Feature Story | 27-Feb-2025

Kidney cancer: Understanding what a renal cell carcinoma diagnosis means

World Kidney Day is March 13

Mayo Clinic

ROCHESTER, Minn. — Renal cell carcinoma is the most common form of kidney cancer. It can take time to fully process a diagnosis and what, exactly, it may mean. Developing a good understanding of your disease — and especially the diagnostic process — can help you set realistic expectations and take an active part in your treatment plan, says Bradley Leibovich, M.D., a urologist at Mayo Clinic.

The kidneys are two bean-shaped organs located on each side of the spine. The kidneys perform a few important functions for the body, including filtering waste and managing acid and fluid balance. The kidneys help maintain a delicate balance of water, salt and minerals in the blood and help ensure that all systems in the body function correctly.

Renal cell carcinoma typically develops as a single tumor in one kidney. Rarely, people have two or more tumors develop in one or both kidneys. In the early stages of disease, kidney cancer doesn’t usually cause any symptoms. As the disease progresses, however, certain symptoms may develop, such as anemia, weight loss, night sweats and fever, blood in the urine, and consistent pain in the side or back.

Because there are initially so few symptoms, kidney cancer is often a surprising diagnosis — particularly because people with the condition may be feeling completely well. An estimated 50% of all kidney cancers are discovered by chance, meaning they are found by accident when scans are being performed to evaluate unrelated issues. Unfortunately, there are currently no screening tests available for kidney cancer, notes Dr. Leibovich.

As part of the evaluation of a kidney tumor, your care team may use blood and urine tests, computerized tomography (CT), magnetic resonance imaging (MRI), or other imaging scans. Sometimes, a biopsy is performed to obtain a tissue sample. These tests help determine the clinical stage of the tumor, which is represented with a number — 1, 2, 3 or 4 — and indicates how extensive the disease is believed to be.

At stages 1 and 2, the cancer is limited, also called localized, to the kidney, says Dr. Leibovich.

“At stage 3, the cancer involves other tissues, such as the fat surrounding the outside or inside of the kidney, or blood vessels that drain the kidney, for example,” he says.

At stage 4, the cancer has spread beyond the kidney. This type of cancer progression also is called metastatic cancer or metastatic disease. Most people are diagnosed in the earlier stages of disease. Between 2009 and 2015, 65% of renal cell carcinomas were still localized to the kidneys.

You may also hear the term tumor grade, but this isn’t the same as a cancer stage. Tumor grade describes how aggressively a kidney cancer is expected to behave, Dr. Leibovich explains. To determine the grade, the cancer cells are examined under a microscope to see how different they look from noncancerous cells. Just like with the cancer stage, the tumor grade ranges from 1 to 4. Grade 1 and 2 cancers are expected to behave less aggressively, while grade 4 means cancer cells are aggressive.

Though it may sound intimidating to rate cancer on different scales, staging and grading are tools that help you and your care team determine the best possible treatment plan.

It can be overwhelming to discuss — and sometimes even keep up with — new medical information. Don’t be afraid to ask your care team to slow down, repeat key information or rephrase something you don’t understand. You also may consider writing down your most pressing questions before speaking with your healthcare team and taking notes during your discussion.

To help you start, Dr. Leibovich recommends asking the following questions:

  • How likely is my tumor to be cancerous versus benign?
  • What additional testing do I need?
  • What is the clinical stage of the cancer?
  • What is the range of treatment options available? Is it possible the tumor requires observation only?
  • Why do you recommend certain treatments over others? What are my alternative options?
  • What is the expected outcome of treatment?
  • Should I expect changes to my quality of life? How so?
  • How likely am I to be cured?

Dr. Leibovich says that for most people, a renal cell carcinoma diagnosis does not usually impact quality of life. And for certain people, Dr. Leibovich says it may even be possible to cure the cancer altogether.

“More than 60% of those with renal cell carcinoma are cured with surgery alone, though success rates are very dependent on multiple factors,” he says.

Treatment options have advanced dramatically over the past few decades.

“Even in cases of advanced disease where we could not have done much to help people in the past, a combination of therapies — targeted therapies and immunotherapies — can significantly extend life and even cure certain people,” Dr. Leibovich says. “For people that we can’t cure, we are now able to keep them going long enough that the new generation of drugs hopefully will extend their lives even more or eventually cure them.”

For more information, visit Mayo Clinic Press and MayoClinic.org.

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