At the OHSU Knight Cancer Institute, we provide expert care for patients with kidney cancer. We offer you:

• Specialists with advanced training and years of experience treating patients with this complex illness.
• A team approach, with experts from many different specialties meeting together to decide the best plan of action for each patient.
• Minimally invasive surgery, including laparoscopic surgery and robotic surgery, for less pain and a faster recovery.
• Clinical trials that may offer you access to promising new treatments. This may include targeted therapy or systemic therapy for advanced 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?

About 82,000 people in the U.S. are diagnosed with kidney cancer every year, according to the National Cancer Institute. Roughly 647,000 people in the U.S. are living with it.

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 Asian Americans and Pacific Islanders but affects others about the same. 
• Lifestyle: Smoking and obesity increase risk.
• Exposure to certain substances: Prolonged contact with the metal cadmium or certain herbicides may increase risk.
• 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, Lynch syndrome, sickle cell disease, tuberous sclerosis complex and others. Learn about OHSU’s expert genetic counseling and testing to identify and manage risk.

Kidney cancer survival rates

A key concept in understanding survival is five-year relative survival rate. This is the percentage of people who are still alive five years after they were first diagnosed, compared to the general population. (It doesn’t count death from other causes.)

The five-year survival rate for kidney cancer is 78%. This rises to 93% if the cancer is caught at its earliest stage. 

It's important to remember that these figures are averages and can't predict the outcome for any one patient. It's also important to remember that these figures are based on the treatments that were available more than five years ago. Patients who are diagnosed now may have a better outlook. Treatments are getting better all the time.

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:

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.

Stages of kidney cancer

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 renal cell carcinoma (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.

Monitoring

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

The main treatment for kidney cancer is typically surgery. 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

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

Immunotherapy

Immunotherapy medications harness the power of the immune system to fight cancer. Immunotherapy helps the immune system recognize and destroy cancer cells. Similar to targeted therapy, it can be used for late-stage kidney cancer or cancer that has spread. It can control cancer growth, relieve symptoms and extend life.  The most common types of immunotherapy used for renal cell carcinoma are nivolumab and pembrolizumab.

Clinical trials

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.

Learn more

• Kidney Cancer, National Cancer Institute
• Kidney Cancer, American Cancer Society
• What is Kidney Cancer? Urology Care Foundation
• Kidney Cancer: Introduction, Cancer.Net, American Society of Clinical Oncologists