Types of Kidney Cancer

There are many different types of kidney cancer, each of which may be managed and treated differently. Papillary renal cell carcinomas These cancer cells create finger-like projections, known as papillae, in the tumor. This is the second most common subtype of renal cell carcinoma, making up about 10 percent of cases.

Chromophobe renal cell carcinomas Cancer cells in this type appear pale like clear cells but are much larger and have other distinct features. This subtype accounts for about 5 percent of renal cell carcinomas. Rarer types Other infrequently seen types of renal cell carcinoma include medullary carcinoma; collecting duct RCC; multilocular cystic RCC; mucinous tubular and spindle cell carcinoma; and neuroblastoma-associated RCC. In addition, some renal cell carcinomas are described as “unclassified,” either because they include more than one type of cancer cell or they don’t fit into any of the existing groupings.

Other Types of Kidney Cancer

Transitional cell carcinoma Instead of starting in the kidney itself, these cancers start in the lining of the renal pelvis — the area where the ureters, tiny tubes that carry urine to the bladder, meet the kidneys.Wilms tumor (nephroblastoma) This type of kidney cancer primarily affects children.Renal sarcoma Renal sarcomas begin in the blood vessels or connective tissue of the kidney. They are rare, making up less than 1 percent of all kidney cancers.

“The kidneys are located in the back of the abdomen, and tumors there can grow quite large without any symptoms at all,” explains Andrew J. Armstrong, MD, a professor of medicine, surgery, pharmacology, and cancer biology at Duke University School of Medicine in Durham, North Carolina.

Blood in the urine, which may look red, pink, or cola-coloredPersistent pain in the back or sideUnexplained weight lossLoss of appetiteFatigueFeverAnemia (a low red blood cell count)

Tests

Physical exam This includes an exam to check for any unusual issues, as well as a review of the patient’s medical history.Urine tests Urine samples are taken to see if they contain blood.Blood tests Blood tests can help doctors determine if a person’s blood cell count and kidney function are normal.Imaging tests Computed tomography (CT), magnetic resonance imaging (MRI), X-ray, and ultrasound may be used to look for kidney tumors or abnormalities.Biopsy A small sample of tissue may be removed from a tumor to check for the presence of cancer cells. But biopsies for kidney cancer are not always accurate.

Staging Kidney Cancer

The size and location of the tumorWhether and how much the cancer has spread to other tissues and organsWhether and how much the lymph nodes — immune system structures that contain white blood cells — are affected

Which Medical Experts Diagnose and Treat Kidney Cancer?

Urologist A doctor with special training in treating diseases of the urinary systemNephrologist A doctor who specializes in treating kidney conditionsOncologist A doctor who treats cancerRadiation oncologist A doctor who treats cancer with radiation therapyUrologic oncologist An oncologist who specializes in diagnosing and treating cancers of the urinary system

Lee suggests finding a doctor with extensive experience treating kidney cancer.

“Even though kidney cancer is among the top 10 malignancies in terms of incidence, it is important to see a urologist and medical oncologist that has specific expertise with management of the disease who can help you determine whether standard treatments or a clinical trial would make the most sense for you,” says Dr. Lee.

Cryoablation A hollow needle is inserted through the skin and into the kidney to deliver cold gas to freezes and destroy cancer cells.Radiofrequency ablation A probe is inserted through the skin and into the kidney to deliver an electrical current that heats and destroy cancer cells.Radiation therapy High energy beams that kill cancer cells are sometimes used to manage kidney cancer that has spread to other areas of the body.

Medications for Kidney Cancer

“In patients who are at high risk of recurrence of their disease, their urologist or oncologist can discuss whether adjuvant treatment or treatment with medications will decrease their risk of the disease coming back,” Lee says. “Chemotherapy is generally ineffective for kidney cancer,” Armstrong says.

Targeted therapies These drugs focus on blocking specific abnormalities in cancer cells. For kidney cancer, targeted therapies typically focus on tumor blood-vessel growth or the mTOR protein linked to the disease.Immunotherapy A person’s own immune system can be triggered to fight cancer with medicines called immune checkpoint inhibitors, cytokines, and others.

Newer Treatments and Clinical Trials

Researchers continue to search for new ways to target and treat kidney cancers. “Currently, we are working on developing new biomarkers that will help oncologists decide which treatment approach will provide the best outcomes for their patients,” says Lee. “We are interested in developing novel pathways to attack the cancer. We are doing a lot of working to better understand how the genetics of the kidney cancer and the genetics of the patient impact the response to provide more personalized therapies, and we hope that in the future we will be able to develop more personalized approaches for patients,” he adds.

HypertensionKidney diseaseObesityAnemia

American Cancer SocietyNational Cancer InstituteNational Kidney FoundationUrology Care FoundationKidneyCANKidney Cancer AssociationCure Educated Patient: Kidney Cancer SummitCancerCareCancer.net