Kidney Cancer

Kidney cancer usually means renal cell carcinoma, which starts in the filtering tubules of the kidney. More than half of cases are now found by chance on a scan done for another reason, often as a small mass. Not every kidney tumour is cancer: around one in five small solid masses proves benign, for example an oncocytoma or angiomyolipoma.

When the tumour is confined to the kidney, surgery is the main treatment and chemotherapy plays no part. Small tumours in older or frail people can be watched safely. Cancer that has spread is treated with immunotherapy and targeted tablets.

Symptoms

• No symptoms, with the mass found incidentally
• Blood in the urine
• A persistent ache in the side or lower back
• A lump felt in the abdomen or flank
• Tiredness, weight loss, night sweats or fever without infection
• High blood pressure or abnormal blood results such as anaemia or raised calcium
• Bone pain or a persistent cough if the cancer has spread

Causes and risk factors

The main risk factors are smoking, obesity and high blood pressure. Risk is also higher in people on long-term dialysis, who develop cysts in their kidneys, and in those with a close relative affected. A few percent of cases are due to inherited conditions, the best known being von Hippel-Lindau disease, which causes multiple tumours at a young age and needs kidney-sparing management. Men are affected about twice as often as women, and most cases occur after 60.

How it is diagnosed

• Ultrasound: Often the test that first reveals a mass and distinguishes simple cysts, which are harmless, from solid lesions.
• CT with contrast, before and after injection: The key investigation. It characterises the mass, shows the renal vein and the other kidney, and stages the chest and abdomen.
• MRI: An alternative when contrast dye cannot be used, and helpful for complex cysts and vein involvement.
• Renal mass biopsy: A needle biopsy under local anaesthetic, used when the result would change management, such as before ablation or surveillance, or when spread is present.
• Kidney function tests: Measure how well both kidneys work, which influences whether the whole kidney can be removed.

Treatment options

• Active surveillance: Regular scans for small masses, generally under 3 to 4 centimetres, particularly in older people. Many grow slowly or not at all.
• Partial nephrectomy: Removal of the tumour alone, preserving the rest of the kidney. The preferred operation for small tumours, commonly done robotically.
• Radical nephrectomy: Removal of the whole kidney for large or central tumours, usually by keyhole surgery. One healthy kidney is normally enough.
• Ablation: Freezing (cryoablation) or heating the tumour through needles under imaging guidance, for small tumours in people who are poor candidates for surgery.
• Immunotherapy and targeted therapy: Combinations of checkpoint inhibitors and tyrosine kinase inhibitor tablets for advanced disease, and sometimes after surgery for high-risk tumours.

When it is urgent

Go to a local emergency department for heavy bleeding in the urine with clots or inability to pass urine, for sudden severe flank pain with faintness, which can mean bleeding from a tumour, or for new leg weakness or loss of bladder control with back pain. After kidney surgery, fever, increasing pain or very low urine output need urgent review.

Travelling to Türkiye for treatment

Because most kidney tumours grow slowly, there is usually time to seek a second opinion, and scans can be reviewed remotely first. A planned robotic partial nephrectomy or ablation fits a stay of about 10 to 14 days. Surveillance scans for 5 years or more, and drug treatment for advanced disease with its blood tests and side effect management, should be based at home.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

Frequently Asked Questions