Kidney Cancer: What You Need to Know

A kidney cancer diagnosis can be overwhelming — especially when most cases are found by chance imaging. Therefore, it is key for patients and their loved ones to understand the basics of the disease.

At A Vision of Hope: A Kidney Cancer Educational Symposium, Dr. Thomas J. Guzzo — who is the chief of the division of urology and an associate professor of urologic surgery at the University of Pennsylvania Health System – explained that the kidneys are a pair of organs in the abdomen that filter waste out of the blood and make urine. The ureters, bladder and urethra hold and transport the urine before it is released from the body.

While not all renal masses are cancer, approximately 85% of masses are. However, size is everything, Guzzo said during the symposium — hosted by the Judy Nicholson Kidney Cancer Symposium and Penn Medicine Abramson Cancer Center. Masses that are 1 centimeter, or the size of a pea have a 50% chance of being cancerous, and the bigger the mass gets, the more of a chance it is malignant. Those that are 3 to 4 centimeters, or the size of a golf ball, have a 75% change of being cancerous. Lastly, tumors that are 7 centimeters, or the size of a baseball are 90% likely to be kidney cancer.

However, the plus side is improved technology is helping to find these masses, even coincidentally. “The incidence of kidney cancer has been increasing in the United States pretty steadily since the 1970s. mostly due to increase use of axial imaging needed, like CAT scans and MRIs,” Guzzo said. “Nowadays, if you go into the emergency room with abdominal pain or back pain, and one of the initial things that will happen is you'll get imaging done, and so we're finding a lot more of these small renal masses just incidentally or by luck, and that's continued to increase over the past decade.” For example, the incidence of kidney cancer has increased by about 1% per year.

In 2019, kidney cancer is the sixth and seventh most common cancer among men and women, respectively. The disease is most commonly diagnosed between the ages of 55 to 74, with a median age of 64 at diagnosis. Unfortunately, more than 14,000 individuals will die from kidney cancer this year.

While most kidney cancers are found by chance because the majority of cases are asymptomatic, Guzzo said, one in 10 people do experience symptoms like pain in the side of the body, an abdominal mass or blood in the urine. Moreover, bone pain or a consistent cough can also be signs that the cancer has spread — also known as metastatic disease.

Stages of kidney cancer vary by tumor size, its regional lymph nodes and distant metastases. They include:

• Stage 1: The tumor is 7 centimeters or smaller and found only in the kidney; there is no cancer in nearby lymph nodes; and the cancer has not spread to other parts of the body.
• Stage 2: The tumor is larger than 7 centimeters and found only in the kidney; there is no cancer in nearby lymph nodes; and the cancer has not spread to other parts of the body.
• Stage 3: The tumor is the same as the previous stages, but there is cancer in nearby lymph nodes but has not spread to other parts of the body. Or the tumor has grown outside of the kidney into major veins or tissues, but not into Gerota’s faschia.
• Stage 4: The tumor has grown beyond Gerota’s faschia and regional lymph nodes, but the cancer has not spread to other parts of the body. Or the tumor is any size, has spread to regional lymph nodes and has spread to other parts of the body.

“When we're talking about the stage (of kidney cancer), we're really just talking about where this tumor is in relation to the kidney and structures around it,” Guzzo explained.

Lastly, depending on cancer stage and complexity, as well as the patient’s general health and personal preferences, there are a variety of treatment options, including surgery, active surveillance, thermal ablation, targeted therapy, immunotherapy and clinical trials.

“Surgery is the main treatment for the majority of kidney cancers, with the goal of removing the tumor and preserving normal kidney function,” Guzzo said.