What is kidney cancer?
Your kidneys are two fist-sized organs toward the back of your belly. They filter your blood and make urine. Renal cell carcinoma is the most common type of kidney cancer in adults. It starts in the lining of the tiny tubes inside the kidney that filter the blood.
Not every mass on a kidney is cancer. Simple fluid-filled cysts are common and harmless, and some solid masses turn out to be benign (not cancer). Your imaging helps tell them apart.
How is it found?
Kidney cancer usually causes no symptoms. Most is found by chance on a CT scan, ultrasound or MRI done for another health problem. Only about 1 in 10 people have the classic combination of pain in the side (flank pain), blood in the urine and a lump in the side or belly.
If a scan has shown a mass on your kidney, the next step is a visit with a urologist to look at the images closely. What to do when a kidney mass shows up on a scan.
Tests Dr. Su may order
To understand the mass and plan treatment, Dr. Su looks at both lab work and imaging.
Blood and urine
- Urinalysis, a test of your urine
- Complete blood count (CBC) with differential, which counts your blood cells
- Complete metabolic panel: electrolytes, kidney function and liver function
Scans
- CT scan
- Ultrasound
- MRI
These show the size of the tumor, where it sits in the kidney and whether there is any sign of spread. This is called staging.
At your consultation, Dr. Su reviews all of the images with you and goes over your options in detail. In some cases, a needle biopsy of the mass helps decide on treatment.
Treatment options
The main treatments for renal cell carcinoma are:
Surgery
Removing the tumor, or sometimes the whole kidney. Surgery is the only known cure for kidney cancer that has not spread. It is also used in some cases of cancer that has spread, to improve the outcome or relieve symptoms.
Active surveillance
Some small tumors grow slowly. Watching them with regular imaging can be a reasonable choice, especially for older adults or people with other serious health problems.
Thermal ablation
A needle placed through the skin destroys the tumor by freezing or heating it. It is an option for some small tumors, especially in people who are not good candidates for surgery. An interventional radiologist performs the ablation. Dr. Su arranges the referral and follows your kidney afterward.
Targeted therapy and immunotherapy
Medicines that block the signals tumors use to grow (targeted therapy), or that help your immune system attack the cancer (immunotherapy). These are the standard of care for cancer that has spread.
Radiation therapy
Used in selected situations, such as to control a tumor that can’t be removed or to relieve symptoms from cancer that has spread.
Chemotherapy is used only occasionally, for certain tumor types.
Saving your kidney: partial nephrectomy
Dr. Su has extensive training and experience in kidney cancer surgery, and she tailors each operation to the patient and the tumor. When possible, she saves as much of the kidney as she can by removing only the tumor with a small rim of healthy tissue around it. This is called a partial nephrectomy. For suitable tumors, it treats the cancer effectively while preserving kidney function, which matters for your long-term health.
Robotic partial nephrectomy
In suitable candidates, Dr. Su performs the partial nephrectomy through a few small incisions, using specialized instruments and the da Vinci surgical system, instead of one large incision.
- Hospital stay
- Typically one night
- Back to most activities
- Within 1 to 2 weeks
- Heavy lifting and hard exercise
- Avoid for 4 weeks, so the incisions and kidney heal well
When open surgery is the better choice
In rare situations, robotic surgery is not a suitable option and an open operation is used instead. This is often done through an incision in the side (the flank), reaching the kidney between the lower ribs. After an open partial nephrectomy, patients are typically in the hospital for 3 to 5 days and return to most normal activities within 2 weeks. They should avoid heavy lifting and exercise for about 4 weeks while the incision and kidney heal.
When the whole kidney needs to come out
Sometimes a partial nephrectomy is not possible. The tumor may have replaced most of the kidney, or it may sit where the kidney’s blood supply cannot be preserved. In these cases, Dr. Su performs a radical nephrectomy, removing the entire kidney along with the tumor.
A radical nephrectomy can usually be done with a minimally invasive approach (laparoscopic or robotic), using several small incisions. At the end of the operation, one incision is made slightly longer so the kidney can be removed. Radical nephrectomy is an effective treatment for kidney cancer, and the minimally invasive approach usually means less pain, a shorter hospital stay and a quicker return to daily activities.
Want to read more? The National Comprehensive Cancer Network (NCCN) publishes a free, detailed guide for patients who want to learn more about kidney cancer. NCCN Guidelines for Patients.
Questions patients ask
Is every kidney mass cancer?
No. Many are simple cysts, which are harmless, and some solid masses are benign. The features on your CT or MRI help sort this out. Sometimes a biopsy or a follow-up scan is the next step.
Can I live a normal life with one kidney?
Yes. Most people live normal, healthy lives with one healthy kidney. Your kidney function and blood pressure are checked at follow-up visits. Saving kidney function is one reason Dr. Su favors partial nephrectomy when it is possible.
Will I need chemotherapy?
Most kidney cancers found early are treated with surgery and then followed with regular checkups. Some people at higher risk of the cancer coming back are offered immunotherapy after surgery. Chemotherapy is used only occasionally, for certain tumor types.
What follow-up will I need after surgery?
Regular checkups with imaging, and blood tests to check your kidney function and watch for any sign that the cancer has come back. How often depends on the type and stage of the tumor.
Is cancer in the kidney’s drainage system the same thing?
No. Cancer can also start in the lining of the part of the kidney that collects urine, or in the ureter (upper tract urothelial carcinoma). It is related to bladder cancer and is treated differently. One option is removing the kidney and ureter together, which Dr. Su performs robotically (robotic nephroureterectomy).