Kidney Cancer Symptoms

Kidney Cancer Symptoms

This article describes the symptoms that occur with cancer of the kidney. If these symptoms are noticed early, this may facilitate treatment sooner and possibly a better outcome.

The kidneys are paired bean shaped organs that are found in the retroperitoneum. They receive a substantial amount of blood and filter the entire blood many times per hour. The kidneys have several important functions.
A list of some of the key functions of the kidneys includes:

  • Regulation of body water
  • Electrolyte balance
  • Maintenance of normal body pH
  • Blood pressure regulation
  • Filtration of waste products from the blood (mostly nitrogen based)
  • Proper red blood cell levels

Unfortunately, many kidney cancers do not have much in the way of symptoms until they have grown for some time. There are however some that cause symptoms and these “red flag” symptoms should be used to alert for the possibility of kidney cancer. The symptoms caused by kidney cancer also tend to be fairly nonspecific, as with many cancers. The primary symptom that alerts most to its presence is blood in the urine, however there is a long list of possible causes for blood in the urine. Even so these abnormalities should not be dismissed.

There are several different types of kidney cancer based upon different cell types and mutations of these. All of these may be referred to as renal cell carcinoma (RCC). The major subtypes include clear cell, papillary, chromophobe, oncocytoma, and collecting duct tumors. Each of these has different genetic mutations and family syndromes that have been described. Clear cell renal carcinoma accounts for about 75% of all kidney cancers but is the most aggressive type of kidney tumor and accounts for > 90% of the spreading varieties. There are other kidney cancers that occur in childhood (such as Wilms tumor) but these are beyond the scope of this brief introductory article.

Kidney cancers cause three classes of symptoms. The first is symptoms directly from the tumor on the kidney. An example of this would be hematuria or bloody urine. The second is symptoms from spread of the tumor. An example of this would be kidney cancer that has spread to bone and causes bone pain or fracture. The third type of symptom is from the tumors production of hormone or antibody that causes a generalized body reaction or broad type of symptom. These are referred to as paraneoplasticsyndrome. An example of a kidney tumor paraneoplastic syndrome would be production of hormone that stimulates the parathyroid glands to elevate the blood calcium.

Common symptoms and findings with kidney cancer (and the percent of those found in people diagnosed with kidney cancer at presentation) include:

  • Hematuria (60%)
  • Abdominal pain (40%)
  • Anemia (50%)
  • Liver disease (33%)
  • Weight loss (25%)
  • Malnutrition (20%)
  • Fatigue (20%)
  • High calcium (15%)
  • Loss of appetite (10%)
  • “classic triad” (10%)
  • Excess platelets (10%)
  • Night sweats (8%)
  • Fevers or Chills (8%)
  • Excess blood cells (5%)
  • High blood pressure (3%)
  • Acute varicocele (2%)

The “classic” triad of symptoms that is taught to students in medical school is: 1) blood in the urine, 2) palpable mass in the flank, and 3) pain in the flank. This “classic triad” is seen in less than 10% of those with kidney cancer, but it emphasizes the key problems that kidney cancer can cause.

Unintentional weight loss and anemia occurs with several cancers and should never be overlooked. These are the most common initial symptoms for kidney cancer. Investigation of these symptoms will generally involve examination of the body, blood and urine studies. Some type of imaging is necessary such as ultrasound, CAT scan or magnetic resonance imaging (MRI). A sample of the cells or biopsy is not usually used for kidney cancer because the diagnosis can usually be made without a biopsy and surgical removal is almost always needed.

Unfortunately, about 30% of people diagnosed with kidney cancer already have spread of the tumor outside of the kidney. This spread (or metastatic disease) may account for some of the symptoms that bring the tumor to attention. Renal cell carcinoma spreads to other organs such as the lung (most commonly), lymph nodes, liver, bone, adrenal glands, and rarely the brain. For many cancers there are very effective non-surgical treatments such as chemotherapy or radiation. Renal cell cancer does not respond very well to chemotherapy and the only proven curative therapy is surgical removal of the tumor. This is why early diagnosis is so important to prognosis and survival. Early recognition and early imaging tests to diagnose the kidney tumor provides the best possible chance for cure.

Symptoms of metastatic disease will be more severe than the above symptoms. Tumor spreading to bone will cause deep or severe bone pain possibly with fracture. Tumor spreading to the lungs may cause chest pain or pressure, shortness of breath or coughing up blood. Tumor spreading to the liver may cause jaundice, nausea, vomiting, or changes in digestion. Symptoms of spread to the brain will involve headache, seizure, confusion or passing out spells.

Definitive treatment of a kidney cancer involves removing the affected kidney and the surrounding fat or lymph nodes. This procedure is referred to as a radical nephrectomy.

REFERENCES:

  1. www.nlm.nih.gov/medlineplus/ency/article/000516.htm
  2. www.cancer.gov/cancertopics/pdq/treatment/renalcell/Patient/page1
  3. Goldman, L ; Schafer A.I. (2011). Goldman: Goldman’s Cecil Medicine, 24th ed. Chapter 203. New York, NY: Elsevier Saunders.
  4. Brenner, B.M. (2007) Brenner: Brenner and Rector’s The Kidney, 8th ed. Chapter 38. Philadelphia, PA:Saunders Elsevier
  5. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.