group of patients, chemotherapy is now usually used for kidney cancer only after targeted and/or immunotherapy treatments have already been used.

In general, kidney cancer is predominantly treated through surgery, targeted therapy and immunotherapy. Sometimes radiation therapy and chemotherapy will be used. Some patients may require multiple types of treatments. As with every type of cancer treatment, there may be certain side effects that the patient will need to consider.

New Research and The Future of Kidney Cancer
New advances in diagnosing and treating kidney cancer are not only helping more patients to live with this disease, but to also maintain a normal lifestyle.

Doctors and scientists are continuously looking for improved ways to treat patients who have kidney cancer. Many clinical trials are now helping to get more of these new drugs approved by the FDA , such as targeted therapies and immunotherapy treatment.