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At Boston Medical Center (BMC), caring for patients is a collaborative, multidisciplinary process. BMC’s Cancer Care Center organizes its services around each patient, bringing together the expertise of diverse specialists to manage care from the first consultation through treatment and follow-up visits. The Cancer Care Center is dedicated to providing treatment that is effective and innovative in curing and controlling cancer, while managing its impact on quality-of-life.

As the primary teaching affiliate of the Boston University School of Medicine, BMC combines personal, patient-focused care with the state-of-the-art-expertise and technological advances of a major teaching hospital. BMC is at the forefront of clinical practice, surgical expertise, and research in oncology.

Patients with kidney cancer, also called renal cell carcinoma (RCC), work with a urologist who takes the lead in the diagnosis, monitoring, and treatment planning of individual patients. Surgery is usually the first treatment for patients with malignant kidney tumors. 

The surgeons at BMC offer state-of-the-art surgical treatment and have extensive experience with using laparoscopic and robotic techniques to operate on kidneys. In fact, they performed some of the earliest such cases in the Boston area. When possible, the surgeons perform a partial nephrectomy, which involves removing only part of the kidney rather than a total radical nephrectomy, in which the entire kidney is removed. 

The BMC team follows the National Cancer Institute and the American Urological Association guidelines for the treatment of renal cell carcinoma. 

What is Kidney Cancer?

Kidney cancer begins in the kidneys. Each of the two kidneys are about the size of an adult fist, bean-shaped and weigh around 150 grams each. One kidney is located at each side of the backbone, just under the rib cage. They are protected from injury by a large padding of fat, the lower ribs, and several muscles.

The kidneys play a major role in maintaining general health and wellbeing. Their purpose is to continuously sort non-recyclable waste from recyclable waste in the body while also cleaning the blood. The kidneys make urine from excess fluid and unwanted chemicals or waste in the blood.

Kidney cancer is caused by the abnormal growth of cells in the kidneys. Renal cell carcinomas (RCCs) make up approximately 90% of kidney cancer cases. Other types of kidney cancers include:

  • Transitional cell carcinoma, or kidney pelvis cancer which begins in the lining of the kidney pelvis
  • Wilms tumor (nephroblastoma), the most common cancer in children 14 and under
  • Renal sarcoma, which is rare, develops in the soft tissue of the kidney

According to the American Cancer Society, kidney is the ninth most common cancer in the United States, accounting for approximately 3.7% of new cancer cases in 2016. Among men, the kidneys and renal pelvis (combined) is one of the top 10 cancer sites, and the seventh most common cancer.

Causes of Kidney Cancers

There are several risk factors of kidney cancer, including gender, age, race, and lifestyle choices. Men are nearly twice as likely to develop RCC as women. Kidney cancer is typically found in people age 50-75, with the average age of diagnosis being 64. The risk of developing the disease is slightly higher for African Americans and American Indians/Alaska Natives than for Caucasians.

Other risk factors include:

  • Smoking
  • Obesity
  • Exposure to certain substances in the workplace
  • High blood pressure
  • Certain genetic and hereditary conditions (such as von Hippel-Lindau disease, hereditary papillary renal cell carcinoma, and others)
  • Family history of the disease
  • Advanced kidney disease

Symptoms of Kidney Cancer

Early kidney cancers do not usually cause any signs or symptoms, but larger ones may. Some possible signs and symptoms of kidney cancer include:

  • Stomach pain
  • Lower back pain on one side
  • Blood in the urine
  • Loss of appetite

These symptoms, however, can be caused by other benign diseases.

Diagnosis

Because kidney cancer is usually asymptomatic, the tumor is usually found when a patient undergoes a medical test for another reason.  Still, a doctor may order the following tests to confirm the diagnosis.

Staging

Staging is the process of determining how extensive the cancer is. It is an important part of diagnosis because the stage determines the most appropriate course of treatment options. The stages of kidney cancer range from Stage I (the least severe stage) to Stage IV. When patients are confirmed to have kidney cancer, the doctor will discuss the staging.

Stage I The tumor is 7 cm or smaller and is only located in the kidney. It has not spread to the lymph nodes or distant organs.

Stage II The tumor is larger than 7 cm and is only located in the kidney. It has not spread to the lymph nodes or distant organs.

Stage III Either of these conditions:

  • A tumor of any size is located only in the kidney. It has spread to the regional lymph nodes but not to other parts of the body.
  • The tumor has grown into major veins or perinephric tissue and may or may not have spread to regional lymph nodes. It has not spread to other parts of the body.

Stage IV Either of these conditions:

  • The tumor has spread to areas beyond Gerota's fascia—the layer of connective tissue compressing the kidneys and the adrenal glands—and extends into the adrenal gland—small glands located on top of each kidney that produce hormones—on the same side of the body as the tumor, possibly to lymph nodes, but not to other parts of the body.
  • The tumor has spread to any other organ, such as the lungs, bones, or the brain.

Treatment

When a person is diagnosed with kidney cancers, a team of doctors will meet and determine the right treatment plan for that patient.  Typically, the plan includes some combination of the following:

  • Active surveillance
  • Minimally invasive or open surgery
  • Ablative therapies (Radiofrequency ablation, cryotherapy, and other energy based treatments)
  • Immunotherapy
  • Chemotherapy
  • Radiation therapy

Treatments in Terms of Stage:

Stage IA: Usually requires surgery with a partial nephrectomy (generally through robotic or laparoscopic partial nephrectomy) being performed.  Active surveillance with serial imaging is performed in select patients, and radiofrequency ablation is performed for nonsurgical candidates who require treatment.

Stage IB: Partial or radical nephrectomy is generally performed, but whenever possible partial is performed.   

Stage II: Most patients undergo radical nephrectomy, though in select patients partial nephrectomy is performed. 

Stage III: Radical nephrectomy is performed.  In certain patients with renal cell carcinoma with blood clots in the vena cava—a large vein carrying deoxygenated blood into the heart—removal of the tumor and thrombus are performed.

Stage IV, or for recurrence: Patients are treated with immunotherapy and/or chemotherapy, or a combination of surgery and immunotherapy)

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