Kidney cancer

What causes kidney cancer?

Doctors don’t know the exact causes of kidney cancer. But there are risk factors that can increase your chance of developing it.

Macmillan Cancer Support has more information about the causes and risk factors of kidney cancer.

Kidney cancer is sometimes found during a scan being done for something else. But if you have symptoms, the first step is to see your doctor.

Your doctor will examine you. They may test your urine and blood to check:

• your general health
• how well your kidneys are working

If needed, they will refer you to the hospital to see a specialist doctor called a urologist. You will get an urgent referral if your test results or symptoms suggest you may have kidney cancer. This means you should get an appointment as soon as possible.

If you have blood in your urine, you may be referred to a haematuria clinic. Haematuria means blood in the urine. The clinic can often do tests on the same day as your appointment.

Macmillan Cancer Support has further information if you have just been diagnosed with cancer.

Tests at the hospital

The urologist or a specialist nurse will examine you and arrange any tests you need. This may include some of the following.

Blood tests check:

• how well your kidneys and liver are working
• the number of blood cells in your blood, known as a blood count

An ultrasound scan can look for changes in the shape of the kidneys. It can show whether a lump is a fluid-filled cyst or a more solid tumour. It can also show the position of a cancer and its size.

If doctors also want to look at the bladder, you will need a full bladder for the scan. The hospital will give you instructions for this.

If doctors notice a possible kidney cancer while doing a scan for another reason, they may request a CT scan to look at the kidneys more closely. Your doctor or nurse may call this a triple-phase CT scan.

A CT urogram is a type of CT scan that checks the kidneys, ureters and bladder. You may have this scan if you have blood in your urine.

A flexible cystoscopy is a camera test that looks for changes inside the bladder. You may have this test if you have blood in your urine.

Sometimes tests for kidney cancer find a kidney cyst instead. Kidney cysts are fluid-filled lumps. They are common and usually harmless, though your doctor may sometimes recommend follow-up tests, scans or treatment.

Further tests

If tests show you are likely to have kidney cancer, your doctor may want to do some further tests. These give more information about the cancer and help you and your doctor choose the best treatment for you.

A biopsy is when a small sample of tissue is taken from the body and tested for cancer cells. Usually the sample is collected from the affected part of the kidney. But if doctors think the cancer has spread to another part of the body, the sample may be taken from there instead.

During a biopsy, the doctor injects a local anaesthetic into the skin to numb the area around the kidney. They use an ultrasound or CT scan to guide them to the right spot, then use a needle to take a small tissue sample. This sample is sent to the laboratory for testing.

You may need to stay in hospital for a few hours, or overnight, after a biopsy.

You may also have a CT scan of your chest, tummy (abdomen) and pelvis, to see whether the cancer has spread beyond the kidney to other parts of the body.

An MRI scan is sometimes done to check whether the cancer has spread to other parts of the body, such as the bones or brain. This scan uses magnetism to build a detailed picture of areas inside the body.

Waiting for test results can be a difficult time. Macmillan Cancer Support has more information that can help.

Staging and grading of kidney cancer

The results of your tests give your cancer team information about:

• the stage of the cancer, which describes its size and whether it has spread
• the grade of the cancer, which gives an idea of how quickly it might grow and spread

Knowing the stage and grade helps your doctors plan the best treatment for you.

Treatment for kidney cancer

A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team (MDT).

Your doctor, cancer specialist or nurse will explain the different treatments and their side effects. They’ll also talk to you about things to consider when making treatment decisions. They need your permission (consent) before you have any treatment.

The following treatments are used for kidney cancer. Your treatment plan will depend on several factors.

Macmillan Cancer Support’s have more information about treatments for kidney cancer.

Depending on the stage of the cancer and your general health, you may have surgery to remove part of your kidney or the whole kidney.

Rarely, surgery may be used to remove cancer that has spread to another part of the body (secondary cancer).

Tumour ablation may be used instead of surgery to treat small kidney cancers. It can be used in some other situations too. This treatment destroys the cancer cells with very high or low temperatures.

Arterial embolisation may be offered if surgery isn’t possible for you. It can’t cure the cancer by itself but it can help control symptoms like pain or bleeding.

Monitoring a kidney cancer is a way of delaying treatment until it’s needed. It’s sometimes called active surveillance. The main advantage of monitoring is that you can avoid the risks or side effects of treatment.

Cancer drugs are used to treat kidney cancer in the following ways.

Belzutifan

If you have a genetic condition called von Hippel-Lindau disease (VHL), you may have a drug called belzutifan instead of surgery. This can control a small early kidney cancer.

Pembrolizumab

After surgery to remove a locally advanced kidney cancer, you may have a drug called pembrolizumab. This helps to reduce the risk of the cancer coming back.

Sometimes other drugs are used before or after surgery as part of a clinical trial.

Targeted therapy and immunotherapy

If you have advanced kidney cancer, the main treatment usually involves:

• targeted therapy
• immunotherapy drugs

You may have a combination of drugs or one drug on its own.

Macmillan Cancer Support have more information about treatments for kidney cancer

Radiotherapy is sometimes used to treat early kidney cancer if surgery is not an option.

There are different types of radiotherapy. Usually the following types are used:

• stereotactic ablative body radiotherapy (SABR)
• stereotactic body radiation therapy (SBRT)

Radiotherapy can also be given to control kidney cancer and treat any symptoms. This is called palliative treatment.

Palliative radiotherapy may help control the cancer for longer when it’s not possible to cure it.

It might be used to treat:

• symptoms of kidney cancer – like bleeding
• cancer that has spread to other parts of the body – like the lung, brain or bones

You may have some treatments as part of a clinical trial.

Macmillan Cancer Support have further information on getting organised before cancer treatment.

After kidney cancer treatment

You’ll have regular check-ups with your cancer doctor, urologist or nurse after kidney cancer treatment. They’ll explain how often and how long you’ll need to have these.

You might have regular tests or scans to check:

• how well your kidney or kidneys are working
• for any signs of the cancer coming back

You can talk to your cancer doctor or specialist nurse about any problems or worries you have at your check-ups. If cancer comes back in the kidney but nowhere else, it may be possible to have further surgery to remove it.

Tell your doctor or specialist nurse as soon as possible if you have any problems or notice new symptoms between appointments.

Macmillan Cancer Support have more information about follow-up care after treatment.

Support after kidney cancer

People often have many different feelings when they finish kidney cancer treatment. You may feel relieved that treatment has finished, but worried about what will happen in the future.

It’s important to know where to get support or information from if you need it. People often need support even some time after kidney cancer treatment. But it can be difficult to know who to ask for help.

Ask your GP or someone from your cancer team for advice about support in your area.

Macmillan Cancer Support also has further information to support you. You can:

• phone the Macmillan Support Line on 0808 808 00 00
• chat to Macmillan specialists online
• use the Macmillan kidney cancer forum – you can talk to others affected by kidney cancer, ask questions and share your experience
• use the Cancer Care Map to find cancer support services near you

Other organisations who offer information and support include:

• Action Kidney Cancer – connects patients, families and friends to share information and support
• Kidney Cancer UK – provide information, support and counselling for people with kidney cancer and their carers
• Kidney Care UK – provide practical, emotional and financial support for people with kidney conditions and their families

Hope Programme

The HOPE programme is a free 6 session self-management course. It’s designed to help you develop techniques and strategies when living with or after cancer.

Topics include goal setting, fatigue management, and wellbeing.

Kidney cancer prognosis

Some people may try to find kidney cancer statistics to help them understand what might happen in their situation. This is called a prognosis.

Doctors can’t predict exactly what will happen. But they may use some of the following statistics to help them make an estimate:

Kidney cancer survival rates

This is the number of people who are alive after certain periods of time following a kidney cancer diagnosis. For example, 1, 2, 5 or 10 years later. It includes people who have no signs of cancer and also people who have kidney cancer that has come back.

Kidney cancer recurrence or relapse rates

This is the number of people who have had treatment, but their kidney cancer has come back after certain periods of time.

Kidney cancer mortality

This is the number of people who have died because of kidney cancer during a certain period of time.

More about prognosis

You may find information about prognosis helpful. But not everyone wants or needs this information.

Statistics can be complex and difficult to understand. They may help you understand more, but they can’t tell you what will definitely happen to you.

Talk to your cancer doctor or specialist nurse about kidney cancer prognosis. You can also ask them about whether information online might apply to you.

They can explain:

• which statistics apply to someone with your diagnosis
• what the information may mean to someone with your diagnosis
• how this may affect any treatment decisions you are thinking about

Wellbeing and recovery

It can take time to recover after kidney cancer treatment. Some days you may feel better than others.

A healthy lifestyle can:

• help speed up your recovery
• protect your remaining kidney or kidneys
• improve your wellbeing and long-term health

Macmillan Cancer Support has more information about recovery from treatment for kidney cancer.

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