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Dr. Wade Sexton checks a patient's records

Kidney cancer occurs when cells in one or both kidneys change and begin to grow uncontrollably, eventually forming a tumor. There are several different types of kidney cancer, and each is determined largely by characteristics such as its location and how the cells look when examined under a microscope.

The main types of kidney cancer are:

Renal cell carcinoma

Renal cell carcinoma is by far the most common form of adult kidney cancer, accounting for about nine of every 10 diagnoses. This type of kidney cancer tends to grow as a single tumor in one kidney, but it sometimes develops as two or more tumors in the same kidney or both kidneys.

Additionally, renal cell carcinoma has several subtypes that are determined by the appearance of the cells when viewed under a microscope. For instance, clear cell renal cell carcinoma has cells that are very pale or clear, while papillary renal cell carcinoma has cells with finger-like projections. Chromophobe renal cell carcinoma also has pale or clear cells, but the cells are quite large and have other recognizable features.

Most kidney tumors are diagnosed incidentally, or before they cause noticeable symptoms. Typically, symptoms occur as a tumor grows and reaches approximately 7 to 10 centimeters in diameter.

Some of the most common signs and symptoms of renal cell carcinoma include:

  • A lump on the lower back, side or stomach
  • Low back pain on one side
  • Unexplained weight loss
  • Blood in the urine
  • Fever

As is the case with most cancers, renal cell carcinoma is easier to treat when it is diagnosed in an early stage and has not spread (metastasized) to other areas of the body. Treatment typically involves surgery to remove the tumor(s) and affected tissues, which may include the entire kidney.

Transitional (urothelial) cell carcinoma

Also referred to as urothelial cell carcinoma, transitional cell carcinoma forms in the lining of the renal pelvis, or the space in the kidney where urine collects before it is expelled into the bladder. This type comprises around 5% to 10% of kidney cancer diagnoses in adults and is strongly linked to tobacco use, exposure to certain chemicals and taking large amounts of pain medications such as phenacetin.

People with transitional or urothelial cell carcinoma usually report the following symptoms:

  • Blood-tinged urine
  • Unrelenting back pain
  • Frequent or painful urination
  • Extreme fatigue
  • Unexplained weight loss

A combination of surgery and chemotherapy is often used to treat transitional or urothelial cell carcinoma. Some patients may also be candidates for promising new therapies such as fulguration, a procedure that uses electrical currents to destroy cancerous tissues, or intrapelvic chemotherapy gel (Jelymto).

Renal sarcoma

Renal sarcoma is a rare type of kidney cancer that develops in soft tissues, such as the connective tissue that encapsulates the kidney and the surrounding fatty layers. Renal sarcomas account for less than 1% of kidney tumors. A combination of surgery, chemotherapy and radiation therapy may be used to treat this cancer, which tends to recur and require additional treatment.

The signs and symptoms of renal sarcoma are much the same as other types of kidney cancer, often involving:

  • A lump in the lower back or side
  • Low back pain on one side
  • Blood in the urine
  • Unexplained weight loss
  • Fever

Lymphoma

Although rare, it is possible for lymphoma—or cancer of the lymphatic system—to develop in the kidneys. More commonly, lymphoma originates in lymphocytes in the lymph nodes, bone marrow, thymus or spleen, then travels to the kidneys. Kidney lymphoma is often detected in its late stages after it causes noticeable health changes, such as:

  • Stomach swelling
  • Fever
  • Unexplained weight loss
  • Fatigue
  • Chest pain
  • Easy bruising and bleeding
  • Blood in the urine
  • Shortness of breath
  • Frequent infections

Chemotherapy is the primary form of treatment for kidney lymphoma, sometimes in combination with surgery to remove all or part of the kidney. Other progressive approaches may also be considered, such as targeted therapy, monoclonal antibody therapy and CAR T-cell therapy.

Chromophobe renal cell carcinoma

Chromophobe renal cell carcinoma is a relatively uncommon type of kidney cancer that develops in the cells that line the small tubules of the kidneys. After blood is filtered by a cluster of capillaries (glomerulus) at the end of each tubule, the tubule reabsorbs and returns the essential minerals and nutrients to the bloodstream. The remaining waste and excess water are then eliminated from the body in the form of urine.

Even though early-stage chromophobe renal cell carcinoma does not usually produce noticeable symptoms, it tends to be diagnosed earlier than other types of kidney cancer. In many cases, the tumor is discovered in an imaging scan performed for an unrelated reason, such as a suspected kidney stone.

If symptoms occur, they may include:

  • Low back or flank pain
  • Blood-tinged urine

As chromophobe renal cell carcinoma progresses and spreads to other organs and tissues, it may also cause:

  • Bone pain
  • Unexplained weight loss
  • Persistent coughing
  • Fever
  • Leg swelling

Surgery is the main form of treatment for early-stage chromophobe renal cell carcinoma. This may involve a partial or radical nephrectomy to remove part or all of the affected kidney. If surgical treatment is not possible or the tumor is very small, other options include destroying the cancerous tissue by freezing it (cryosurgery), applying a radio current (radiofrequency ablation) or applying microwave energy (microwave ablation). Chemotherapy may be considered to address late-stage chromophobe renal cell carcinoma that has spread throughout the body.

Clear cell renal cell carcinoma

Clear cell renal cell carcinoma is the most common type of kidney cancer. Like chromophobe renal cell carcinoma, it develops in the tubules that filter excess water and waste from the blood. Compared to other kidney cancers, it tends to be more aggressive and spread faster. When viewed under a microscope, the cancerous cells have a distinctive appearance that resembles clear soap bubbles.

Much like other forms of kidney cancer, clear cell renal cell carcinoma usually does not cause noticeable symptoms in its early stages. As the malignancy progresses, it may produce:

  • Blood in the urine
  • Flank pain or a lump that can be felt
  • Fever
  • Overwhelming fatigue
  • Unexplained weight loss

Possible complications of clear cell renal cell carcinoma include blood clots in the renal vein of the affected kidney, which is the largest blood vessel that carries blood from the kidney to the heart.

Treatment options for clear cell renal cell carcinoma include:

  • A radical or partial nephrectomy to surgically remove all or a portion of the affected kidney
  • Immunotherapy to help the body’s immune system recognize and destroy the cancerous cells
  • Targeted therapy to prevent the cancerous cells from growing and multiplying
  • Radiation therapy to destroy cancerous cells with high-energy rays
  • Cryosurgery to destroy cancerous cells with extreme cold
  • Thermal ablation to destroy cancerous cells with heat

Usually, surgery is the first step in confirming the diagnosis and treating the cancer.

Papillary renal cell carcinoma

Papillary renal cell carcinoma is similar to—but much less common than—clear cell renal carcinoma. Both conditions generally produce the same symptoms and have the same treatment options. The main distinguishing factor is that most papillary tumors have long, thin, finger-like projections, which can be seen with the aid of a microscope.

There are two types of papillary renal cell carcinoma: type 1, which is slow-growing, and type 2, which is aggressive and more likely to spread.

Moffitt's approach to kidney cancer

The experts in Moffitt Cancer Center’s Urologic Oncology Program have an in-depth understanding of all types of kidney cancer and offer a full scope of diagnostic and treatment options in a single location. Our multispecialty team includes physicians who focus exclusively on urologic cancers and routinely address even the most uncommon types of kidney cancer.

As Florida’s No. 1 cancer hospital, Moffitt is committed to employing the most effective and least invasive treatment options available, helping to improve outcomes and quality of life for our patients. We take an individualized approach to treatment that is continually adapted to the characteristics and dynamics of each patient’s cancer. Furthermore, Moffitt spearheads a groundbreaking clinical trial program that gives our patients access to promising new therapies before those options are widely available.

Medically reviewed by Dr. Brandon Manley

If you are experiencing possible symptoms of kidney cancer, are concerned about your risk or would like to receive a second or third opinion about your diagnosis or treatment, contact Moffitt Cancer Center by calling 1-888-663-3488 or completing a new patient registration form online. No referral is necessary.

References

American Cancer Society - Kidney Cancer
Cancer.Net - Kidney Cancer: Introduction
National Cancer Institute - Kidney (Renal Cell) Cancer
Kidney Lymphoma: Symptoms, Treatment Options, and Support