There are several known risk factors for kidney cancer:

• Age – the likelihood of kidney cancer increases with age, similar to most cancers.
• Smoking – smokers are at an increased risk for kidney cancer but quitting drops the risk significantly!
• High blood pressure – poorly controlled blood pressure increases the risk of kidney cancer.
• Obesity – higher body weight increases the risk of kidney cancer.
• Family history of kidney cancer – some individuals with a history in their family are more susceptible.
• Chronic kidney failure and/or dialysis – patients on dialysis for multiple years have a higher risk of developing solid renal masses.
• Inherited syndromes – syndromes such as Von Hippel-Lindau syndrome, tuberous sclerosis, Birt-Hogg-Dube syndrome, and familial papillary renal cell carcinoma are associated with increased risk.

In the early stages, kidney cancer is unlikely to present with symptoms and is often found ‘incidentally’ during evaluation for other issues. However, in some cases kidney cancer may be associated with one or more of the following symptoms:

• Blood in the urine, which may make urine appear pink, red, or cola/tea colored
• Back pain to the left or right of the spine that does not go away
• A lump in the abdomen or side
• Weight loss
• Loss of appetite
• Fatigue
• Intermittent fever
• Anemia (low blood counts)

The diagnosis of kidney cancer typically involves a combination of physical exam with history, lab work, and imaging. For example, if a patient has certain risk factors and is found to have blood in their urine, the doctor might recommend further steps to screen for kidney cancer. In many circumstances, a renal mass will be detected on a CT, ultrasound, or MRI ordered for other reasons and will prompt referral to a urologist.

• Imaging – Kidney cancer is typically diagnosed with imaging methods such as CT, ultrasound, or MRI. This imaging will provide a clearer picture of the likelihood of cancer and treatment options.
• Biopsy – If the diagnosis is unclear, a percutaneous kidney biopsy may be recommended to determine whether a mass is cancerous. This is typically a short (~30 minutes) outpatient procedure that does not require anesthesia.

For kidney cancers, there are both surgical treatments and non-surgical treatments. Kidney surgery is typically the preferred treatment for kidney cancer, especially when caught early. Removing the tumor, or even the whole kidney itself, eliminates the cancer entirely. Luckily, patients can live an entirely normal life with just one kidney.

Surgical Options:

• Radical Nephrectomy – This is typically reserved for larger tumors and involves removal of the entire kidney and possibly the attached adrenal gland. Most radical nephrectomies are performed laparoscopically using special instruments inserted through small (~1cm) incisions. Usually, one of the incisions has to be made longer in order to remove the kidney.
• Partial Nephrectomy – Also called nephron-sparing surgery, this is now the preferred treatment for many people with early-stage kidney cancer depending on the location of the tumor. This is typically performed robotically, using very small incisions for quicker recovery and decreased post-operative pain. For this surgery, only the tumor and a small rim of healthy tissue around it is removed, sparing the rest of the kidney in order to maintain better kidney function. Usually, partial nephrectomy is reserved for tumors less than 4cm, but may be considered for masses up to 7cm.

Non-Surgical Options:

Unfortunately, there are no proven medication / chemotherapy options to treat kidney cancer. However, for patients who are not surgical candidates or who wish to avoid surgery, there may be alternative, effective non-surgical treatment options:

• Active Surveillance – This is the least invasive approach, sometimes used for older patients with small tumors, in which they are closely monitored by imaging (ultrasound, CT or MRI scan) every 3 to 6 months, as approximately 20% of these small tumors are benign. It has been shown that small tumors can generally be safely monitored, and if the tumor grows quickly or larger than 4 cm, treatment is pursued.
• Cryoablation – This is a procedure in which a special probe or needle is inserted through the skin and into the kidney tumor using real time imaging guidance. Cold gas is then administered through the needle into the tumor in order to freeze and kill the cancer cells.
• Radiofrequency Ablation – This is a procedure similar to cryoablation, but utilizing heat. A special needle with an electrical probe is inserted through the skin and into the kidney tumor. An electrical current passes through the needle and into tumor in order to burn the cancerous cells.
• Radiation Therapy – This procedure is not very effective for most kidney cancers, so is used for only very particular types or to help with relief of symptoms. This uses high-powered energy beams via imaging guidance to target and kill cancer cells.

American Cancer Society – https://www.cancer.org/cancer/kidney-cancer.html

Urology Care Foundation – https://www.urologyhealth.org/urologic-conditions/kidney-cancer

National Cancer Institute – https://www.cancer.gov/types/kidney

Mayo Clinic – https://www.mayoclinic.org/diseases-conditions/kidney-cancer/symptoms-causes/syc-20352664

Image References:

https://www.mayoclinic.org/tests-procedures/nephrectomy/multimedia/img-20332175

http://patients.infocaster-linux.net/radical-nephrectomy-4/

https://www.mayoclinic.org/tests-procedures/kidney-biopsy/about/pac-20394494