What Is The Survival Rates For Kidney Cancer?

Kidney cancer is one of the most common cancers, with a lifetime risk of 2.02% for men and 1.03% for women.¹ However, the typical 5-year survival rate is fairly high. Most people diagnosed with kidney cancer are between 65 and 74 years old, and it is very uncommon in people under 45.

Early diagnosis significantly improves the survival rate, so it's important to be aware of risk factors and symptoms.

What are the symptoms of kidney cancer?

Early kidney cancer does not cause any symptoms, making screening particularly important. As cancer grows, it can cause the following symptoms:

• Persistent fever

• Hematuria or blood in the urine

• Low back pain on one side

• Fatigue

• Loss of appetite

• Unexpected weight loss

• Anemia

• A mass on the side or lower back

These symptoms are more commonly caused by other, more common diseases. For example, blood in the urine is more often a sign of a kidney stone or urinary tract infection.

However, many diagnoses of kidney cancer are incidental. One sign of kidney cancer is an abnormal complete blood count, which typically shows anemia. Screening might also discover elevated levels of liver enzymes or blood calcium.

With kidney cancer, biopsies are seldom needed. Doctors will diagnose most cases using a combination of urinalysis and imaging, such as a CT or MRI scan. This differs from most cancers. However, some patients will need a biopsy.

Some forms of kidney cancer are hereditary. If you have a family history of kidney cancer, especially if it affects multiple family members or younger people, you may be referred for genetic counseling to identify risk factors. Your doctor may recommend you for regular screening if you have a genetic susceptibility.

What are the risk factors for kidney cancer?

Kidney cancer is a fairly common cancer in adults. The known risk factors include:

• Family history of kidney cancer

• Advanced age (Most kidney cancer is diagnosed in individuals between 65 and 74 years old.)

• Smoking

• Obesity

• High blood pressure, even if you are taking medication

• Workplace exposure to certain substances, including trichloroethylene

• Male sex (Although this may be because more men have potentially dangerous workplace exposure and men are slightly more likely to smoke.)

• African-American race

• Extensive use of acetaminophen, an over-the-counter pain reliever

• Kidney disease

Some of these risk factors, such as smoking, are controllable. Others are not, and screening should be undertaken as necessary. If you smoke, even if you have done so for many years, quitting will improve your health and reduce your risk of kidney cancer and other preventable conditions.

What are the different types of kidney cancer?

One of the factors affecting survival is the type² of kidney cancer, which is primarily determined by what cells cancer starts in.

Renal cell cancer

The most common form of kidney cancer is renal cell cancer or renal cell adenocarcinoma. This accounts for more than 80% of kidney cancers. In this type, cancer starts in the lining of the tubules, the tiny tubes inside the kidney that filter the blood to make urine. This can be further divided into three common types and some rare ones.

The common subtypes are:

• Clear cell

• Papillary

• Chromophobe renal cell cancer

More rarely, cancer can start in the collecting ducts or renal medullary.

Transitional cell cancer of the kidney or ureter

This cancer³ starts in the cells lining the renal pelvis( where urine collects) or the ureter. It is a rare form of cancer and is even rarer in the ureter. A potential indicator is a pain when passing urine or frequent urination, in addition to other symptoms of kidney cancer.

Sarcomatoid renal cancer

This starts in the same cells as renal cell cancer, but cancer itself is different. Instead of resembling "regular" kidney cancer, the cells look like the kind of cells that develop in cancer of connective tissues such as muscles and fat. Sarcomatoid cancer usually grows faster and is more likely to spread beyond the kidneys.

Wilms tumor

This very rare cancer primarily affects young children. It is a congenital condition in which some neuroblasts, or immature kidney cells, fail to develop correctly and grow out of control. Many cases are associated with other developmental disorders, such as Beckwith-Wiedemann syndrome (which causes enlarged internal organs and tongue) or Denys-Drash syndrome (which causes kidney problems and lack of genital development in boys).

This is a very different thing from kidney cancer in adults. While these children require surgery and typically chemotherapy, most recover, and the cancer does not return. However, the standard treatment for unilateral Wilms tumors is the removal of the affected kidney, leaving children with a single kidney.

What are the stages of kidney cancer?

Kidney cancer is staged by looking at the SEER database. Unlike some cancers, it is not grouped by AJCC TNM Stages (the stage 1, stage 2, etc. terminology you might have heard used in other cancers).

Instead, kidney cancer is staged in three parts as follows:

• Localized. The cancer is confined to the kidney.

• Regional. Cancer has spread to nearby structures or lymph nodes.

• Distant. Cancer has spread to distant parts, such as the lungs or brain.

The survival rate varies tremendously by stage. Localized cancers have a 93% 5-year survival rate, while those with cancer that has reached the distant point of spread have only a 14% 5-year survival rate.

This makes early diagnosis of kidney cancer particularly important. However, the outlook improves all the time. Today, the average five-year survival rate is 75%⁴ and keeps increasing.

How is kidney cancer treated?

Various potential treatments are available depending on the stage and type of your cancer. Five standard treatments are used, potentially in combination.

Surgery

Surgery to remove all or part of the affected kidney is common. In a partial nephrectomy, a surgeon removes cancer and some surrounding tissue. However, this is typically only done if you only have one kidney or the other is damaged because of the risk of recurrence.

A simple nephrectomy is more common, in which the affected kidney is removed. It is possible to live a normal life with only one kidney.

Some doctors may perform a radical nephrectomy, in which nearby lymph nodes and the adrenal gland are removed. Doctors typically carry out this surgery when there is concern over the cancer spreading.

If you are not a candidate for surgery, a surgeon may perform an arterial embolization. In this, a small incision is made, and a catheter is inserted into the main blood vessel that flows to the kidney. Gelatin sponge pieces are inserted to block blood flow and prevent the cancer cell from growing.

After surgery, your doctor may or may not recommend you for adjuvant chemotherapy or radiation therapy.

Radiation therapy

Kidney cancer may be treated with external radiation therapy, which sends radiation toward the area of the body with cancer. In kidney cancer, radiation therapy is often used as a palliative measure for patients whose cancer has spread and for whom treatment is unlikely to help further. It may also be used if surgery is not possible.

Chemotherapy

Systemic chemotherapy is occasionally used. Chemotherapy⁵ drugs may be administered by injection or orally. Chemotherapy has a lot of unpleasant side effects, and kidney cancer cells seldom respond well to it. It is typically used as a last-resort treatment. The drugs cisplatin, 5-fluorouracil, and gemcitabine have proven helpful.

Immunotherapy

Immunotherapy is a more recent treatment that primes your immune system to turn it against cancer. The following types are used:

1. Immune checkpoint inhibitor therapy. This blocks the proteins that cancer cells may produce to tell your immune system they are part of your body, allowing T cells to attack and kill them. This therapy is used in advanced cancer that can no longer be removed surgically.

2. Interferon therapy. Interferons slow tumor growth by affecting the division of cells.

3. Interleukin-2 therapy. This therapy boosts your immune system and encourages it to produce more of a type of white blood cell called lymphocytes, which can attack cancer cells.

These new therapies work better than the older cytokine-based therapies and improve constantly.

Targeted therapy

Targeted therapy is a way to identify and attack cancer cells. Chemotherapy and radiation therapy have negative side effects because they kill many healthy cells.

Targeted therapy with antiangiogenic agents can attack advanced renal cell cancer by keeping blood vessels from forming in the tumor and starving it. This generally means monoclonal antibodies, which tell your body that cancer cells are a disease to be fought off, or kinase inhibitors, which inhibit cell division.

New treatments are being worked on all the time, and if your cancer is not responding to standard treatment, talk to your doctor about taking part in a clinical trial.

In some elderly patients, active monitoring may be called for instead of treatment, meaning checking on the growth of the tumor regularly. In some frail, older people, cancer grows so slowly that chances are they would die of something else before it became significant, so attempting surgery would be dangerous. Active monitoring is also sometimes used for cancer that has spread but is still growing slowly and causing no symptoms.

How quickly does kidney cancer spread?

The speed at which kidney cancer spreads is highly variable. Surveillance studies gave a mean tumor growth rate of about 0.3cm/year. However, another study⁶ that looked at "clinically significant" carcinomas treated immediately showed an average growth rate of 2.13cm/year. This shows a lot of variation in the speed of growth, which is also tied to survival rates.

Bear in mind that tumor growth also includes small, slow-growing tumors found in the elderly who may not be treated because of the lack of survival impact.

The speed of spread varies dramatically. Clear cell carcinoma,⁷ for example, are graded by the speed of growth. Your care team will talk to you about how fast your cancer is growing and use it to help determine the best treatment.

Can you survive distant kidney cancer?

The survival rate for distant kidney cancer is low but not zero. Some people do survive, and the survival rates are increasing. The figures above are likely to be lower than the chances of patients diagnosed today.

Following your treatment regimen offers your best chance of survival. Some people may, however, feel that there is a point at which they should switch to palliative care, in which you are made comfortable and your symptoms kept under control for the time you have left.

Can you live normally with one kidney?

While most of us are born with two kidneys, people who only have one kidney lead normal, healthy lives. If you have a kidney removed due to cancer, this will most likely cause no problems.

However, it is recommended that you have your kidney function checked once a year to ensure that your remaining kidney is in good health, especially if you are susceptible to cancer recurrence. You should be careful about engaging in activities such as contact sports that carry a high risk of injury to your remaining kidney.

You will not need to take medication or follow a special diet.

Some people with kidney cancer may end up without functioning kidneys or only part of a kidney. If this is the case, then at some point, you may need dialysis to compensate for the lost kidney function. However, many patients live for years with one only partially working kidney.

As most kidney cancer patients are older, declining kidney function over time is less significant than it would be in younger individuals.

The lowdown

The current five-year survival rates for kidney cancer are high when the cancer is localized to the kidneys and can be treated with surgery, but they are much lower if the cancer spreads through the body. Early diagnosis of kidney cancer is vital for survival rates.

If your cancer is highly localized and treatable with a partial or total nephrectomy, your survival chances are very high. Your doctor will recommend the best treatment regimen to maximize your survival chances and lifespan.