The American Cancer Society estimates that over 81,000 people will be diagnosed with kidney cancer this year and almost 15,000 will die from the disease. Since the 1990s, kidney cancer has been on the rise for unknown reasons and while it’s still a common type of cancer, cases have leveled off in the past few years.  “The number of new kidney cancers in the United States has been increasing for several decades, although that increase has slowed in recent years,” the American Society of Clinical Oncology says. “Between 2009 and 2018, rates rose by around 1% each year. Some of the increase has been due to an increase in the overall use of imaging tests. Imaging tests can find small kidney tumors unexpectedly when the tests are done for another reason unrelated to the cancer.”

“The kidneys play a significant role as the special filter system for the body,” emphasizes Dr. Sumanta (Monty) Kumar Pal, M.D., internationally recognized leader in genitourinary cancers, who practices at City of Hope Orange County Lennar Foundation Cancer Center in Irvine, Calif., and at City of Hope National Medical Center near Los Angeles, Calif. He serves as co-director of City of Hope’s Kidney Cancer Program and heads the organization’s kidney cancer disease team. “This pair of bean-shaped organs in the abdomen are responsible for removing excess water and waste from the body as urine and filtering blood before it makes its way back to the heart. Kidney cancer occurs when there is abnormal and uncontrollable growth of cells in the kidneys.”

Like all cancers, early detection is key to survival.  “When identified early, outcomes are typically very good (small masses have a 95% 5 year survival rate)”, Dr. Michael Johnson, Washington University urologic surgeon at Siteman Cancer Center tells us. Dr. Pal adds, “Your first shot against cancer should be your best shot. If you have symptoms of kidney cancer or have already been diagnosed, speak with a specialist who has a depth of experience treating your specific type of cancer before you start your treatment. One of the best ways to make sure you are getting the right treatment is to seek a second opinion from another physician. We know that cancer care is different. Second opinions benefit patients with cancer because cancer is different from any other disease. Each cancer is unique, and a specialist in your type of kidney cancer will be more knowledgeable in clinical trials, research and treatments that can benefit you.” 

Learning to recognize the signs of cancer, how to lower the risk and paying attention to warning signals your body is trying to tell you can be a matter of life and death. Eat This, Not That! Health spoke with experts who share what to know about kidney cancer and symptoms that indicate you have the disease. As always, please consult your physician for medical advice. 

Dr. Pal tells us, “No kidney cancer is the same. That’s why an accurate and timely diagnosis is key, along with a personalized approach to treatment. Nearly 90 percent of kidney cancers are renal cell carcinomas, which originate in the tubules that transfer waste from the blood to the urine. There are several other, more rare types of kidney cancers, including transitional cell carcinoma, Wilms tumor and renal sarcoma.” 

 Dr. Rodney Ellis, Radiation Oncologist for GenesisCare states, “There is still hope following a kidney cancer diagnosis.  Roughly two-thirds of people diagnosed with kidney cancer have it discovered when the cancer is located only in the kidney. The treatment results these days are fantastic, as the 5-year survival rate is 93%.  Even if it spreads to surrounding tissue, the 5-year survival rate is still 71%. It is only once cancer has spread to distant parts of the body, referred to as metastatic cancer, that the cancer requires more robust treatment. Thus, positive outcomes are incredibly common following a kidney cancer diagnosis today, in general.”

Dr. Johnson says other things to know about kidney cancer include: 

–Not all kidney masses are cancers but certainly need a workup. 

–While surgery is often the standard of care, there are alternative treatments. —–There are important advances in imaging studies to help better identify tumor type, prior to surgery. 

–There are important advances in therapies – such as immune-based therapies – that have shown promise in treating advanced disease.”

Dr. Ellis says, “The chance of developing kidney cancer, much like many other cancers, increases as you age. Smoking can lead to an increased chance of developing kidney cancer, as can obesity caused by an unhealthy diet.  Other risk factors include high blood pressure, a family history of kidney cancer, certain inherited syndromes, and having received treatment for kidney failure in the past. Always work with a physician to determine if you might be at a higher risk of cancer, so you can start working to mitigate that risk as soon as possible.”6254a4d1642c605c54bf1cab17d50f1e

According to Dr. Pal, “Risk factors of kidney cancer include smoking, gender, race, age, family history, having an advanced kidney disease, obesity, and high blood pressure. We know that kidney cancer is more common in men than women; men are two to three times more likely to develop this disease. As with most cancers, the risk for developing kidney cancer increases with age. Most patients who are diagnosed with kidney cancer are between the ages of 50 and 70. Research shows that smoking tobacco doubles the risk of developing cancer — it’s thought to be the cause of nearly 30 percent of kidney cancers in men. We are also seeing that kidney cancer is more prevalent in certain ethnic groups.” 

According to Dr. Ellis, “The rate at which kidney cancer can spread is dependent on a variety of factors including age, exact type of cancer, and overall health. The most common form of kidney cancer is renal cell carcinoma, which is the cancer experienced in roughly 7 out of 10 cases. It has two subtypes, sarcomatoid and rhabdoid, both of which can be very aggressive. Kidney cancer has an incredibly high survival rate of 93% in cases where the cancer is localized to the kidney. In cases where cancer has spread to the surrounding tissue and organs the survival rate is 71%.”

Dr. Johnson explains, “Kidney cancer spreads at variable rates (average 1-3 mm/yr) but can grow faster. We can sometimes monitor patients who have small masses (scans every 6 months) and intervene only if it’s getting too big or growing too fast. Small masses have a 95% cancer-specific survival at 5 years. When it becomes metastatic, this number can drop down to 15%.”

Dr. Pal tells us, “After kidney cancer is diagnosed, the next step is determining the stage of the cancer. This helps physicians determine the most appropriate treatment option for a patient’s unique type of kidney cancer. It is staged according to its size, number of lymph nodes affected and whether it has spread to nearby or distant organs. Kidney cancer is also evaluated by “grades” based on how much it resembles normal kidney cells and how aggressively it grows. The rate at which kidney cancer spreads is dependent on all of these factors. Kidney tumors are generally slow-growing and respond better to treatment when caught early. 

The latest data from American Cancer Society indicates the 5-year relative survival rate for a person diagnosed with localized kidney cancer is 93 percent and 76 percent for all SEER stages combined. Keep in mind that survival rates are estimates and may apply differently to each person. It’s important to note that the five-year survival rate is based on the past five years, in this case from 2011 – 2017, and does not include new advances in clinical trials. Research also shows that outcomes, including survival outcomes, are better if treatment is received at a National Cancer Institute—designated cancer center like City of Hope. At City of Hope, we have more active clinical trials for kidney cancer patients than any other center in the region.” 

Dr. Pal states, “The best way to stop cancer is to prevent it in the first place. It is important for people to know the factors that increase their chance of kidney cancer and the steps to take to lower their risk. While several of the factors that can influence the risk of developing this disease are ones that are out of people’s control, there are ones that I encourage my patients to be proactive about to lower their risk. I advise my patients to try to make changes in the areas that they can, such as quitting smoking/tobacco use, lowering blood pressure, increasing daily exercise and eating a nutritious diet. Family history of kidney cancer is also a factor that can increase a person’s risk, which is why it is important to know your family history and share this with your doctor. Your doctor and care team can help you identify your personal risk. Exposure to cadmium, which is found in batteries, welding materials and paints, can also increase your risk and should be shared with your doctor if you are around these materials often.” 

According to Dr. Johnson, “Some key ways to reduce the risk of kidney cancer include ensuring good blood pressure and avoiding tobacco. I also recommend maintaining good overall heart and lung health so patients do well if they ever need treatment.”

Dr. Ellis explains, “The best way to lower your risk of developing kidney cancer is to lead the healthiest lifestyle possible. That means consuming a healthy diet coupled with exercise to help decrease blood pressure and prevent obesity, all of which helps to reduce the risk of developing kidney cancer. If you’re a smoker, do your best to stop as soon as possible, as this is also a major contributing factor.”

Dr. Ellis says, “There are several ways in which kidney cancer can be diagnosed if you are showing symptoms. The first most common way is through pathology tests like biopsies and blood tests. Alternative methods include using CT scans and MRIs to detect abnormalities within the kidneys. Other advanced tests can provide additional information regarding your cancer and its location, making treatment more effective. Your physician may use other techniques to identify the problem, but these are the most common and effective methods for detecting kidney cancer.”

Dr. Johnson says, “Currently, there really aren’t any effective screening tools, although there are emerging tests. If patients notice blood in their urine, seeing their primary care provider and then a urologist is often prudent. If patients have a family history of kidney disease or kidney cancer, it is important to establish care with a primary care provider.”

According to Dr. Pal, “In early stages of kidney cancer, most patients do not experience symptoms. If a patient experiences symptoms or is considered at high risk, a doctor will then perform several tests to determine the cause of the symptoms and check for cancer. These tests include a physical exam, blood test (abnormal readings in blood analysis), urine lab test (urinalysis) and a biopsy to surgically remove tissue for further examination. Early kidney cancers are often found during testing for other health reasons. For example, imaging of the abdomen for different symptoms may expose kidney cancer, a blood test could detect anemia, or a urine sample may reveal blood. If cancer is detected or a physician suspects it may be kidney cancer, diagnostic tests, including CT scan, MRI and ultrasound imaging, will be performed to determine the type and stage of kidney cancer. While there are currently no screening guidelines for kidney cancer, your physician may recommend screening if you present a high risk of developing this disease based on your personal/family history, kidney conditions, genetic mutations and workplace chemical exposure. Early detection is key for optimal results, which is why warning signs should never be ignored.”

Dr. Ellis tells us, “Renal cell carcinoma may remain clinically occult for most of its course. Only 10% of patients present with the “classic triad” of flank pain, hematuria, and flank mass. Although kidney cancer doesn’t usually show symptoms in the early stages, the warning signs include:

• Blood in your urine
• Loss of appetite
• Tiredness
• Fever
• Unexplained weight loss
• Persistent pain in the backside
• Flank pain caused by a new mass

If you are experiencing these symptoms and believe it may be related to kidney cancer, speak with your physician as soon as possible.”

Dr. Johnson says, “Blood in the urine and flank pain are the traditional signs, although this is often when the disease is more advanced. Most often, there are little to no signs or symptoms.”

Dr. Pal explains, “While it is among the 10 most common cancers in the United States, many symptoms of kidney cancer are overlooked or dismissed. The most common symptoms of kidney cancer are associated with changes in urination. Warning signs people should know and notify their doctor of include: blood in the urine, a lump in the lower back, persistent pain in the lower back on one side, fatigue, loss of appetite, unexplained weight loss and anemia.

While these symptoms could be caused by other conditions, it is essential to check with a doctor – preferably a urologist – for an accurate diagnosis. If you have been diagnosed with kidney cancer, consult with a physician who specializes in this before starting treatment.”