Kidney cancer

The main types of kidney cancer are renal cell cancer (RCC), transitional cell cancer (TCC), and Wilms' tumor.^[7] RCC makes up approximately 80% of kidney cancers, and TCC accounts for most of the rest.^[8] Risk factors for RCC and TCC include smoking, certain pain medications, previous bladder cancer, being overweight, high blood pressure, certain chemicals, and a family history.^[1][2] Risk factors for Wilms' tumor include a family history and certain genetic disorders such as WAGR syndrome.^[3] Diagnosis may be suspected based on symptoms, urine testing, and medical imaging.^[1][2][3] It is confirmed by tissue biopsy.^[1][2][3]


Treatment may include surgery, radiation therapy, chemotherapy, immunotherapy, and targeted therapy.^[1][2][3] Kidney cancer newly affected about 403,300 people and resulted in 175,000 deaths globally in 2018.^[5] Onset is usually after the age of 45.^[4] Males are affected more often than females.^[4] The overall five-year survival rate is 75% in the United States, 71% in Canada, 70% in China, and 60% in Europe.^{[4][9][10][11]} For cancers that are confined to the kidney, the five-year survival rate is 93%, if it has spread to the surrounding lymph nodes it is 70%, and if it has spread widely, it is 12%.^[4] Kidney cancer has been identified as the 13th most common form of cancer,^[12] and is responsible for 2% of the world's cancer cases and deaths.^[13] The incidence of kidney cancer has continued to increase since 1930. Renal cancer is more commonly found in populations of urban areas than rural areas.^[14]

Signs and symptoms[edit]

Early on, kidney masses do not typically cause any symptoms and are undetectable on physical examination.^[15] As kidney cancer becomes more advanced it classically results in blood in the urine, flank or back pain, and a mass.^[15] Other symptoms that are consistent with advanced disease include weight loss, fever, night sweats, palpable swollen lymph nodes in the neck, non-reducing varicocele, bone pain, continuous cough, and bilateral lower leg swelling.^[15][16][17]


The classic triad of visible blood in the urine (hematuria), flank pain and palpable abdominal mass occurs in less than 15% of the cases. RCC may present with signs and symptoms caused by the substances the cancer cell produce (i.e. paraneoplastic syndromes).


Paraneoplastic syndromes caused by kidney cancer can be broadly classified as endocrine and non-endocrine. Endocrine dysfunctions include increase in blood calcium levels (hypercalcemia), high blood pressure (hypertension), increased red bloods (polycythemia), liver dysfunction, milky nipple discharge unrelated normal breast-feeding (galactorrhea), and Cushing's syndrome. Non-endocrine dysfunctions include deposition of protein in tissue (amyloidosis), decrease in hemoglobin or red blood cells (anemia), disorders of nerves, muscles (neuromyopathies), blood vessels (vasculopathy) and blood clotting mechanisms (coagulopathy).^[18]

Causes[edit]

Factors that increase the risk of kidney cancer include smoking, high blood pressure, obesity, faulty genes, a family history of kidney cancer, having kidney disease that needs dialysis, being infected with hepatitis C, and previous treatment for testicular cancer or cervical cancer.^[19][20]


There are also other possible risk factors such as kidney stones being investigated.^[21][22]


About 25–30% of kidney cancer is attributed to smoking.^[20] Smokers have a 1.3 times higher risk of developing kidney cancer compared to non-smokers. Moreover, there is a dose-dependent increased risk of cancer development. Men who smoke more than 20 cigarettes per day have twice the risk. Likewise, women who smoke more than 20 cigarettes per day have 1.5 times the risk of non-smokers. After 10 years of smoking cessation, a substantial reduction is seen in the risk of developing kidney cancer.^[23]