Kidney Cancer Diagnoses Rise in Younger Adults, Expert Says

March marks Kidney Cancer Awareness Month, a time dedicated to raising awareness about risk factors, early detection and advances in treatment for one of the most common urologic cancers. The conversation has taken on renewed urgency following the recent passing of Brad Arnold, who revealed in May 2025 that he had been diagnosed with stage 4 clear cell renal cell carcinoma. Arnold, best known as the frontman of 3 Doors Down, helped bring attention to a disease that often develops quietly and is frequently discovered incidentally through imaging.

To better understand what patients should know about kidney cancer today, CURE spoke with Dr. Christopher Koller, a fellowship-trained urologic oncologist and assistant professor of urology at the Hackensack Meridian School of Medicine. Koller also serves as director of urologic oncology at the Hackensack Meridian Health Clifton Health and Wellness Center.

In the discussion below, he shares insights into emerging trends in kidney cancer diagnoses, including a concerning rise among younger adults, along with risk factors, warning signs and how advances are shaping the future of care.

CURE: Recent data suggest a rise in kidney cancer diagnoses among adults under 50. With that said, what kind of trends are you observing in your practice, and how significant is the shift compared with historical patterns?

Koller: It's a good question, and something that I think all of us are trying to figure out. Basically, there has been a rising trend of people being diagnosed younger. Anything under 50 is considered quite young for renal tumors, as the average age at diagnosis is typically in the mid-60s, around 65. When there is an uptick in people under 50, it certainly raises an alarm bell. There has been about a 5% increase in this cohort between 2000 and 2016, which is when we have the most reliable data, and that is a significant number when you consider the total population of the United States.

The reality is that it’s a bit of a murky picture. Many patients are receiving significantly more abdominal imaging now. If you go to the ER with abdominal pain today, you are much more likely to get a CT scan or MRI than you were 15 or 20 years ago. Because of that, we are catching many tumors very early in their development, which is a good thing. We are identifying masses that we label as small renal masses; consequently, while patients might be diagnosed earlier, we are simply seeing the disease much earlier in its clinical time course.

Many epidemiologists and neurologic surgeons are trying to determine if there has been a true market increase in the disease or if this is a phenomenon of improved screening technology.

Certain factors cited as key risk factors for this disease are obesity, hypertension, and smoking. How do these variables contribute to RCC development, and are there emerging risk factors clinicians should monitor in younger populations?

Obesity is indeed one of the main risk factors for kidney cancer. While we don't entirely have a perfect understanding of the mechanism, it likely relates to a higher inflammatory state and perhaps insulin mechanics. Regarding hypertension, or high blood pressure, the mechanism likely involves chronic hypoxia, meaning the oxygenation of the kidney is not as efficient as it is when blood pressure is within a normal range. Whenever you have oxidative stress on cells, they do not process free radicals efficiently, which can lead toward tumorigenesis.

The body relies on various mechanisms to clear cells and ensure there isn't a buildup of toxins or waste products from normal daily living. When that balance is pushed too far in either direction, it can increase the risk of developing a malignancy. On the other side of that coin, putting carcinogens into the body (such as those from smoking, vaping, or other substances) overloads the system. The kidneys must filter these carcinogens, which puts you at a higher risk of developing a kidney tumor.

In the urology world, we also know that because these toxins are filtered by the kidney and then trickle down to the bladder, smoking significantly increases the risk of bladder cancer. These toxins can sit in the bladder for hours before you go to the bathroom, which is why smokers have a higher incidence of bladder cancer as they age.

You mentioned that we are more likely to get imaging done in the ER now than we were 20 years ago. Are there any other red flags that would prompt this imaging earlier, particularly in younger patients?

Historically, there was a classic triad of kidney cancer symptoms: blood in the urine (hematuria), flank pain from a large tumor, and a palpable flank bulge. This was common when patients were diagnosed in the 60s, 70s, or 80s before cross-sectional imaging was widespread. Kidney cancer is often ‘quiet,’ and kidneys frequently do not cause pain even if a large tumor is growing. Because we now use serial imaging and find tumors at much earlier stages, symptoms can be harder to identify, and there is no national screening test for kidney cancer; no recommendation for an annual ultrasound like there is for a colonoscopy, mammogram, or PSA test.

However, there are red flags. Blood in the urine is never normal and should always prompt a conversation with a urologist. While there are many reasons for bleeding in the urinary tract (from the kidney and ureter to the bladder and prostate), a small population will have a kidney tumor related to that bleeding. Other non-specific symptoms include unexplained weight loss, severe bone pain, or persistent fatigue. There are also rarer paraneoplastic syndromes that can elevate liver enzymes, cause anemia, or worsen renal function. Persistent flank or back pain that does not improve after orthopedic causes have been ruled out is another concern. Finally, family history is vital.

If you have a strong history of kidney cancer on either your paternal or maternal side, that is a compelling reason to seek screening, see a urologist, and potentially undergo genetic testing.

When is germline testing appropriate?

I trained at the National Cancer Institute, where much of the data on this subject originates, and my partners here at Hackensack are similarly trained. We work closely with genetic counselors. The gold standard is that if you are diagnosed with a kidney tumor and are under age 46, there is compelling data suggesting a higher risk for a hereditary syndrome. A strong family history of kidney cancer or a known hereditary syndrome in the family is also a clear indication for testing.

There are several known syndromes, such as Von Hippel-Lindau (VHL), HLRCC, and Birt-Hogg-Dubé. These are best managed by a urologic oncologist who handles high-volume kidney cancer cases because the genetics can be unique. Having bilateral kidney tumors is another important reason for testing. Sometimes we perform genetic testing after surgery, whether it was a partial nephrectomy or a radical nephrectomy, if the pathology is specific to a germline phenomenon. For example, HLRCC tumors are fumarate hydratase-deficient and behave much differently than the more common clear cell kidney cancer. These cases require very close follow-up with both a urologic oncologist and a medical oncologist.

What would you like patients to take away from our conversation today? Are there any other prevention or public awareness strategies you’d like to highlight?

First, do not smoke. If you do smoke, look for ways to stop. It puts you at a higher risk for kidney, lung, and bladder cancer, and it is incredibly tough on your blood vessels. While stopping is easier said than done, there are excellent medications and counseling options available. Second, try to maintain a relatively healthy body weight. Everyone has a different set point, but staying close to a baseline that feels good for you helps. This involves the basics: a healthy diet, exercise, and fresh air.

As a urologist, I always recommend staying hydrated with plenty of water while avoiding sugary or highly caffeinated beverages. There is some reasonable data suggesting that green tea, black tea, and matcha can be helpful for the urinary system. From a screening standpoint, know your family and genetic history.

The good news is that if kidney cancer is localized and the tumors are four centimeters or smaller, the chance of a cure through surgery alone is over 90%. Even for advanced kidney cancer that has spread to the lymph nodes, bones, or liver, immunotherapy has changed the game over the last decade. It is no longer an automatic death sentence. Many patients remain stable on immunotherapy for five to ten years with excellent results, and in rare cases, we see complete responses.

We have learned a lot in the last 40 years, and with improvements in drug design and AI, the next ten years hold a lot of exciting hope for the field.

What would you want patients to know about radical versus partial nephrectomy?

I want to emphasize that here at [my institution], the preference is always to save as much of the kidney as possible. While sometimes a radical nephrectomy is necessary, patients at high-volume centers should always ask if they are a candidate for a partial nephrectomy, also known as nephron-sparing surgery. If you are diagnosed young, you may need that kidney function for another 40 or 50 years.

If we can provide a surgery that offers the same oncologic outcomes while keeping the healthy portion of the kidney in place, that is always our ultimate goal.

Transcript has been edited for clarity and conciseness.

References

1. “Increasing incidence of early-onset kidney cancer in young adults aged <50 years in England: an analysis of the national cancer registration data by age and gender, 1985–2020,” by Dr. Anjum Memon, et al. BJC Reports; Nature.

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