At the OHSU Knight Cancer Institute, our experts provide advanced, compassionate care for patients with kidney cancer. We offer you:
- Specialists with years of experience treating patients with this complex illness.
- A team approach, with providers from many specialties meeting twice a month to combine their expertise for each patient.
- Minimally invasive surgery and ablation options for less pain and a faster recovery.
- If needed, an experienced kidney transplant team.
- Clinical trials that may offer you access to promising new treatments. This may include targeted therapy or immunotherapy for late-stage cancer.
- A full range of support services for you and your family.
Read more about OHSU’s urologic cancer services.
Urinary System Anatomy
Understanding kidney cancer
What is kidney cancer?
The kidneys are two bean-shaped organs that form part of the urinary tract, the system that removes waste and extra fluid. They sit just below the rib cage on each side of the body and filter blood to produce urine.
Cancer occurs when cells in one or both kidneys grow out of control, forming one or more tumors. The cancer may stay in a kidney or spread to a nearby adrenal gland or other parts of the body.
Who gets kidney cancer?
Kidney cancer is one of the most common cancers in the U.S., with an estimated 76,080 new cases expected in 2021. It is highly treatable, especially if found early. Causes are unclear, but scientists have identified risk factors:
- Age: Three in four patients are 55 or older when diagnosed. Fewer than one in 10 cases are diagnosed in people younger than 45.
- Gender: Men are about twice as likely to get kidney cancer.
- Race and ethnicity: Kidney cancer is less common in Asians and Pacific Islanders but affects others roughly equally.
- Lifestyle: Smoking and obesity increase risk.
- Exposure to certain substances: Prolonged contact with the metal cadmium or certain herbicides may increase risk.
- Diuretic pills: Studies have shown a link between diuretics, also called water pills, and a risk of kidney cancer.
- Family history: People with relatives who had kidney cancer are at higher risk.
Certain health conditions can increase risk:
- High blood pressure.
- Advanced kidney disease that requires dialysis.
- Rare inherited genetic conditions, such as Von Hippel-Lindau syndrome, Birt-Hogg-Dubé syndrome or tuberous sclerosis complex. Learn about OHSU’s expert genetic counseling and testing to identify and manage risk.
Kidney cancer survival rates
Just over 75% of patients live at least five years after diagnosis compared with the general population. This is called the relative survival rate, and it leaves out the risk of dying from another cause. Keep in mind that survival rates are averages, though, and can’t predict an individual outcome. They also reflect, by definition, treatments that were available five or more years ago.
Kidney cancer symptoms
Kidney cancer can cause symptoms similar to those of other conditions. That’s why it’s important to see your doctor if you notice signs that include:
- Blood in urine
- Loss of appetite
- Pain, pressure or a lump in the side or back
- Repeated fevers not caused by an infection
- Swelling in ankles and legs
- Unexplained weight loss
- In men, a cluster of enlarged veins (varicocele) around one testicle
Other symptoms include:
- Anemia (low red blood cell count)
- High blood pressure (hypertension)
Screening for kidney cancer
Finding kidney cancer early increases chances for a successful outcome. Routine screening doesn’t help everyone, though, so screening is usually done only if you have a higher risk. At OHSU, we may recommend regular imaging if you have an inherited genetic syndrome linked to higher risk of kidney cancer.
Diagnosing kidney cancer
Tests may include:
Your doctor will do a complete exam to check for lumps or swelling in the belly. For men, the doctor will look for a varicocele in the scrotum.
These show levels of red blood cells, liver enzymes, calcium and other substances. The results provide information about kidney function and indicators of kidney cancer.
Urinalysis: A urine sample can detect blood or other substances that may be signs of kidney cancer.
Urine cytology: Our specialists can find cancer or precancerous cells by looking at a urine sample under a microscope.
Urine culture: Testing a urine sample in a lab can show whether bacteria grow, which may mean an infection is causing symptoms.
CT scan: Special X-ray equipment takes pictures of a cross section of the affected area, and a computer creates 3D images.
MRI scan: Radio waves and a large magnet create detailed images of structures inside the body. The Knight Cancer Institute is the only center in Oregon with a 3 Tesla MRI to show small areas in great detail.
Ultrasound: Sound waves create still or moving images of soft tissue inside the body. OHSU has contrast-enhanced ultrasound, which is not available at most hospitals. We inject dye for greater clarity, showing whether a tumor is cancerous without the radiation of a CT scan.
Chest X-ray: We may recommend an X-ray to see if cancer has spread to the lungs.
We take a tissue sample to examine under a microscope for cancer. For larger tumors, we may do a surgical biopsy, which removes the entire tumor. For smaller tumors, we use ultrasound or CT to guide a wide, hollow needle to take the sample.
Types of kidney cancer
Renal cell carcinoma: RCC is the most common type in adults. It accounts for about 90% of cases. It develops in tiny units called tubules that make up the kidney’s filtration system. RCC has several subtypes.
Urothelial carcinoma: This type, formerly known as transitional cell carcinoma or TCC, makes up about 5-10% of kidney cancers in adults. It grows in the renal pelvis, a part of the kidney where urine collects before draining to the bladder. We treat this type using the same options as for bladder cancer because both begin in the same cell type.
Wilms tumor: This rare kidney cancer is also known as nephroblastoma. It occurs most often in young children. Learn more about our care for children with kidney cancer and other tumors at OHSU Doernbecher Children’s Hospital.
Renal sarcoma: This rare type develops in the kidney’s blood vessels or connective tissue. Treatment usually begins with surgery. Your care team may also recommend chemotherapy or additional surgery to keep the cancer from spreading or coming back.
Kidney cancer staging
Your care team determines your cancer’s stage by evaluating the tumor’s size and any cancer spread. This information helps guide treatment recommendations.
Your care team will also take your cancer’s grade into account. The grade is how normal or abnormal your cancer cells look under a microscope. The more abnormal cells look, the more aggressive the cancer tends to be.
This staging is for RCC, the most common type of kidney cancer:
Stage I: The tumor is 7 centimeters or smaller and limited to the kidney.
Stage II: The tumor is larger than 7 centimeters and limited to the kidney.
Stage III: One of the following:
- The tumor may be as big as 10 centimeters, and cancer has spread to a nearby lymph node or nodes.
- Cancer may or may not have spread to nearby lymph nodes, or the lymph nodes cannot be assessed. In addition, the tumor extends into major veins such as the renal vein or the vena cava (a large vein that returns blood to the heart). Or the tumor extends into connective and fatty tissue surrounding the kidney (perinephric tissues).
Stage IV: Cancer has spread beyond the connective tissue surrounding the kidney (Gerota’s fascia), including into the nearest adrenal gland. Or cancer has spread to distant parts of the body, such as the bones, brain or lungs.
Treatments for kidney cancer
At the Knight Cancer Institute, we offer you the latest treatments for kidney cancer. Your care team may recommend a combination of treatments, including options such as surgery, targeted therapy and immunotherapy. We generally don’t recommend chemotherapy or radiation therapy because they aren’t effective for kidney cancer.
Very small kidney tumors usually don’t grow aggressively. Your team may suggest regular imaging tests to check for growth. Monitoring, also called active surveillance, is an option for older people or those with health conditions that make cancer treatment difficult. If the tumor grows or symptoms worsen, we will discuss other options with you.
Surgery is typically the main treatment for kidney cancer. The goal is to remove the tumor while preserving kidney function. Working kidneys help you avoid dialysis. Whenever possible, our cancer surgeons use minimally invasive techniques for less pain and faster recovery.
Depending on the tumor’s stage and your overall health, your team may consider:
Partial nephrectomy: Our experienced surgeons preserve kidney function by removing just the tumor. We can do this surgery with robot-assisted laparoscopy, a minimally invasive technique that uses only a few small incisions. Our experience and precision result in less pain and a faster recovery.
Total (radical) nephrectomy: For larger tumors, we may remove the entire kidney and the closest adrenal gland. Most people can live with just one kidney. In rare cases, people whose remaining kidney isn’t healthy enough to take over kidney function may consider a transplant. Learn more about OHSU’s kidney transplant program.
Lymph node removal: Lymph nodes are small, bean-shaped structures of the immune system that filter infection and disease. If kidney cancer spreads to nearby lymph nodes, they may also need to be removed. We typically remove only lymph nodes that look enlarged.
Ablation destroys cancer cells with heat or cold. Your care team will work with specialists in our interventional radiology department. In ablation treatment, doctors use imaging, such as CT or ultrasound, to guide a needle into the tumor. Our techniques for kidney cancer include:
- Microwave ablation: This method sends microwaves through the needle to burn the tumor.
- Radiofrequency ablation: This type uses high-frequency electrical currents to burn the tumor.
- Cryoablation: This technique uses technology in the needle tip to rapidly freeze the tumor.
At OHSU, we recommend ablation for people who:
- Are not candidates for surgery.
- Have one or a few small tumors near the outside of the kidney.
- Have only one healthy kidney and need to preserve kidney function.
Targeted therapy is medication that targets or blocks specific parts of cancer cells, such as molecules or proteins. Targeted therapy attacks cancer while minimizing damage to healthy cells.
For late-stage cancer: Our team combines surgery with targeted therapy to treat late-stage kidney cancer. After surgery to reduce the tumor, you receive targeted therapy to destroy remaining cancer cells.
For cancer that has spread: Targeted therapy is an option for metastatic kidney cancer (cancer that has spread to other parts of the body). It can control cancer growth, prolong life and relieve symptoms.
Immunotherapy medications harness the immune system to fight cancer. Immunotherapy can control cancer growth, relieve symptoms and extend life for patients with metastatic kidney cancer. One medication (cytokine aldesleukin) activates immune cells called T-cells. Another (nivolumab) keeps cancer from hiding from the immune system.
Knight Cancer Institute researchers are testing new approaches to kidney cancer care. One goal is to find a way to use immunotherapy to shrink tumors that haven’t spread and that can’t be safely removed with surgery.
Clinical trials enroll patients to test new medications and approaches. Your care team will talk with you about whether a clinical trial is right for you.
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Portland, OR 97239
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