Renal cell cancer

Cancers of the kidney are highly prevalent in the UK, affecting approximately 13,300 people per year. They are the seventh most common form of cancer affecting adults in the UK (Cancer Research UK, 2020).

There are three main types of cancers of the kidney:

• Wilms tumour (nephroblastoma) – usually affects children.
• transitional cell cancer
• renal cell cancer (also known as renal cell carcinoma, renal cell adenocarcinoma and previously known as hypernephroma or Grawitz tumour).

Renal cell cancer is the most prevalent in adults, accounting for over 80% of cancers affecting the kidney (Cancer Research UK, 2020).  

The signs and symptoms for renal cell cancer are non-specific. They include:

• haematuria
• pain in the abdomen/flank/back
• weight loss
• a palpable mass (Ellis, 2012; Pessoa and Kim, 2022).

Further rare signs and symptoms include:

• testicular varicocele
• hirsutism (in females)
• visual disturbance
• signs of liver dysfunction
• oedema in the legs (Ellis, 2012; Pessoa and Kim, 2022).

Healthcare professionals need to be alert to the possibility of renal cell cancer in patients presenting with any of these signs or symptoms.

There are a number of different forms of renal cell cancer. The three main types are:

Other forms of renal cell cancer account for the remaining 5% (Cancer Research UK, 2020). Renal cell cancer arises in the renal parenchyma (the functional cells) or cortex (the outer layers) (Pessoa and Kim, 2022).

The risk factors for developing renal cell cancer include:

• smoking
• being older
• being male
• African or Caribbean heritage
• hypertension
• obesity
• trichloroethylene exposure (affects mechanics and dry cleaners, for example)
• being on dialysis
• polycystic kidney disease (Ellis, 2012; Gray and Harris, 2019; Agarwal, 2022).

There are some hereditary kidney cancer syndromes which suggests that some renal cell cancers have a genetic basis (Ljunberg et al, 2015; Petejova and Martinek, 2016).

The aetiology of renal cell cancer is not clearly understood (Agarwal, 2022). There are a number of theories, one of

Many cases of renal cell cancer are identified by chance, when people have abdominal or chest scans for other reasons (Gray and Harris, 2019). Similarly, investigations into haematuria also frequently identify renal cell cancer as the cause (Gray and Harris, 2019). The European Society of Medical Oncology guidelines (Escudier et al, 2019) identify how suspicion of renal cell cancer should be increased by the presence of paraneoplastic (signs and symptoms of cancer) syndrome such as:

These signs should prompt the healthcare professional to consider the need for more tests. These include:

• serum creatinine
• full blood count
• liver function tests
• lactate dehydrogenase
• C-reactive protein
• serum-corrected calcium (Escudier et al, 2019; Pessoa and Kim, 2022).

A diagnosis of renal cell cancer may be confirmed by a computed tomography scan – this can identify the degree of

Patients with renal cell cancer less than 2 cm in diameter may opt for active surveillance of their disease, especially if:

• they are older
• they are frail
• they are otherwise unwell
• they have chronic kidney disease or a hereditary from of kidney cancer which is likely to affect both kidneys in time (Kidney Cancer UK, 2023).

People with tumours of less than 7 cm diameter may benefit from a partial nephrectomy either via open surgery or laparoscopically. Partial nephrectomy is also indicated in people with:

• one kidney
• bilateral renal cell cancer
• chronic kidney disease (Escudier et al, 2019).

Surgery for people with early localised disease is often curative, although the risk of later recurrence of renal cell cancer remains about one in three (Pessoa and Kim, 2022).

More widespread disease may require a nephrectomy with adrenalectomy and lymph node dissection as indicated by the abdominal computed tomography scan (Escudier et

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Ljunberg B, Bensalah K, Bex A et al.