What is kidney cancer?

Kidney cancer is cancer that starts in the cells of the kidney. The most common type of
kidney cancer is renal cell carcinoma (RCC), accounting for about 90% of all cases.
Usually only one kidney is affected, but in rare cases the cancer may develop in both
kidneys.

Other less common types include:

Urothelial carcinoma (also called transitional cell carcinoma) which can begin in the
ureter or renal pelvis where the kidney and ureter meet. It is generally treated like
bladder cancer.
Wilms tumour, which is most common in younger children although it is still rare.

It is estimated that more than 4,500 people were diagnosed with kidney cancer in 2022.
The average age at diagnosis is 64 years old.

Kidney cancer is the seventh most commonly diagnosed cancer in Australia, and it is
estimated that one in 65 people will be diagnosed by the time they are 85.

Kidney cancer signs and symptoms

In its early stages, kidney cancer often does not produce any symptoms.

Symptoms may include:

blood in the urine or passing urine frequently or during the night, change in urine
colour – dark, rusty or brown
pain or a dull ache in the side or lower back that is not due to an injury
a lump in the abdomen
constant tiredness
rapid, unexplained weight loss
fever not caused by a cold or flu.
These symptoms can occur with other illnesses and so they don’t necessarily mean you
have kidney cancer. If you have any concerns, contact your doctor.

Causes of kidney cancer

The causes of kidney cancer are not known, but factors that put some people at higher
risk are:

smoking – smokers have almost twice the risk of developing kidney cancer as
nonsmokers
workplace exposure to chemicals such as arsenic, some metal degreasers or
cadmium used in mining, welding, farming and painting
a family history of kidney cancer
being overweight or obese
high blood pressure
having advanced kidney disease
being male - men are more likely to develop kidney cancer.

Diagnosis of kidney cancer

Tests to diagnose kidney cancer include:

Blood and urine tests

These tests do not diagnose kidney cancer but will check your general health and for
any signs of a problem in the kidney.

Imaging tests
If kidney cancer is detected, you may have scans to see if the cancer has spread to
other parts of your body, such as an ultrasound, chest x-ray, CT scan, MRI, or
radioisotope bone scan.
Biopsy
A biopsy removes a tissue sample for examination under a microscope and is a
common way to diagnose cancer. However, biopsies are not often needed for kidney
cancer before treatment ad imaging scans are good at showing if a kidney tumour is
cancer.

If you do have a biopsy, it will be a core needle biopsy where an interventional

radiologist will put a hollow needle through the skin to remove a tissue sample.

Treatment for kidney cancer

The main treatment for kidney cancer is surgery, alone or with radiation therapy
(radiotherapy) and will depend on the extent of the cancer.

If you are a smoker, your doctors will advise you quit before you start treatment.

Staging
A CT scan, bone (radioisotope) scan and chest x-ray are done to determine the extent of
the cancer.

The most common staging system used for kidney cancer is the TNM system, which
describes the stage of the cancer from stage I to stage IV

Active surveillance
If small tumours are found in your kidney your doctor may recommend active
surveillance or observation as it is likely that the tumours will not be aggressive and
may not grow in your lifetime. You will have regular ultrasounds or CT scans to monitor
the tumours.

Surgery
A radical nephrectomy (removal of the affected kidney) is the most common type of
surgery for renal cell carcinoma.
A partial nephrectomy (removal of part of the kidney) may be an option for people who
have a small tumour in one kidney (less than 4cm), people with cancer in both kidneys
and those who have only one working kidney.

Radiofrequency ablation
Radiofrequency ablation heats the tumour with high energy waves in order to kill the
cancer cells. Your doctor will insert a needle into the tumour and an electrical current is
passed into the tumour.

Immunotherapy
Immunotherapy works to enhance your body's own immune system. Immunotherapy is
an option for people with advanced kidney cancer. Cytokines (proteins that activate the
immune system) can be given intravenously or orally, and may shrink the cancer.

Targeted therapy
Targeted therapies may be recommended by your doctor if you have advanced kidney
cancer or your cancer is growing quickly. Targeted therapies target specific molecules
in cells to block cell growth. Targeted therapy drugs are usually given in the form of
tablets or intraveneously.

Tyrosine kinase inhibitors (TKIs) have been trialled in people with advanced kidney
cancer and found to cause fewer side effects than chemotherapy drugs.

Radiation therapy (radiotherapy)

Standard radiation therapy is not effective in treating primary kidney cancer but it may
be used in advanced kidney cancer to shrink tumours and relieve symptoms.