Renal cell carcinoma: kidney cancer symptoms, tests and treatment in the UK

The kidneys filter waste from the blood and make urine. NHS inform describes kidney cancer as a disease where abnormal cells develop and grow in one of the kidneys, forming a tumour. Most people have 2 kidneys and cancer usually affects only one.

Renal cell carcinoma starts in the main outer area of the kidney, the renal cortex. NHS inform says about 80% of kidney cancers are RCCs, and the main types are clear cell RCC, which is the most common, papillary RCC and chromophobe RCC. Very rare types include renal medullary cancer and collecting duct cancer, which may be treated differently. Upper urinary tract urothelial cancer, which affects the renal pelvis, develops and is treated differently from RCC.

The NHS says kidney cancer is usually found when testing for something else. Kidney cysts, which are fluid-filled lumps, are common and usually harmless, and NHS inform notes that tests for kidney cancer sometimes find them.

When there are symptoms, the NHS lists blood in your pee; a lump or swelling in your back, under your ribs or in your neck; pain between your ribs and waist that does not go away; loss of appetite or losing weight without trying; feeling tired or having no energy; a high temperature that does not go away; and sweating a lot, including at night.

The NHS says to ask for an urgent GP appointment or get help from NHS 111 if your pee is smelly, cloudy or has blood in it, it is painful to pee or you need to pee suddenly or more often, you have pain in your back under your ribs that does not go away, pain in your genitals, or a lump or swelling in your back, under your ribs or in your neck, because the symptoms can be similar to a kidney infection. It advises seeing a GP if you have lost a noticeable amount of weight, a high temperature that does not go away, or extreme tiredness.

• Blood in the urine, even once.

• Persistent pain between the ribs and the waist.

• A lump or swelling in the back, under the ribs or in the neck.

• Unexplained weight loss, loss of appetite or tiredness.

• A temperature that does not settle, or night sweats.

NHS inform says doctors do not know the exact causes of kidney cancer, but there are risk factors that can increase the chance of developing it, and points to Macmillan for details. The NHS says some of the symptoms are common and can have many causes, so having them does not definitely mean kidney cancer, but it is important to get them checked.

NHS inform notes that people with a genetic condition called von Hippel-Lindau disease (VHL) may be offered a drug called belzutifan instead of surgery to control a small early kidney cancer, which shows that hereditary forms exist and are managed differently.

NHS inform says kidney cancer is sometimes diagnosed during a scan done for another reason. A GP will examine you and may test your pee and blood to check general health and kidney function, and refer you to a urologist. An urgent referral is made if tests or symptoms suggest kidney cancer, and if you have blood in your pee you may be referred to a haematuria clinic.

Tests at hospital may include blood tests, an ultrasound scan to show whether a lump is a cyst or a solid tumour, a kidney CT scan (sometimes called a triple-phase CT), a CT urogram, and a flexible cystoscopy if there is blood in the pee. If cancer is likely, a guided biopsy, and CT scans of the chest, tummy and pelvis or an MRI scan, show whether it has spread. The results give the stage (size and spread) and grade (how quickly it might grow), which guide treatment.

The NHS says treatment depends on the type of kidney cancer, where it is and how big, whether it has spread and your general health, and may include surgery, cryotherapy, radiofrequency ablation, targeted medicines, radiotherapy or chemotherapy. A team of specialists, a multidisciplinary team, meets to discuss the best treatment.

Surgery is the main treatment for early cancer: removing the kidney (nephrectomy), or removing the cancer but leaving as much of the kidney as possible (partial nephrectomy), sometimes with nearby lymph nodes. If surgery is not possible, arterial embolisation can block the blood supply, cryotherapy or radiofrequency ablation can treat small cancers, and monitoring may be offered. For advanced cancer, NHS inform says the main treatment usually involves targeted therapy and immunotherapy drugs, and pembrolizumab may be offered after surgery for locally advanced cancer to reduce the risk of recurrence.

Radiotherapy is not used very often but may be used to control symptoms, or sometimes for early cancer when surgery is not an option, and NHS inform lists stereotactic ablative body radiotherapy. The NHS says chemotherapy is not used very often for kidney cancer.

NHS inform says you will have regular check-ups with your cancer doctor, urologist or nurse, with tests or scans to check how well the kidney is working and for signs of the cancer coming back. If cancer comes back in the kidney alone, further surgery may be possible.

On outlook, NHS inform explains that doctors cannot predict exactly what will happen, that survival statistics are general estimates and that not everyone wants this information, and advises discussing with the cancer team which statistics apply. The NHS says if advanced cancer cannot be cured, the aim is to limit the cancer and its symptoms and help you live longer, with a palliative care team supporting symptoms.

On the NHS, suspected kidney cancer is investigated through urgent referral to urology, often via a haematuria clinic, with treatment planned by a multidisciplinary team. A clinical nurse specialist or palliative care team can help with support.

Private urology and oncology consultations are used by some people for quicker scans or a second opinion. The NHS and private treatment options are the same, and complex surgery and drug treatment are often concentrated in specialist units in both sectors.