Kidney cancer

About 8 out of 10 kidney cancers (80%) are renal cell cancers, or RCCs. These start in the main outer part of the kidney, called the renal cortex.

The main types of renal cell cancer are:

• clear cell RCC, which is the most common type
• papillary RCC
• chromophobe RCC

Two very rare types of renal cell cancer (RCC) are:

• renal medullary cancer (RMC), a fast-growing cancer linked to a blood condition called sickle cell disease
• collecting duct cancer (CDC), a cancer with features of both RCC and UTUC

These may be treated differently to other types of RCC. Your doctor can give you more information about RMC or CDC.

Sometimes, other cancers like lymphoma or sarcoma are found in the kidney. These are not types of kidney cancer and may be treated differently.

The urologist or a specialist nurse will examine you and arrange whatever tests you need. These 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 (this is called a blood count)

An ultrasound scan can look for changes in the shape of the kidneys. It can show whether a lump is a cyst or a more solid tumour, and it can also show where a cancer is and how big it is.

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

Sometimes doctors see a possible kidney cancer while doing a scan for another reason. In that case they may ask for a CT scan to look at the kidneys. 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 pee.

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

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

If tests show you're likely to have kidney cancer, your doctor may want to do some of the following tests. They give more information about the cancer, which helps you and your doctor choose the best treatment for you.

A biopsy is when a sample of tissue is taken from the body and tested for cancer cells. Usually the sample comes from the area of the kidney affected by cancer. But if doctors think the kidney cancer has spread to a different part of the body, they may take the sample from there instead.

During a biopsy, the doctor injects some local anaesthetic into the skin to numb the area around the kidney. They use an ultrasound scan or a CT scan to guide them to the area they want to take the biopsy from. Then they use a needle to take a small sample of tissue, and 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 have a CT scan of your chest, tummy (abdomen) and pelvis. This is to see whether the cancer has spread outside the kidney to other parts of your body.

An MRI scan is sometimes done to see whether a kidney cancer has spread to other parts of the body, like the bones or brain. This type of scan uses magnetism to build up a detailed picture of areas of the body.

Waiting for test results can be a difficult time, and support can help.

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

• the stage of the kidney 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.

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

If your kidney cancer is locally advanced and you have surgery to remove it, you may be given a drug called pembrolizumab afterwards. It helps to reduce the risk of the cancer coming back.

In some cases, other drugs are used before or after surgery as part of a clinical trial.

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 these 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. When the cancer can't be cured, palliative radiotherapy may help control it for longer.

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.

Some people with kidney cancer look up statistics to get a sense of what might happen in their own situation. This is called a prognosis.

Doctors can't say exactly what will happen. But they may use some of the following statistics to make an estimate:

Survival rates for kidney cancer tell you how many people are still alive after a certain amount of time following their diagnosis, for example 1, 2, 5 or 10 years later. The figure counts people who have no signs of cancer, and it also counts people whose kidney cancer has come back.

This figure shows how many people have had treatment for kidney cancer and then found that the cancer came back after certain periods of time.

Kidney cancer mortality means the number of people who have died because of kidney cancer over a certain period of time.

Information about prognosis can be helpful for some people with kidney cancer, but not everyone wants or needs it.

Statistics can be complex and hard to follow. 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 the prognosis for kidney cancer. You can also ask them whether information you find 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

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

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

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

If you have any problems or notice new symptoms between appointments, tell your doctor or specialist nurse as soon as possible.

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

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

It helps to know where to get support or information if you need it. Many people need support even some time after kidney cancer treatment, but it can be hard to know who to ask.

Ask your doctor 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, where 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 that offer information and support include:

• Action Kidney Cancer, which connects patients, families and friends so they can share information and support
• Kidney Cancer UK, which provides information, support and counselling for people with kidney cancer and their carers
• Kidney Care UK, which provides practical, emotional and financial support for people with kidney conditions and their families