When physicians at outside hospitals encounter complex or challenging cases of kidney cancer, they often refer their patients to Yale Medicine for expert opinion. While the majority of kidney cancers are renal cell carcinoma (RCC), scientific advances have led to an increasingly complex understanding of tumor types which can be important for personalized treatment. 

"Our management of kidney cancer has changed dramatically," says Joseph Brito, MD, a Yale Medicine urologist and assistant professor of urology at Yale School of Medicine. “With the increasing use of imaging techniques such as CT scan, we are able to diagnose kidney tumors at very early stages, which allows us to treat the tumor and save the healthy portion of the kidney.” Treatment can range from active surveillance to surgery, depending on the size and type of tumor identified.

At Yale Medicine, patients have full access to leading physicians and world-class resources at Smilow Cancer Hospital at Yale New Haven. Our doctors are also at the forefront of kidney cancer treatment and research, including novel immunotherapy approaches and the genetic characterization of kidney cancers.

In addition, the Yale School of Medicine's Hereditary Kidney Cancer and Genetic Assessment Program investigates potential genetic causes of kidney cancer in young patients, those with a family history, and individuals with multiple tumors. This approach allows for a deeper dive into the family history to help family members determine if they carry a risk for the same type of cancer.

The kidneys are two bean-shaped organs that are responsible for filtering waste from the body. They also stimulate the production of the body’s red blood cells and regulate blood pressure.

Kidney cancer occurs when malignant cells grow within one or both of the kidneys. The most common type of kidney cancer is renal cell carcinoma (RCC), which occurs when cancer cells develop in the small tubes that run through the kidneys.

RCC makes up about 90% of kidney cancer cases.

There is no single cause of kidney cancer, but many factors may significantly increase the risk. These include: 

• Age: The risk of kidney cancer increases as we get older.
• Smoking: Smokers are twice as likely to contract kidney cancer as non-smokers.
• High blood pressure: High blood pressure has been linked with kidney cancer.
• Obesity: Being overweight or obese can lead to a higher risk of kidney cancer.
• Genetic conditions: Kidney cancer may have a strong genetic component and can cluster in certain families. Approximately 5 to 8 percent of kidney cancers are linked to an inherited gene. There are over a dozen genes that are now linked to a greater likelihood of developing kidney cancer.

The early symptoms of kidney cancer may be very subtle and are often mistaken for other conditions. These symptoms can include:

• Blood in the urine
• Abdominal pain or an abdominal mass
• Unexplained weight loss
• Extreme fatigue and anemia
• Loss of appetite
• Recurrent fevers that are not caused by a cold or the flu

In recent years, the number of kidney cancer diagnoses has greatly increased. This may be due to the greater availability of imaging tests such as computerized tomography (CT) or magnetic resonance imaging (MRI) scans.

Often doctors detect kidney cancer at a very early stage, picking it up incidentally when patients are still symptom-free.

Doctors diagnose kidney cancer by taking a medical history, performing a physical exam, and ordering one or more diagnostic tests.

Your doctor will begin to make a diagnosis by asking you about your symptoms and whether you have any risk factors for kidney cancer. During the physical exam, they will check your blood pressure, feel for lumps in the abdominal area, and look for other signs and symptoms indicative of kidney cancer.

If your doctor suspects you may have kidney cancer, they will order blood work and collect a urine sample for testing. Imaging tests such as a computed tomography (CT) scan, magnetic resonance (MRI) study, and/or ultrasound are an essential part of the workup. In some cases, a biopsy of the kidney may be necessary to confirm diagnosis.

In a kidney biopsy, a doctor removes a small piece of tissue from the kidney using a needle. A pathologist then examines the tissue sample under a microscope to check for the presence of cancer cells. If cancer cells are detected, the pathologist will give the cancer a grade. This is a measure of how likely and rapidly the cancer is to spread.

If your doctor diagnoses kidney cancer, they will order some additional screening tests such as a chest X-ray or bone scan to determine whether the cancer has spread to other parts of the body. Your doctor will then assign the cancer to a stage based on the size of the kidney tumor, the grade of the cancer cells, and the extent to which the cancer has spread on the body. The stage is used to indicate the extent of the cancer and to help doctors make a prognosis and determine the best course of treatment for each patient. Stages are numbered from I to IV, and in general, the lower the stage, the less extensive the cancer.

Surgery is the most common kidney cancer intervention. This can involve removing a tumor from a kidney (partial nephrectomy) or removing the kidney altogether (nephrectomy).

Our physicians use the most advanced, minimally invasive techniques, including laparoscopic surgery and robot-assisted surgery. These approaches allow for the removal of cancerous tumors through the smallest possible incisions, resulting in less discomfort, minimal blood loss and faster recovery time. 

In some cases with small tumors or when a patient cannot safely undergo surgery, radiofrequency ablation or cryoablation treatment is also available. These minimally invasive treatments involve inserting a needle through the skin into a tumor and using extreme temperatures to kill the cancerous cells.

Our doctors combine breakthrough technology and cutting-edge medicine with patient-focused, compassionate care. We understand how complex a diagnosis of kidney cancer is for our patients, and provide them with all available resources to better understand their treatment options.

We also know the vital role that families and loved ones play in the support system needed for recovery.

Finally, we offer clinical trials for eligible patients, providing treatments not available elsewhere, says Dr. Brito. Participating in clinical trials also advances care, helping further our understanding of the disease itself with the goal of developing new treatment options.