Risk Factors for Kidney Cancer

A risk factor is anything that affects your chance of getting a disease such as cancer. Different cancers have different risk factors. Some risk factors, like smoking, can be changed. Others, like your age or family history, can’t be changed.

But having a risk factor, or even several risk factors, does not mean that you will get the disease. And some people who get the disease may have few or no known risk factors. Even if a person with kidney cancer has a risk factor, it is often very hard to know how much that risk factor contributed to the cancer.

Scientists have found several risk factors that could make you more likely to develop kidney cancer.

Smoking :

Smoking increases the risk of developing renal cell carcinoma (RCC). The increased risk seems to be related to how much you smoke. The risk drops if you stop smoking, but it takes many years to get to the risk level of someone who never smoked.

Obesity :

People who are very overweight have a higher risk of developing RCC. Obesity may cause changes in certain hormones that can lead to RCC.

Workplace exposures :

Many studies have suggested that workplace exposure to certain substances increases the risk for RCC. Some of these substances are cadmium (a type of metal), some herbicides, and organic solvents, particularly trichloroethylene.

Family history of kidney cancer :

People with a strong family history of renal cell cancer (without one of the known inherited conditions listed below) have a higher chance of developing this cancer. This risk is highest for people who have a brother or sister with the cancer. It’s not clear whether this is due to shared genes, something that both people were exposed to in the environment, or both.

High blood pressure :

The risk of kidney cancer is higher in people with high blood pressure. Some studies have suggested that certain medicines used to treat high blood pressure may raise the risk of kidney cancer, but it is hard to tell if it’s the condition or the medicine (or both) that may be the cause of the increased risk.

Certain medicines :

Phenacetin: This drug used to be a popular non-prescription pain reliever and has been linked to RCC in the past. But it has not been available in the United States for over 30 years, so it no longer appears to be a major risk factor.

Diuretics: Some studies have suggested that diuretics (water pills) may be linked to a small increase in the risk of RCC. It is not clear whether the cause is the drugs or the high blood pressure they treat. If you need to take diuretics, don’t avoid them to try to reduce the risk of kidney cancer.

Advanced kidney disease :

People with advanced kidney disease, especially those needing dialysis, have a higher risk of RCC. Dialysis is a treatment used to remove toxins from your body if the kidneys do not work properly.

Gender :

RCC is about twice as common in men as in women. Men are more likely to be smokers and are more likely to be exposed to cancer-causing chemicals at work, which may account for some of the difference.

Race :

African Americans and American Indians/Alaska Natives have slightly higher rates of RCC than do whites. The reasons for this are not clear.

Genetic and hereditary risk factors :

Some people inherit a tendency to develop certain types of cancer. The DNA in each of your cells that you get from your parents may have changes that give you this tendency. Some rare inherited conditions can cause kidney cancer. It is important that people who have hereditary causes of RCC see their doctors often, especially if they have already been diagnosed with RCC. Some doctors recommend regular imaging tests (such as CT scans) to look for new kidney tumors in these people.

People who have the conditions listed here have a much higher risk for getting kidney cancer, although they account for only a small portion of cases overall.

von Hippel-Lindau disease :

People with this condition often develop several kinds of tumors and cysts (fluid-filled sacs) in different parts of the body. They have an increased risk for developing clear cell RCC, especially at a younger age. They may also have benign tumors in their eyes, brain, spinal cord, pancreas, and other organs; and a type of adrenal gland tumor called pheochromocytoma. This condition is caused by mutations (changes) in the VHL gene.

Hereditary papillary renal cell carcinoma :

People with this condition have a tendency to develop one or more papillary RCCs, but they do not have tumors in other parts of the body, as is the case with the other inherited conditions listed here. This disorder is usually linked to changes in the MET gene.

Hereditary leiomyoma-renal cell carcinoma :

People with this syndrome develop smooth muscle tumors called leiomyomas (fibroids) of the skin and uterus (in women) and have a higher risk for developing papillary RCCs. It has been linked to changes in the FH gene.

Birt-Hogg-Dube (BHD) syndrome :

People with this syndrome develop many small benign skin tumors and have an increased risk of different kinds of kidney tumors, including RCCs and oncocytomas. They may also have benign or malignant tumors of several other tissues. The gene linked to BHD is known as FLCN.

Familial renal cancer :

People with this condition develop tumors called paragangliomas of the head and neck region, as well as tumors known as pheochromocytomas of the adrenal glands and thyroid cancers. They also tend to get kidney cancer in both kidneys before age 40. It is caused by defects in the genes SDHB and SDHD.

Cowden syndrome :

People with this syndrome have a high risk of breast, thyroid and kidney cancers. It is linked to changes in the  PTEN gene.

Tuberous sclerosis :

People with this syndrome develop many, usually benign (noncancerous) tumors in different parts of the body including the skin, brain, lungs, eyes, kidneys, and heart. Although the kidney tumors are most often benign, occasionally they can be clear cell RCC. It is caused by defects in the genes TSC1 and TSC2.

Hereditary renal oncocytoma :

Some people inherit the tendency to develop a kidney tumor called an oncocytoma, which is almost always benign (not cancer).

Although many risk factors can increase the chance of developing renal cell cancer (RCC), it is not yet clear how some of these risk factors cause kidney cells to become cancerous.

Changes (mutations) in genes :

Cancer is caused by changes in the DNA inside our cells. DNA is the chemical in our cells that makes up our genes, which control how our cells function. DNA, which comes from both our parents, affects more than just how we look.

Some genes help control when our cells grow, divide into new cells, and die:

• Certain genes that help cells grow, divide, and stay alive are called oncogene
• Genes that help keep cell division under control or cause cells to die at the right time are called tumor suppressor genes.

Cancers can be caused by DNA mutations (changes) that turn on oncogenes or turn off tumor suppressor genes, resulting in cells growing out of control. Changes in many different genes are usually needed to cause kidney cancer.

Inherited gene mutations :

Certain inherited DNA changes can lead to conditions running in some families that increase the risk of kidney cancer. These syndromes, which cause a small portion of all kidney cancers, were described in What Are the Risk Factors for Kidney Cancer?

For example, VHL, the gene that causes von Hippel-Lindau (VHL) disease, is a tumor suppressor gene. It normally helps keep cells from growing out of control. Mutations (changes) in this gene can be inherited from parents. When the VHL gene is mutated, it is no longer able to control the abnormal growth, and kidney cancer is more likely to develop. The genes linked to hereditary leiomyoma  (the FH gene), Birt-Hogg-Dube syndrome (the FLCN gene), and familial renal cancer (the SDHB and SDHD genes) are also tumor suppressor genes, and inherited changes in these genes lead to an increased risk of kidney cancer.

People with hereditary papillary renal cell carcinoma have inherited changes in the MET oncogene that cause it to be turned on all the time. This can lead to uncontrolled cell growth and makes the person more likely to develop papillary RCC.

Special genetic tests can detect some of the gene mutations associated with these inherited syndromes. If you have a family history of kidney cancer or other cancers linked to these syndromes, you may want to ask your doctor about genetic counseling and genetic testing. The American Cancer Society recommends discussing genetic testing with a qualified cancer genetics professional before any genetic testing is done. For more on this, see Understanding Genetic Testing for Cancer and What Happens during Genetic Testing for Cancer?

Acquired gene mutations :

Some gene mutations happen during a person’s lifetime and are not passed on. They affect only cells that come from the original mutated cell. These DNA changes are due to acquired mutations.

In most cases of kidney cancer, the DNA mutations that lead to cancer are acquired during a person’s life rather than having been inherited. Certain risk factors, such as exposure to cancer-causing chemicals (like those found in tobacco smoke), probably play a role in causing these acquired mutations, but so far it’s not known what causes most of them. Progress has been made in understanding how tobacco increases the risk for developing kidney cancer. Your lungs absorb many of the cancer-causing chemicals in tobacco smoke into the bloodstream. Because your kidneys filter this blood, many of these chemicals become concentrated in the kidneys. Several of these chemicals are known to damage kidney cells in ways that can cause the cells to become cancerous.

Obesity, another risk factor for this cancer, alters the balance of some of the body’s hormones. Researchers are now learning how certain hormones help control the growth (both normal and abnormal) of many different tissues in the body, including the kidneys.

Most people with sporadic (non-inherited) clear cell RCC have changes in the VHL gene in their tumor cells that have caused it to stop working properly. These changes are acquired during life rather than being inherited.

Other gene changes may also cause renal cell carcinomas. Researchers continue to look for these changes. For more about how genes changes can lead to cancer, see Genes and Cancer.

Can Kidney Cancer Be Prevented?

In many cases, the cause of kidney cancer is not known. In some other cases (such as with inherited conditions that raise kidney cancer risk), even when the cause is known it may not be preventable. But there are some ways you may be able to reduce your risk of this disease.

Cigarette smoking is responsible for a large percentage of cases, so stopping smoking may lower your risk.

Obesity and high blood pressure are also risk factors for renal cell cancer. Maintaining a healthy weight by exercising and choosing a diet high in fruits and vegetables, and getting treatment for high blood pressure may also reduce your chance of getting this disease.

Finally, avoiding workplace exposure to harmful substances such as cadmium and organic solvents may reduce your risk for renal cell cancer.

Kidney Cancer Signs and Symptoms

Early kidney cancers do not usually cause any signs or symptoms, but larger ones might. Some possible signs and symptoms of kidney cancer include:

• Blood in the urine (hematuria)
• Low back pain on one side (not caused by injury)
• A mass (lump) on the side or lower back
• Fatigue (tiredness)
• Loss of appetite
• Weight loss not caused by dieting
• Fever that is not caused by an infection and that doesn’t go away
• Anemia (low red blood cell counts)

These signs and symptoms can be caused by kidney cancer (or another type of cancer), but more often they are caused by other, benign, diseases. For example, blood in the urine is most often caused by a bladder or urinary tract infection or a kidney stone. Still, if you have any of these symptoms, see a doctor so that the cause can be found and treated, if needed.

Tests for Kidney Cancer

Kidney cancer might be found because of signs or symptoms a person is having, or it might be found because of lab tests or imaging tests a person is getting for another reason. If cancer is suspected, tests will be needed to confirm the diagnosis.

Medical history and physical exam

If you have any signs or symptoms that suggest you might have kidney cancer, your doctor will want to take a complete medical history to check for risk factors and to learn more about your symptoms.

A physical exam can provide information about signs of kidney cancer and other health problems. For example, the doctor may be able to feel an abnormal mass (lump) when he or she examines your abdomen (belly).

If symptoms or the results of the physical exam suggest you might have kidney cancer, more tests will probably be done. These might include lab tests and imaging tests.

Blood tests

Lab tests cannot show for sure if a person has kidney cancer, but they can sometimes give the first hint that there may be a kidney problem. If cancer has already been diagnosed, they are also done to get a sense of a person’s overall health and to help tell if the cancer might have spread to other areas. They also can help show if a person is healthy enough to have an operation.

Urinalysis (urine testing): This test may be done if your doctor suspects a kidney problem.

Microscopic and chemical tests are done on a urine sample to look for small amounts of blood and other substances not seen with the naked eye. About half of all patients with renal cell cancer will have blood in their urine. If the patient has transitional cell carcinoma (in the renal pelvis, the ureter, or the bladder), sometimes a special exam of the urine sample (called urine cytology) in the lab will show actual cancer cells in the urine.

Complete blood count (CBC): This is a test that measures the amounts of different cells in the blood. This test result is often abnormal in people with renal cell cancer. Anemia (having too few red blood cells) is very common. Less often, a person may have too many red blood cells (called polycythemia) because the kidney cancer cells make a hormone (erythropoietin) that causes the bone marrow to make more red blood cells. Blood counts are also important to make sure a person is healthy enough for surgery.

Blood chemistry tests: These tests are usually done in people who might have kidney cancer, because the cancer can affect the levels of certain chemicals in the blood. For example, high levels of liver enzymes are sometimes found. High blood calcium levels may indicate that cancer has spread to the bones, and may therefore prompt a doctor to order a bone scan. Blood chemistry tests also look at kidney function, which is especially important if certain imaging tests or if surgery is planned.

Imaging tests to look for kidney cancer

Imaging tests use x-rays, magnetic fields, sound waves, or radioactive substances to create pictures of the inside of your body. Imaging tests can be done for a number of reasons, such as:

• To look at suspicious areas that might be cancer
• To learn how far cancer has spread
• To help determine if treatment is working

Unlike most other cancers, doctors can often diagnose kidney cancer with fair certainty based on imaging tests without doing a biopsy (removing a sample of the tumor to be looked at under a microscope). In some patients, however, a biopsy may be needed.

Computed tomography (CT) scan

The CT scan uses x-rays to produce detailed cross-sectional images of your body. It is one of the most useful tests for finding and looking at a tumor in your kidney. It can provide precise information about the size, shape, and location of a tumor. It is also useful in checking to see if a cancer has spread to nearby lymph nodes or to organs and tissues outside the kidney. If a kidney biopsy is needed, this test can also be used to guide a biopsy needle into the mass (lump) to obtain a sample.

When a CT is done to look at the kidneys, an IV (intravenous) contrast dye is often needed to make certain areas stand out better on the scan. This CT contrast can damage the kidneys. This happens more often in patients whose kidneys are not working well in the first place. Because of this, your kidney function will be checked with a blood test before you get IV contrast.

Magnetic resonance imaging (MRI) scan

MRI scans are used less often than CT scans in people with kidney cancer. They may be done in cases where CT scans aren’t practical, such as if a person can’t have the CT contrast dye because they have an allergy to it or they don’t have good kidney function. MRI scans may also be done if there’s a chance that the cancer has grown into major blood vessels in the abdomen (like the inferior vena cava), because they provide a better picture of blood vessels than CT scans. Finally, they may be used to look at abnormal areas in the brain and spinal cord that might be due to cancer spread.

Ultrasound

Ultrasound can help find a kidney mass and show if it is solid or filled with fluid (kidney tumors are more likely to be solid). Different echo patterns also can help doctors tell some types of benign and malignant kidney tumors from one another.

If a kidney biopsy is needed, this test can also be used to guide a biopsy needle into the mass to obtain a sample.

Positron emission tomography (PET) scan

A PET scan uses a form of radioactive sugar that is put into the blood. Body cells take in different amounts of the sugar, depending on how fast they are growing. Cancer cells, which grow quickly, are more likely to take up larger amounts of the sugar than normal cells. A special camera is used to create a picture of areas of radioactivity in the body. The picture from a PET scan is not as detailed as a CT or MRI scan, but it provides helpful information about whether abnormal areas seen on these other tests are likely to be cancer or not. This scan can be useful in seeing if the cancer has spread to lymph nodes near the kidney. PET scans can also be useful if your doctor thinks the cancer may have spread but doesn’t know where.

Special machines can perform both a PET and CT scan at the same time (PET/CT scan). This lets the doctor compare areas of higher radioactivity (suggesting an area of cancer) on the PET scan with the more detailed picture of that area on the CT.

Still, PET and PET/CT scans are not a standard part of the work-up for kidney cancers.

Intravenous pyelogram

An intravenous pyelogram (IVP) is an x-ray of the urinary system taken after a special dye is injected into a vein. The kidneys remove the dye from the bloodstream and it then concentrates in the ureters and bladder. An IVP can help find abnormalities of the renal pelvis and ureter, such as cancer, but this test is not often used when kidney cancer is suspected.

Angiography

Angiography is an x-ray test for looking at blood vessels. A contrast dye is injected into the renal artery, and the dye outlines the blood vessels. X-rays are taken to identify and map the blood vessels that supply a kidney tumor. This type of contrast dye though, is not the same as the one used for an IVP.

This test can help in planning surgery for some patients. Angiography can also help diagnose renal cancers since the blood vessels usually have a special appearance with this test.

Angiography can often be done as a part of a CT or MRI scan, instead of as a separate x-ray test. This means less contrast dye is used, which is helpful since the dye can damage kidney function further if it is given to people whose kidneys aren’t working well.

Chest x-ray

An x-ray may be done after kidney cancer has been diagnosed to see if cancer has spread to the lungs.

Bone scan

A bone scan can help show if a cancer has spread to your bones. It might be done if there is reason to think the cancer might have spread to the bones (because of symptoms such as bone pain or blood test results showing an increased calcium level). PET scans can usually show the spread of cancer to bones as well, so if you’ve had a PET scan you might not need a bone scan.

Kidney biopsy

Unlike with most other types of cancer, biopsies are not often used to diagnose kidney tumors. Imaging tests usually provide enough information for a surgeon to decide if an operation is needed. The diagnosis is then confirmed when part of the kidney that was removed is looked at in the lab.

However, a biopsy is sometimes done to get a small sample of tissue from an area that may be cancer when the imaging tests are not clear enough to permit surgery. Biopsy may also be done to confirm cancer if a person might not be treated with surgery, such as with small tumors that will be watched and not treated, or when other treatments are being considered.

Fine needle aspiration (FNA) and needle core biopsy  are 2 types of kidney biopsies that may be done.

In cases where the doctors think kidney cancer might have spread to other sites, they may take a biopsy of the metastatic site instead of the kidney.

Biopsy results

The biopsy samples are sent to a lab, where they are looked at by a pathologist, a doctor who specializes in diagnosing diseases with lab tests. If kidney cancer is found, an important feature that is evaluated is the grade, specifically called Fuhrman grade.

The Fuhrman grade is found by looking at kidney cancer cells (taken during a biopsy or during surgery) in a lab. Many doctors use it to describe how quickly the cancer is likely to grow and spread. The grade is based on how closely the cancer cells look like those of normal kidney cells. Renal cell cancers are usually graded on a scale of 1 through 4. Grade 1 renal cell cancers have cells that look a lot like normal kidney cells. These cancers usually grow and spread slowly and tend to have a good prognosis (outlook). At the other extreme, grade 4 renal cell cancer looks quite different from normal kidney cells. These cancers have a worse prognosis.

Kidney Cancer Stages

After someone is diagnosed with kidney cancer, doctors will try to figure out whether it has spread, and if so, how far. This process is called staging. The stage of a cancer describes the extent of the cancer in the body. It helps determine how serious the cancer is and how best to treat it. The stage is one of the most important factors in deciding how to treat the cancer and determining how successful treatment might be.

To determine the cancer’s stage after a kidney cancer diagnosis, doctors try to answer these questions:

• How large has the cancer grown in the kidney?
• Has the cancer reached nearby structures, such as major blood vessels?
• Has the cancer spread to the nearby lymph nodes or to distant organs?

The stage of kidney cancer is based on the results of the physical exam, imaging tests (CT scan, chest x-ray, PET scan, etc.), and sometimes biopsies which are described in Tests for Kidney Cancer

Understanding your kidney cancer stage

After looking at your test results, your doctor will tell you the stage of your cancer. The staging system most often used for kidney cancer is the American Joint Committee on Cancer (AJCC) TNM system. The TNM system is based on 3 key pieces of information:

• The size of the main (primary) tumor (T) and whether it has grown into nearby areas.
• If the cancer has spread to nearby (regional) lymph nodes (N). Lymph nodes are small bean-shaped collections of immune system cells to which cancers often spread first.
• If the cancer has spread (metastasized) to other organs (M). Kidney cancer can spread almost anywhere in the body, but common sites of spread are the bones, brain, and lungs.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once a person’s T, N, and M categories have been determined, usually after surgery, this information is combined in a process called stage grouping to assign an overall stage.

The earliest stage cancers are called stage 0 (carcinoma in situ), and then range from stages I (1) through IV (4). Some of the stages have sub-stages with the letters A, B, and C. The letter X means “cannot be assessed because the information is not available.”

As a rule, the lower the number, the less the cancer has spread. A higher number, such as stage IV, means a more advanced cancer. And within a stage, an earlier letter means a lower stage. Cancers with similar stages tend to have a similar outlook and are often treated in much the same way. Patients with lower stage numbers tend to have a better prognosis.

The staging system in the table below uses the pathologic stage. It is based on the results of physical exam, biopsy, imaging tests, and the results of surgery. This is likely to be more accurate than clinical staging, which only considers the tests done before surgery.

Kidney cancer staging can be complex. If you have any questions about your stage, please ask your doctor to explain it to you in a way you understand. (An explanation of the TNM system also follows the stage table below.)

Explaining the TNM system

T categories for kidney cancer

TX: The primary tumor cannot be assessed (information not available).

T0: No evidence of a primary tumor.

T1: The tumor is only in the kidney and is no larger than 7 centimeters (cm), or a little less than 3 inches, across.

T1a: The tumor is 4 cm (about 1½ inches) across or smaller and is only in the kidney.

T1b: The tumor is larger than 4 cm but not larger than 7 cm across and is only in the kidney.

T2: The tumor is larger than 7 cm across but is still only in the kidney.

T2a: The tumor is more than 7 cm but not more than 10 cm (about 4 inches) across and is only in the kidney.

T2b: The tumor is more than 10 cm across and is only in the kidney.

T3: The tumor is growing into a major vein or into tissue around the kidney, but it is not growing into the adrenal gland (on top of the kidney) or beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue).

T3a: The tumor is growing into the main vein leading out of the kidney (renal vein) or into fatty tissue around the kidney.

T3b: The tumor is growing into the part of the large vein leading into the heart (vena cava) that is within the abdomen.

T3c: The tumor has grown into the part of the vena cava that is within the chest or it is growing into the wall of the vena cava.

T4: The tumor has spread beyond Gerota’s fascia (the fibrous layer that surrounds the kidney and nearby fatty tissue). The tumor may have grown into the adrenal gland (on top of the kidney).

N categories for kidney cancer

NX: Regional (nearby) lymph nodes cannot be assessed (information not available).

N0: No spread to nearby lymph nodes.

N1: Tumor has spread to nearby lymph nodes.

M categories for kidney cancer

M0: There is no spread to distant lymph nodes or other organs.

M1: Distant metastasis is present; includes spread to distant lymph nodes and/or to other organs. Kidney cancer most often spreads to the lungs, bones, liver, or brain.

Other staging and prognostic systems

The TNM staging system is useful, but some doctors have pointed out that there are factors other than the extent of the cancer that should be considered when determining prognosis and treatment.

University of California Los Angeles (UCLA) Integrated Staging System

This is a more complex system that came out in 2001. It was meant to improve upon the AJCC staging that was then in place. Along with the stage of the cancer, it takes into account a person’s overall health and the Fuhrman grade of the tumor. These factors are combined to put people into low-, intermediate-, and high-risk groups. Ask your doctor if he or she uses this system and how it might apply to you.

Survival predictors

The stage of the cancer is an important predictor of survival, but other factors are also important. For example, researchers have linked certain factors with shorter survival times in people with kidney cancer that has spread outside the kidney. These include:

• High blood lactate dehydrogenase (LDH) level
• High blood calcium level
• Anemia (low red blood cell count)
• Cancer spread to 2 or more distant sites
• Less than a year from diagnosis to the need for systemic treatment (targeted therapy, immunotherapy, or chemotherapy)
• Poor performance status (a measure of how well a person can do normal daily activities)

People with none of the above factors are considered to have a good prognosis; 1 or 2 factors are considered intermediate prognosis, and 3 or more of these factors are considered to have a poor prognosis and may be less likely to benefit from certain treatments.

Survival Rates for Kidney Cancer by Stage

Survival rates tell you what portion of people with the same type and stage of cancer are still alive a certain amount of time (usually 5 years) after they were diagnosed. They can’t tell you how long you will live, but they may help give you a better understanding about how likely it is that your treatment will be successful. Some people will want to know the survival rates for their cancer type and stage, and some people won’t. If you don’t want to know, you don’t have to.

What is a 5-year survival rate?

Statistics on the outlook for a certain type and stage of cancer are often given as 5-year survival rates, but many people live longer than 5 years. The 5-year survival rate is the percentage of people who live at least 5 years after being diagnosed with cancer. For example, a 5-year survival rate of 90% means that an estimated 90 out of 100 people who have that cancer are still alive 5 years after being diagnosed. Keep in mind, however, that many of these people live much longer than 5 years after diagnosis.

Relative survival rates are a more accurate way to estimate the effect of cancer on survival. These rates compare people with kidney cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific type and stage of cancer is 90%, it means that people who have that cancer are, on average, about 90% as likely as people who don’t have that cancer to live for at least 5 years after being diagnosed.

But remember, the 5-year relative survival rates are estimates – your outlook can vary based on many factors specific to you.

Cancer survival rates don’t tell the whole story

Survival rates are often based on previous outcomes of large numbers of people who had the disease, but they can’t predict what will happen in any particular person’s case. There are a few limitations to remember:

• The numbers below are among the most current available. But to get 5-year survival rates, doctors must look at people who were treated at least 5 years ago. As treatments are improving over time, people who are now being diagnosed with kidney cancer may have a better outlook than these statistics show.
• These statistics are based on the stage of the cancer when it was first diagnosed. They do not apply to cancers that later come back or spread, for example.
• The outlook for people with kidney cancer varies by the stage (extent) of the cancer – in general, the survival rates are better for people with earlier stage cancers. But many other factors can affect a person’s outlook, such as age and overall health, and how well the cancer responds to treatment. The outlook for each person is specific to his or her circumstances.

Your doctor can tell you how these numbers may apply to you, as he or she is familiar with your situation.

Survival rates by AJCC TNM stage

The numbers below come from the National Cancer Data Base and are based on patients first diagnosed in the years 2001 and 2002. These are observed survival rates. They include people diagnosed with kidney cancer who may have later died from other causes, such as heart disease. People with kidney cancer tend to be older and may have other serious health conditions. Therefore, the percentage of people surviving the cancer itself is likely to be higher.

Survival rates in the UCLA Integrated Staging System

Researchers at UCLA have published a study evaluating their system in patients treated there from 1989 to 2005, looking at survival rates of the low-, intermediate- and high-risk groups. All of these patients at least had surgery to remove the tumor in the kidney. These numbers are disease-specific survival rates, meaning they only take into account people who died from their kidney cancer (and not other causes).

• For patients with localized kidney cancer (cancer that had not spread to the lymph nodes or distant organs), 5-year survival rates were 97% for the low-risk group, 81% for intermediate-risk group, and 62% for the high-risk group.
• For patients with kidney cancer that had spread to the lymph nodes or distant organs when it was first found, 5-year survival rates were 41% for the low-risk group, 18% for intermediate-risk group, and 8% for the high-risk group.

Kidney Cancer Treatment

If you’ve been diagnosed with kidney cancer, your cancer care team will discuss your treatment options with you. Think carefully about each of your choices. You will want to weigh the benefits of each treatment option against the possible risks and side effects.

• Surgery is the main treatment for the majority of kidney cancers, with the goal of removing the tumor and preserving normal kidney function. Surgical procedures used to treat kidney cancer may include:
• Removing the affected kidney (nephrectomy). A complete (radical) nephrectomy involves removing the entire kidney, a border of healthy tissue and occasionally additional nearby tissues such as the lymph nodes, adrenal gland or other structures. The surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen (laparoscopic or robotic-assisted laparoscopic nephrectomy).
• Removing the tumor from the kidney (partial nephrectomy). Also called kidney-sparing or nephron-sparing surgery, the surgeon removes the tumor and a small margin of healthy tissue that surrounds it rather than the entire kidney. It can be done as an open procedure, or laparoscopically or with robotic assistance. Kidney-sparing surgery is a common treatment for small kidney cancers and it may be an option if you have only one kidney. When possible, kidney-sparing surgery is generally preferred over a complete nephrectomy to preserve kidney function and reduce the risk of later complications, such as kidney disease and the need for dialysis.

The type of surgery your doctor recommends will be based on your cancer and its stage, as well as your health. Surgery carries a risk of bleeding and infection.

When the cancer is confined to the kidney, surgery is usually the only treatment needed — no drugs or radiation are necessary. Routine follow-up is all that’s needed.

Nonsurgical treatments

For some people, alternative options are available to destroy small tumors without surgery. These options include:

• Treatment to freeze cancer cells (cryoablation). During cryoablation, a special hollow needle is inserted through your skin and into the kidney tumor using ultrasound or other image guidance. Cold gas in the needle is used to cool down or freeze the cancer cells.
• Treatment to heat cancer cells (radiofrequency ablation). During radiofrequency ablation, a special probe is inserted through your skin and into the kidney tumor using ultrasound or other imaging to guide placement of the probe. An electrical current is run through the needle and into the cancer cells, causing the cells to heat up or burn.

These procedures may have advantages for certain patients and are a potential option for people who can’t have other surgical procedures and those with small kidney tumors.

Treatments for advanced and recurrent kidney cancer

Kidney cancer that recurs and kidney cancer that spreads to other parts of the body may not be curable, but may be controlled with treatment. In these situations, treatments may include:

• Surgery to remove as much of the kidney tumor as possible. Even when surgery can’t remove all of your cancer, in some cases it may be helpful to remove as much of the cancer as possible. Surgery may also be used to remove cancer that has spread to another area of the body.
• Drugs that use your immune system to fight cancer (biological therapy). Biological therapy (immunotherapy) uses your body’s immune system to fight cancer. Drugs in this category include interferon and aldesleukin (Proleukin), which are synthetic versions of chemicals made in your body. Nivolumab (Opdivo) is an immunotherapy sometimes used to treat advanced renal cell carcinoma.
• Targeted therapy. Targeted treatments block specific abnormal signals present in kidney cancer cells that allow them to multiply. These drugs show promise in treating kidney cancer that has spread to other areas of the body. The targeted drugs cabozantinib (CaboMetyx), axitinib (Inlyta), bevacizumab (Avastin), pazopanib (Votrient), sorafenib (Nexavar) and sunitinib (Sutent) block signals that play a role in the growth of blood vessels that nourish cancer cells and allow them to spread. Temsirolimus (Torisel) and everolimus (Afinitor) are targeted drugs that block a signal that allows cancer cells to grow and survive. Researchers continue to study how patients with specific genes might respond to certain targeted therapies.
• Radiation therapy. Radiation therapy uses high-powered energy beams, such as X-rays, to kill cancer cells. Radiation therapy is sometimes used to control or reduce symptoms of kidney cancer that has spread to other areas of the body, such as the bones and brain.

Systemic treatments: Kidney cancer can also be treated using drugs, which can be given by mouth or directly into the bloodstream. These are called systemic therapies because they can reach cancer cells almost anywhere in the body. Depending on the type of kidney cancer, several different types of drugs might be used, including:

• Targeted therapy
• Immunotherapy (biologic therapy)
• Chemotherapy

Depending on the stage of the cancer and other factors, different types of treatment may be combined at the same time or used after one another. To learn about the most common approaches to treating these cancers, see Treatment of Kidney Cancer, by Stage.

Some of these treatments can also be used as palliative treatment when all the cancer cannot be removed. Palliative treatment is meant to relieve  symptoms, such as pain, but it is not expected to cure the cancer.