National Cancer Institute What You Need To Know About TM Kidney Cancer U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute Services This is only one of many free booklets for people with cancer. You may want more information for yourself, your family, and your doctor. NCI offers comprehensive research-based information for patients and their families, health professionals, cancer researchers, advocates, and the public. • Call NCI’s Cancer Information Service at 1–800–4–CANCER (1–800– 422–6237) • Visit us at http://www.cancer.gov or http://www.cancer.gov/espanol • Chat using LiveHelp, NCI’s instant messaging service, at http://www.cancer.gov/ livehelp • E-mail us at cancergovstaff@mail.nih.gov • Order publications at http://www.cancer.gov/ publications or by calling 1–800– 4–CANCER • Get help with quitting smoking at 1–877–44U–QUIT (1–877–448–7848) U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES National Institutes of Health National Cancer Institute Contents About This Booklet 1 The Kidneys 3 Cancer Cells 5 Risk Factors 6 Symptoms 9 Diagnosis 9 Staging 11 Treatment 12 Second Opinion 19 Nutrition 20 Follow-up Care 21 Sources of Support 21 Taking Part in Cancer Research 23 Dictionary 24 National Cancer Institute Publications 32 About This Booklet This National Cancer Institute (NCI) booklet is about cancer* that starts in the kidney. Other names for this disease are renal cancer and renal cell carcinoma. About 54,000 Americans are diagnosed with renal cell carcinoma each year. Most are over 55 years old. 1 *Words in italics are in the Dictionary on page 24. The Dictionary explains these terms. It also shows how to pronounce them. This booklet is only about renal cell carcinoma. It’s not about transitional cell cancer (TCC) of the kidney. People with TCC of the kidney have different treatment options than those with renal cell carcinoma. For the latest information about TCC, visit NCI’s Web site at http://www.cancer.gov/cancertopics/types/ transitionalcell or contact NCI’s Cancer Information Service at 1–800–4–CANCER (1–800–422–6237). About 4,000 Americans are diagnosed with TCC of the kidney each year. Also, this booklet is not about childhood kidney cancer. Treatment options are different for children. For the latest information about childhood kidney cancer, visit NCI’s Web site at http://www.cancer.gov/cancertopics/types/ wilms or contact NCI’s Cancer Information Service. Hundreds of children are diagnosed with kidney cancer each year in the United States. Learning about medical care for kidney cancer can help you take an active part in making choices about your care. This booklet tells about: • Diagnosis and staging • Treatment and follow-up care • Taking part in research studies This booklet has lists of questions that you may want to ask your doctor. Many people find it helpful to take a list of questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you talk with the doctor—to take notes, ask questions, or just listen. For the latest information about kidney cancer, visit NCI’s Web site at http://www.cancer.gov/ cancertopics/types/kidney. Also, NCI’s Cancer Information Service can answer your questions about cancer. We can also send you NCI booklets and fact sheets. Call 1–800–4–CANCER (1–800–422–6237). Or chat using LiveHelp, NCI’s instant messaging service, at http://www.cancer.gov/livehelp. 2 3 The Kidneys Your kidneys are a pair of organs in your abdomen. Each kidney is about the size of a fist. Your kidneys are part of the urinary tract. They make urine by removing wastes and extra water from your blood. Urine collects in a hollow space (renal pelvis) in the middle of each kidney. Urine passes from your renal pelvis into your bladder through a long tube called a ureter. Urine leaves your bladder through a shorter tube (the urethra). This picture shows the kidneys and nearby tissues in a man. Kidney Urethra Ureter Renal vein Renal artery Renal pelvis Adrenal gland Bladder 4 Your kidneys also make substances to help control blood pressure and to make red blood cells. Attached to the top of each kidney is an adrenal gland. A layer of fatty tissue and an outer layer of fibrous tissue surround the kidney and adrenal gland. Kidney Urethra Ureter Renal vein Renal artery Renal pelvis Adrenal gland Bladder This picture shows the kidneys and nearby tissues in a woman. 5 This picture shows the kidney and adrenal gland. Kidney Fibrous tissue Adrenal gland Fat layer Ureter Renal pelvis Cancer Cells Cancer begins in cells, the building blocks that make up tissues. Tissues make up the kidneys and the other organs of the body. Normal cells grow and divide to form new cells as the body needs them. When normal cells grow old or get damaged, they die, and new cells take their place. Sometimes, this process goes wrong. New cells form when the body doesn’t need them, and old or damaged cells don’t die as they should. The buildup of extra cells often forms a mass of tissue called a growth or tumor. Tumors in the kidney can be benign (not cancer) or malignant (cancer). Benign tumors are not as harmful as malignant tumors: • Benign tumors (such as cysts): —are usually not a threat to life —can be treated or removed and usually don’t grow back —don’t invade the tissues around them —don’t spread to other parts of the body • Malignant growths: —may be a threat to life —usually can be removed but can grow back —can invade and damage nearby tissues and organs —can spread to other parts of the body Kidney cancer cells can spread by breaking away from the kidney tumor. They can travel through lymph vessels to nearby lymph nodes. They can also spread through blood vessels to the lungs, bones, or liver. After spreading, kidney cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues. See the Staging section on page 11 for information about kidney cancer that has spread. Risk Factors When you get a diagnosis of kidney cancer, it’s natural to wonder what may have caused the disease. Doctors usually can’t explain why one person gets kidney cancer and another doesn’t. 6 However, we do know that people with certain risk factors may be more likely than others to develop kidney cancer. A risk factor is something that may increase the chance of getting a disease. Studies have found the following risk factors for kidney cancer: • Smoking: Smoking tobacco is an important risk factor for kidney cancer. People who smoke have a higher risk than nonsmokers. The risk is higher for those who smoke more cigarettes or for a long time. • Obesity: Being obese increases the risk of kidney cancer. • High blood pressure: Having high blood pressure may increase the risk of kidney cancer. • Family history of kidney cancer: People with a family member who had kidney cancer have a slightly increased risk of the disease. Also, certain conditions that run in families can increase the risk of kidney cancer. —Von Hippel-Lindau (VHL) syndrome: VHL is a rare disease that runs in some families. It’s caused by changes in the VHL gene. People with a changed VHL gene have an increased risk of kidney cancer. They may also have cysts or tumors in the eyes, brain, or other parts of the body. Family members of those with VHL can have a test to check for a changed VHL gene. Many people who get kidney cancer have none of these risk factors, and many people who have known risk factors don’t develop the disease. 7 [...]... moves through your kidneys to your ureters and bladder The x-rays can show a kidney tumor or other problems (IVP is not used as commonly as CT or MRI for the detection of kidney cancer. ) • Biopsy: The removal of tissue to look for cancer cells is a biopsy In some cases, your doctor will do a biopsy to diagnose kidney cancer Your doctor inserts a thin needle through your skin into the kidney to remove a... Surgery to remove part of one kidney or a kidney tumor, but not an entire kidney Pathologist (puh-THAH-loh-jist): A doctor who identifies diseases by studying cells and tissues under a microscope Radiation oncologist (RAY-dee-AY-shun on-KAHloh-jist): A doctor who specializes in using radiation to treat cancer Radiation therapy (RAY-dee-AY-shun THAYR-uhpee): The use of high-energy radiation from x-rays,... Facing Forward: Life After Cancer Treatment You may also want to read the NCI fact sheet Follow-up Care After Cancer Treatment Sources of Support Learning that you have kidney cancer can change your life and the lives of those close to you These changes can be hard to handle It’s normal for you, your family, and your friends to need help coping with the feelings that a diagnosis of cancer can bring Concerns... radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors Radical nephrectomy (RA-dih-kul neh-FREK-tohmee): Surgery to remove an entire kidney, nearby adrenal gland and lymph nodes, and other surrounding tissue Radiofrequency ablation (RAY-dee-oh-FREE-kwensee uh-BLAY-shun): A procedure that uses radio waves to heat and destroy abnormal cells The radio... example, if kidney cancer spreads to a lung, the cancer cells in the lung are actually kidney cancer cells The disease is metastatic kidney cancer, not lung cancer It’s treated as kidney cancer, not as lung cancer Doctors sometimes call the new tumor “distant” disease 11 These are the stages of kidney cancer: • Stage I: The tumor is no bigger than a tennis ball (almost 3 inches or about 7 centimeters) Cancer. .. adrenal glands, one on top of each kidney Benign (beh-NINE): Not cancerous Benign tumors may grow larger but do not spread to other parts of the body Also called nonmalignant Biological therapy (BY-oh-LAH-jih-kul THAYR-uhpee): Treatment to boost or restore the ability of the immune system to fight cancer, infections, and other diseases Also called immunotherapy Biopsy (BY-op-see): The removal of cells... of your options It may take some time and effort to gather your medical records and see another doctor In most cases, it’s not a problem to take several weeks to get a second opinion The delay in starting treatment usually will not make treatment less effective To make sure, you should discuss this delay with your doctor There are many ways to find a doctor for a second opinion You can ask your doctor,... small sample of tissue Your doctor may use ultrasound or a CT scan to guide the needle A pathologist uses a microscope to check for cancer cells in the tissue 10 • Surgery: After surgery to remove part or all of a kidney tumor, a pathologist can make the final diagnosis by checking the tissue under a microscope for cancer cells Staging If kidney cancer is diagnosed, your doctor needs to learn the extent... contribution by helping doctors learn more about kidney cancer and how to control it Although clinical trials may pose some risks, doctors do all they can to protect their patients Doctors are studying new targeted therapies and drug combinations for kidney cancer If you re interested in being part of a clinical trial, talk with your doctor You may want to read the NCI booklet Taking Part in Cancer Treatment... in your side or abdomen • Weight loss for no known reason • Fever • Feeling very tired These symptoms may be caused by kidney cancer or by other health problems, such as an infection or a kidney cyst People with these symptoms should tell their doctor so that any problem can be diagnosed and treated as early as possible Diagnosis If you have symptoms that suggest kidney cancer, your doctor will try to . questions to a doctor visit. To help remember what your doctor says, you can take notes. You may also want to have a family member or friend go with you when you. possible. Diagnosis If you have symptoms that suggest kidney cancer, your doctor will try to find out what s causing the problems. You may have a physical exam. Also, you