Kidney Cancer

Often overlooked and asymptomatic, kidney cancer is considered one of the “complex” cancers. Designated a “referral center” by the National Cancer Institute (INCa), Gustave Roussy treats this type of tumor and also conducts research to develop new treatments.

When a cell in the kidney multiplies uncontrollably, a tumor develops. In most cases, the cancer originates in the parenchyma—the tissue responsible for kidney function—and is called renal cell carcinoma. Other malignant kidney tumors are much rarer: tubulopapillary or papillary tumors, chromophobic cell carcinomas, Bellini tumors, etc. Treatment is highly specific for each type of tumor.

Because it presents few symptoms, kidney cancer may be discovered only by chance during tests performed for other reasons. As a result, in one-third of cases, the diagnosis is made at an advanced stage, when metastases are already present. It is rarely hereditary (2% of cases). Among the reported genetic abnormalities is a mutation in the VHL gene (Von Hippel-Lindau disease), which is indirectly involved in regulating tumor vascularization.

 Figures: National Cancer Institute. 

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Kidney cancer usually causes few symptoms at first, which can delay diagnosis. When symptoms do appear, they are related to the growth of the tumor within the kidney or its effects on the body. These symptoms include:

• Blood in the urine (hematuria): The presence of blood in the urine—whether visible or detected through testing—is the most common sign. It may be intermittent and painless, but always requires medical attention.
• Pain in the lower back or side: Persistent pain in the lower back, often on one side only, may indicate kidney involvement.
• Abdominal mass or swelling: In some cases, a mass may be felt in the abdomen or flank, related to an enlarged kidney.
• Persistent fatigue: Long-lasting fatigue may develop, particularly in connection with a decline in overall health or anemia.
• Loss of appetite and weight loss: A decrease in appetite associated with unintentional weight loss may be observed as the disease progresses.
• Unexplained fever: A prolonged fever with no identified infectious cause may be a warning sign.
• High blood pressure or abnormal lab test results: Kidney cancer can sometimes cause high blood pressure or abnormalities in blood test results.

These symptoms are not specific to kidney cancer and may be related to other diseases. However, if they occur, you should see a doctor to undergo further testing.

The diagnosis is primarily based on radiological tests:

• Abdominal ultrasound.
• Abdominal and pelvic CT scan.
• Sometimes an MRI, chest and/or brain CT scan, or even a bone scan.

The diagnosis is ultimately confirmed by histopathological analysis of the tumor, either after surgery or, in some cases, after a biopsy. This analysis will determine whether the cancer is clear-cell carcinoma (the most common type), the rarer papillary or tubulopapillary carcinoma, or an even more rare form.

Once the diagnosis is made, it is possible to determine the stage of the cancer. The most commonly used classification is the TNM classification, where T stands for tumor, N for lymph node, and M for metastasis. 

Gustave Roussy treats this type of tumor and also conducts research to develop new treatments.

The management (diagnosis and treatment) of kidney cancer requires the joint efforts of several physicians from various disciplines—including medical oncologists, surgeons, radiation oncologists, radiologists, and pathologists—in collaboration with primary care physicians. Every major decision is made during multidisciplinary team meetings (MDTs). In some cases, the patient’s presence at a meeting may be required.

Treatment for kidney cancer is primarily based on surgery. When the cancer is localized, a nephrectomy is performed: this procedure involves removing part or all of the kidney to remove the tumor, while preserving kidney function as much as possible.

In certain situations where there is a high risk of recurrence, adjunctive immunotherapy may be recommended after surgery.

In cases of metastasis, management relies on drug therapies. These include specific targeted therapies, such as anti-angiogenic treatments, which slow tumor growth by blocking the formation of new blood vessels, as well as immunotherapies, which aim to stimulate the immune system’s response against cancer cells.

These treatments have improved the effectiveness of care, but their primary goal is usually to slow and control the progression of the disease.

Many research teams at Gustave Roussy work in collaboration with oncologists specializing in kidney cancer to better understand the mechanisms underlying cancer development, how treatments work, and how cancer evades treatment—all with the goal of continuing to improve our treatments.

Clinical trials for kidney cancer also provide access to innovative treatments, such as anti-angiogenic agents.

[notes: add link to “View ongoing clinical trials for kidney cancer.”]