Hoag Renal (Kidney) Cancer Program

What is renal cancer?

Renal cancer (also referred to as kidney cancer) originates in the kidneys. The most common type in adults is renal cell carcinoma. About 90 out of 100 kidney cancers are RCCs. There are several subtypes of RCC, the most common subtype is clear cell RCC.

Although the incidence of renal cancer appears to be increasing, it may be due to more advanced imaging techniques detecting a greater number of cancers.

Renal cancer is one of the 10 most common cancers, among both men and women. The average age of diagnosis is 64.

There are other less common types of tumors in the kidneys: TCC (transitional cell carcinoma), Wilms tumor, and renal sarcoma.

What are the symptoms?

There are usually no symptoms in the early stages of renal cancer. However, in the later stages, symptoms can include: back pain, blood in the urine, fatigue, intermittent fever and weight loss.

What causes renal cancer?

The causes of renal cancer are unclear. Like many cancers, a DNA mutation can cause an uncontrollable growth of cells. If untreated, these cells can spread to other organs and tissues.

If it runs in my family, am I more likely to get it?

There are some inherited syndromes that increase your risk of getting renal cancer. These include von Hippel-Lindau disease, Birt-Hogg-Dube syndrome, tuberous sclerosis and familial papillary renal cell carcinoma.

Hereditary Renal Cancer

Approximately 4% of renal (kidney) cancers are considered to be familial. There are a number of hereditary renal cancer syndromes, including von Hippel-Lindau, tuberous sclerosis, hereditary papillary renal carcinoma (HPRC), Birt-Hogg-Dubé, hereditary leiomyomatosis & renal cell carcinoma (HLRCC), familial renal oncocytoma and hereditary clear cell cancer. Renal cancer is also part of Lynch syndrome, also known as hereditary non-polyposis colon cancer (HNPCC).

Features that suggest a possible hereditary cause include early age at diagnosis (under age 50), cancer in both kidneys and a family history of renal cancer. Genetic testing for hereditary renal cancer is available through the Hereditary Cancer Program.

For more details about Hoag’s Hereditary Cancer Program, including a list of frequently asked questions, please click here or contact us at hereditarycancer@hoag.org or at 949/764-5764.

Are there other risk factors to be aware of?

Your risk of renal cancer increases with age. Those who smoke, are obese, or have high blood pressure are also at increased risk. Lastly, individuals undergoing long-term dialysis for chronic kidney failure are at greater risk of developing renal cancer.

Screening/Diagnostics

Screening is not recommended unless an individual is at increased risk for renal cancer. For those at higher risk, it is recommended that you receive regular testing to monitor for renal cancer. Computed Tomogrophy (CT) scanning, Magnetic Resonance Imaging (MRI), or an ultrasound may be recommended.

What are the different types of renal cancer?

Renal cell carcinoma (RCC) is the most common type of renal cancer accounting for over 90% of renal malignancies. Subtypes of RCC (from most to least common) include: clear cell, papillary, chromophobe, oncocytic, and collecting duct. The subtype and nuclear grading of the cancer is performed by a pathologist when tissue from biopsy or tumor removal is available.

What is the stage of my cancer?

The staging of a renal cancer diagnosis is most commonly determined by the TNM staging system, which was developed by the American Joint Committee on Cancer (AJCC). The letters within the acronym “TNM” stand for:

T – The size of the main tumor and whether it has grown into areas nearby.

N – The extent to which the tumor has spread to adjacent lymph nodes.

M – An indication of whether the tumor has metastasized, or spread, to other areas of the body.

Numbers or letters generally appear after the T, N and M to indicate details about the severity or whether it is possible to assess the severity in each case.

What are my non-surgical treatment options?

Targeted therapy

Contemporary research on kidney cancer has identified specific molecular and genetic changes in tumors. These changes can be “targeted” with novel drugs which are different from traditional chemotherapy agents. These drugs are now used as first line agents in treating advanced stage cancers. Many of the early targeted therapies focused on inhibiting angiogenesis (formation of blood vessels by the cancer). Newer agents have been discovered which target specific components of one’s immune system (immunotherapy) to fight the cancer.

Chemotherapy and Radiation therapy

In general, traditional radiation therapy and chemotherapy have been relatively ineffective in treating kidney tumors.

What are my surgical treatment options?

Surgery

Kidney tumors that are located primarily in the kidney or surrounding areas are most often treated with surgery. There are various methods of surgical treatment, which are tailored to the individual. They include the following:

Radical nephrectomy involves removing the whole kidney, including adjacent fatty tissue, and sometimes the adrenal gland and nearby lymph nodes as well.

At Hoag, surgeons opt to perform laparoscopic or robot-assisted radical nephrectomy, as compared to standard surgery, whenever possible given the circumstances. Minimally invasive surgery enables the surgeon to make a smaller incision, resulting in less blood loss, shorter hospital stays and a quicker recovery time.

When laparoscopic methods are not possible, the surgeon will perform the surgery via an “open” approach which involves a much larger incision.

With a partial nephrectomy (also called kidney-sparing surgery), the cancerous section of the kidney is removed, along with a margin of the healthy surrounding tissue, rather than the entire kidney.

Prior to surgery, imaging is done to determine the precise portion to be removed. Surgeons may opt for partial nephrectomy in cases where the tumor is in a location that is more easily accessible, co-existing health conditions that could affect outcomes, as well as patient preference. This procedure is most commonly chosen for patients whose tumors are 4 centimeters or less in size.

At Hoag, partial nephrectomy is performed mainly with a robot-assisted approach when feasible to reduce hospital stays and recovery time. Larger or more complex tumors may require an open approach.

Energy ablative techniques – Ablative treatment utilizes extreme cold or heat to treat tumors, without removing the tumor or surrounding kidney. In general, these methods are best suited for patients who are at high risk for surgery and/or have small, favorably located tumors.

Examples of ablative therapies include cryo-ablation (freezing) and radiofrequency ablation (RFA) which destroys the tumor through extreme heat. At Hoag hospital, our physicians have extensive experience with cryoablation of small renal tumors.

How do I take part in follow-up studies?

Hoag participates in a number of ongoing research studies. To find out if there are currently any renal cancer-related studies and if you qualify, call 949-764-4430