Kidney Cancer

Key Risk Factors

• Smoking: Current and former smokers have increased risk.
• Obesity: Excess weight increases risk.
• Hypertension: High blood pressure increases risk.
• Chronic kidney disease: Dialysis patients at higher risk.
• Family history: Some hereditary syndromes increase risk (VHL, hereditary papillary RCC).
• Age: Risk increases with age; most common in 50-70 year-olds.
• Gender: Men have ~2x higher risk than women.

Symptoms and Diagnosis

Early signs (often none - many found incidentally):

• Blood in urine (hematuria)
• Flank pain or back pain
• Abdominal mass (palpable)
• Fever without infection
• Unintentional weight loss
• Fatigue

Diagnosis involves:

• Ultrasound or CT imaging to identify kidney mass
• Biopsy may be done to confirm diagnosis
• MRI or staging scans to check for spread

Staging and Treatment

Stages I-IV based on tumor size and spread:

• Stage I-II: Confined to kidney; excellent prognosis with surgery
• Stage III: Extends to fat around kidney or renal vein
• Stage IV: Spread to other organs; advanced disease

Treatment options:

• Surgical resection: Partial or radical nephrectomy (removal of kidney). Primary curative treatment.
• Active surveillance: Small tumors may be monitored rather than surgically treated.
• Targeted therapy: Tyrosine kinase inhibitors (sunitinib, sorafenib) and mTOR inhibitors for advanced disease.
• Immunotherapy: Checkpoint inhibitors (pembrolizumab, nivolumab); increasingly first-line for advanced RCC.
• Combination therapy: Immunotherapy + targeted therapy for advanced disease.
• Radiation: Palliative for metastatic disease.

Side Effects and Management

• Post-surgical: Pain, reduced kidney function if one kidney removed (usually well-tolerated)
• Targeted therapy: Fatigue, diarrhea, hand-foot skin reaction, hypertension
• Immunotherapy: Immune-related adverse events (pneumonitis, colitis, thyroid dysfunction)
• Combination therapy: Cumulative side effects; close monitoring needed