A National Cancer Institute-designated Comprehensive Cancer Center

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Kidney Cancer

Our Approach
At City of Hope, we are actively developing tomorrow’s treatment protocols today for kidney cancer. As a patient at City of Hope, you have a highly experienced and dedicated team to treat you and help you cope with cancer.
 
Patients at City of Hope have access to the most innovative and advanced treatments available for kidney cancer. Because City of Hope offers the expertise of specialists in all fields related to kidney cancer, patients receive greater continuity of care and more coordinated treatment planning.  Our multidisciplinary team includes urologists, urologic surgeons, medical oncologists, nephrologists, palliative care specialists, case managers and more, working cooperatively to provide the most effective kidney cancer treatment protocol.
 
Driven to provide patients with the best possible outcomes, City of Hope’s kidney cancer specialists bring together two powerful approaches – the latest kidney cancer surgery techniques and the most aggressive therapies – to aid in diagnosis and treatment of kidney cancer.
 

About Kidney Cancer

Patients are often referred to City of Hope following the discovery of a kidney mass, which may or may not be a malignant tumor (cancer). Some masses are benign (not cancerous). A careful diagnosis is needed to confirm the health problem and assess its extent.
 
City of Hope specializes in research designed to improve the care of patients with many kinds of cancer, including kidney cancer. Our services encompass all aspects of care, including prevention, early diagnosis and effective treatment.
 
In addition, through our active clinical trials program, we can often provide patients with access to promising new anticancer drugs and technologies that are not available to the general public.

There are several types of kidney (renal) cancer, including:

  • Renal cell carcinoma (RCC), which accounts for 85 percent of malignant kidney tumors. The most common subtype is called clear cell RCC.
  • Transitional cell carcinomas, which are cancers of the lining of the kidneys, urine collecting system and sometimes the bladder.
  • Wilm’s tumor, which most commonly affects children.

Doctors need to identify the specific sub-type of kidney cancer or cell type to decide the best treatment strategy. Generally, the success of cancer treatment depends on whether or not the malignancy can be completely removed through surgery.
 
  • Benign (noncancerous) kidney tumors include:Renal adenomas, very small, slow growing, benign tumors that can resemble early renal cell carcinomas.
  • Oncocytomas, a type of benign tumor that can grow quite large.
  • Angiomyolipoma, a rare benign tumor.

 

 
 

Kidney Cancer Symptoms

Risk Factors

Certain factors can increase your risk of developing kidney cancer:
 
  • Smoking tobacco
  • Obesity
  • High blood pressure
  • Long-term dialysis
  • Sedentary life style
  • Von Hippel-Lindau syndrome
  • Workplace exposure to chemicals and substances
  • Males are more likely than females to be diagnosed with kidney cancer.
 
Symptoms
 
Possible signs of renal cell cancer include blood in the urine and a lump in the abdomen.

These and other symptoms may be caused by renal cell cancer. Other conditions may cause the same symptoms. There may be no symptoms in the early stages. Symptoms may appear as the tumor grows. A doctor should be consulted if any of the following problems occur:
  • Blood in the urine
  • Abdominal mass
  • Back or flank pain
  • Weight loss
  • Low blood counts (anemia)
  • Tumor calcification on x-ray
  • Symptoms of metastases
  • Fever
  • High calcium in blood
  • High blood counts

Diagnosing Kidney Cancer

A variety of different tests and procedures may be used to detect and diagnose  kidney tumors, as well as to determine their stage – specifically, how advanced the cancer is, and whether it has metastasized (spread outside the kidney).

  • Physical exam and history
  • Laboratory blood tests
  • Urine test
  • IVP (intravenous pyelogram): This procedure uses a contrast dye given through a vein to obtain an X-ray of the kidneys, ureters and bladder. The x-rays can show a kidney tumor or other problems.
  • Angiography: Similar to an IVP, this test uses a contrast dye which outlines blood vessels.
  • CT or CAT (computerized axial tomography) scan: This procedure uses a computer connected to an X-ray machine to obtain detailed pictures of areas inside the body. A dye may be used to help visualize organs or tissues more clearly.
  • MRI (magnetic resonance imaging): MRI creates a series of detailed pictures of areas inside the body, using the combination of a powerful magnet, radio waves and computer imaging.
  • PET (positron emission tomography) scan: This scan is used to identify malignant cells even before an actual “lump or bump” can be detected in a physical exam, or on CAT or MRI scans. A small amount of radionuclide glucose (sugar) is injected into a vein. Because cancer cells divide more frequently than normal cells, they take up more glucose than normal cells and appear brighter in the scan.
  • Ultrasound: This device uses sound waves that people cannot hear. The waves bounce off the kidneys, and a computer uses the echoes to create a picture called a sonogram.
  • Radionuclide scanning: This technique uses small amounts of radiation which are detected by a special camera to assess kidney blood flow (renogram).
  • Biopsy: Tissue samples are examined under a microscope to determine what types of cells are present.

Treatments

At City of Hope, we are actively developing tomorrow’s treatment protocols today for kidney cancer. As a patient at City of Hope, you have a highly experienced and dedicated team to treat you and help you cope with cancer.
 
Patients at City of Hope have access to the most innovative and advanced treatments available for kidney cancer. Because City of Hope offers the expertise of specialists in all fields related to kidney cancer, patients receive greater continuity of care and more coordinated treatment planning.
 
Our multidisciplinary team includes urologists, urologic surgeons, medical oncologists, nephrologists, palliative care specialists, case managers and more, working cooperatively to provide the most effective kidney cancer treatment protocol.

Depending on the size and location of the kidney mass and the patient’s overall health, the cancer can be treated with cryosurgery (freezing the tumor) or high frequency radio ablation (using heat to destroy the affected tissue). In many cases, the mass can be surgically removed.
 
Minimally Invasive Surgery

At City of Hope, our urologists specialize in minimally invasive procedures performed by laparoscopy.  In fact, more than 95 percent of our surgeries are performed using these techniques.  The procedures involve the use small keyhole incisions rather than the large incisions used in traditional open surgery.  Laparoscopy results are comparable to open surgery, but the patient experiences less pain, reduced loss of blood, faster recovery, shorter hospital stays and a lower risk of post-operative complications.
 
City of Hope urologists are also highly skilled in robotic-assisted surgery, using the most advanced da Vinci S Surgical System.  A urologist directs and controls the movements of a specially designed robot equipped with a camera and miniature surgical tools. At the same time, a sophisticated computerized imaging system provides real-time, three-dimensional views of the surgical area, with better visualization than can be achieved with the urologist’s unaided eye alone.
 
Some patients with small transitional carcinomas of the kidney can be treated endoscopically, which is performed using thin, flexible instruments that are passed into the urinary tract.  Our surgeons also use state-of-the-art imaging techniques during nephron-sparing surgery, including fluorescence using indocyanine green (ICG).
 
Ablative Technologies
Although surgery is usually the standard treatment for most primary kidney cancers, some patients could benefit from a non-surgical, minimally invasive, kidney-sparing treatment option. This option is typically elected for patients who are high surgical risks, have multiple medical problems, have multiple recurrent tumors (as with Von Hippel Landau), have borderline kidney function or only have one kidney.
 
Cryosurgery or Cryoablation

Kidney cancer can now be treated with a new, less invasive form of treatment that freezes and destroys small tumors without more extensive open surgery.  Metal probes are placed into the tumor either through the skin under radiology guidance or through an incision in the abdomen. With the patient under general anesthesia, liquid nitrogen is circulated through the metal tips to destroy the tissue by freezing the lesion. Patients can usually be discharged from the hospital the same day or the following day. Although success with this procedure is good, the treatment is a new form of therapy and patients need to be actively followed for several years to assure there is no recurrence.
 
Radiofrequency ablation (RFA)

This procedure is another new minimally invasive form of treatment that uses a special probe to destroy cancer cells with electrical current. The destroyed tumor cells are not removed but are gradually replaced by fibrosis and scar tissue. The probe is usually inserted directly through the skin under radiology guidance while the patient is under general anesthesia. Although no long-term prospective randomized trials have been reported, early results are optimistic. Nevertheless, patients need to be actively followed to assure effectiveness.
 
Targeted Therapies
One of the most exciting new developments in recent years is the introduction of drugs that interfere with the growth of cancer cells at a molecular level. By focusing on specific molecular growth pathways, these drugs prevent cell replication, or disrupt the blood flow supply to the cell. City of Hope’s kidney cancer experts play a leading role in the investigation of these exciting new therapies.
 
Angiogenesis Inhibitors

For malignant tumors to expand and metastasize, they must be able to form new blood vessels by a process called angiogenesis. Two recent FDA-approved medications, Sorafenib and Sunitinib, disrupt the angiogenesis process. Temisrolimus is another drug that disrupts the angiogenesis process but targets a different pathway than Sorafenib and Sunitinib. RAD001 is an investigational drug therapy that is effective for patients who do not respond to either of the other two therapies.  At City of Hope, all of these drugs are used when appropriate.
 
Monoclonal Antibodies

An antibody is a protein produced by the body’s immune system that fights infections and foreign substances in the body.  Monoclonal antibodies are genetically engineered antibodies designed to attach to particular sites on a tumor. Future clinical trials on monoclonal antibodies will offer more information about the potential benefit of investigational drugs, such as Bevacizumab, for kidney cancer.


Immunotherapy

Kidney cancers may respond to immune-based therapy, sometimes called biologic therapy, using the body’s own defense system to help destroy cancer cells. City of Hope is a national leader in immunotherapy, which is considered one of the standard treatment options for kidney cancer patients with advanced metastatic disease. The building blocks of immunotherapy are biologic response modifiers. These are substances that enhance the body’s immune system and improve its ability to fight cancer. A biologic response modifier can be either a man-made drug or a natural substance produced by the body, and include Interleukin-2 and Interferons.

Radiation Therapy

Radiation therapy uses energy beams to destroy cancer cells. Although not considered a primary form of therapy for kidney cancer, radiation is used in situations where cancer has spread outside the kidney. At City of Hope, our radiation oncologists work with highly accurate new treatments that maximize the delivery of radiation to malignant cells while minimizing the exposure of healthy tissues.

Several procedures may be useful in these cases:
 
  • 
Stereotactic radiosurgery -This treatment uses sophisticated three-dimensional computerized imaging to deliver a concentrated dose of radiation to the affected area while protecting the surrounding healthy tissue from exposure. Stereotactic radiosurgery is not “surgery” in the usual sense because there are no incisions, and anesthesia is not required.
  • Intensity-modulated radiation therapy (IMRT) - This procedure administers therapeutic X-rays to patients with great precision. High-energy X-ray machines linked with imaging systems deliver targeted radiation doses that are sculpted to the tumor’s exact shape by modulating the radiation beam intensity and aiming beams from many directions.
  •  Helical TomoTherapy - This advanced radiation therapy system combines precision spiral CT scanning with IMRT, allowing doctors to match the highest dose of radiation to fit the exact shape of the tumor. The system provides effective treatment while reducing unwanted exposure to normal tissues, and reducing potential complications.
 
Chemotherapy
Chemotherapy is standard treatment for many tumors; however, kidney cancer is generally resistant to chemotherapy. Chemotherapy is typically used in combination with other therapies or reserved for patients entering clinical trials to test new agents and for patients who failed to respond to immunotherapy.
 
For additional information about kidney cancer and kidney cancer treatment please review the Kidney Cancer Association’s booklet, We Have Kidney Cancer.
 

Kidney Cancer Resources

All of our patients have access to the  Sheri & Les Biller Patient and Family Resource Center, which offers a wide array of support and educational services. Patients and loved ones may work with a coordinated group of social workers, psychiatrists, psychologists, patient navigators, pain management specialists and spiritual care providers at the center, as well as participate in programs such as music therapy, meditation and many others.
 
Additional Resources
 
American Urological Association
1-866-746-4282
The American Urological Association (AUA) is the premier professional association for the advancement of urologic patient care, and works to ensure that its members are current on the latest research and practices in urology.
 
American Cancer Society
800-ACS-2345
866-228-4327 for TYY
The American Cancer Society has many national and local programs, as well as a 24-hour support line, to help cancer survivors with problems such as travel, lodging and emotional issues.
 
Support groups at City of Hope for patients with specific types of cancer or specific needs. View our calendar for specific groups and meeting times.
 
Kidney Cancer Association
The Kidney Cancer Association is the only global organization serving the needs of kidney cancer patients and their families.
 
888-909-NCCN (6226)
The National Comprehensive Cancer Network, an alliance of 19 of the world's leading cancer centers, is an authoritative source of information to help patients and health professionals make informed decisions about cancer care.
 
National Cancer Institute (NCI)
800-4-CANCER
The National Cancer Institute, established under the National Cancer Act of 1937, is the federal government's principal agency for cancer research and training.
 
U.S. Dept. of Health & Human Services National Institutes of Health (NIH)
301-496-4000
301-402-9612 for TYY
The National Institutes of Health (NIH) is one of the world's foremost medical research centers, and the federal focal point for medical research in the United States. The NIH, comprising 27 separate institutes and centers, is one of eight health agencies of the Public Health Service, which, in turn, is part of the U.S. Department of Health & Human Services.
 

Kidney Cancer Team

City of Hope cancer research hospital's multidisciplinary team includes urologists, medical oncologists, radiation oncologists and surgical oncologists working cooperatively to create the most effective kidney cancer treatment plan and optimize outcomes. Treatment locations are in southern California: Duarte (near Los Angeles),   Antelope Valley (Lancaster/Palmdale),  South Pasadena , Palm Springs and Santa Clarita.

Kidney Cancer Clinical Trials

City of Hope has one of the largest numbers of open kidney cancer clinical trials underway on the West Coast.  Our scientists are engaged in outcomes, translational, and basic science research. We also collaborate on research projects with other institutions, such as MD Anderson Cancer Center in Texas and Dana-Farber Cancer Institute in Massachusetts.
 
Some of the innovative clinical trials underway at City of Hope include:

PD-1 inhibitors (nivolumab): These drugs stimulate the body's immune system to fight kidney cancer. City of Hope has ongoing studies in conjunction with the Dana-Farber Cancer Institute and Fox Chase Cancer Center in Philadelphia
 
S1PR1 inhibitors (ASONEP/sonepcizumab): These drugs also stimulate the anticancer immune response, but through a mechanism that is distinct (this mechanism was uncovered at City of Hope). City of Hope is doing this study in association with the Harvard Cancer Center.
 
Stem cell (CD105) antibodies (TRC105): These studies are exploring drugs that target cancer stem cells; these drugs target the "bad" stem cells that appear to be responsible for the growth and propagation of kidney cancer.
 
MET inhibitors (XL184/cabozantinib): Led by City of Hope investigators, this study is exploring MET inhibitors; this class of drugs may be helpful in papillary kidney cancer, one of the more uncommon subtypes of the disease.
 
Prevention of kidney cancer recurrence (pazopanib, everolimus):  There are many drugs approved to treat metastatic kidney cancer, and the trials noted above explore treatments in this setting. However, City of Hope has two large trials underway for patients who have had their tumors surgically removed; these trials use conventional drugs for metastatic kidney cancer to determine if they have a preventative effect.
 
Imaging of kidney cancer: In addition to using leading-edge robotic techniques, City of Hope surgeons have been exploring the use of fluorescent dyes that may highlight areas of kidney cancer during surgical procedures; this may prove to be an invaluable technique that enables surgeons to more completely excise kidney cancer.
 
There are a number of studies that are ongoing collaborations between the medical and research teams at City of Hope.  One example is a protocol that will examine the bacterial stool content of patients receiving drugs for kidney cancer.  Diarrhea is a common side effect of these drugs, and studies underway may ultimately eliminate such side effects.  Scientists are also conducting biologic studies to explore rare types of kidney cancer, such as sarcomatoid kidney cancer. Using tumor tissues derived from patients at City of Hope, these biologic studies aim to uncover new treatments for the disease.
 

Support This Program

It takes the help of a lot of caring people to make hope a reality for our patients. City of Hope was founded by individuals' philanthropic efforts 100 years ago. Their efforts − and those of our supporters today − have built the foundation for the care we provide and the research we conduct. It enables us to strive for new breakthroughs and better therapies − helping more people enjoy longer, better lives.

For more information on supporting this specific program, please contact us below.

Rick Leonard
Associate Vice President
Direct: 213-241-7218
Email: rleonard@coh.org

 
 
Kidney Cancer Care
City of Hope specializes in research designed to improve the care of patients with many kinds of cancer, including kidney cancer. Our services encompass all aspects of care, including prevention, early diagnosis and effective treatment.
 
City of Hope is committed to making the process of becoming a patient here as easy as possible. Call 800-826-HOPE (4673) or complete the Schedule a Callback form.
Led by multidisciplinary teams of volunteers and professionals, the Sheri & Les Biller Patient and Family Resource Center offers an integrated array of cancer support services.
Our treatment facilities are located throughout our 100+ acre grounds in Duarte, California as well as in  Antelope Valley, South Pasadena, Santa Clarita and Palm Springs.
For the 10th year in a row, City of Hope is named as one of the top cancer hospitals in the country by U.S.News & World Report.
Clinical Trials
Our aggressive pursuit to discover better ways to help patients now – not years from now – places us among the leaders worldwide in the administration of clinical trials.
 
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