Kidney cancer prognosis: What you need to know
According to the American Cancer Society, kidney cancer will affect nearly 64,000 people in the U.S. in 2017. There is a 1.6 percent chance that a person will be diagnosed with kidney cancer during their lifetime.
The average age for a diagnosis of kidney cancer is 64 years old, with the disease being uncommon in people under 45.
In this article, we take a look at the outlook for people with kidney cancer, including diagnosis, the stages of the disease, and 5-year survival rates.
Kidney cancer diagnosis
Kidney cancer is diagnosed using many different tests and tools. These include the following:
A urinalysis may be ordered by a doctor if there is a concern that kidney cancer is present.
Certain laboratory tests may be ordered to check for kidney cancer.
Blood is often present in the urine of people with kidney cancer. As a result, urine will be evaluated for blood, other substances, or cancer cells.
Certain blood tests may be performed during the testing process, such as a complete blood count (CBC) and blood chemistry tests.
A CBC measures how many red blood cells, white blood cells, and platelets are present in the body. In some cases of kidney cancer, there can be either too few or too many cells present. People with kidney cancer are often anemic, meaning they do not have not enough red blood cells.
Blood chemistry tests may be ordered to check how the kidneys and liver are functioning. They are also done to check the levels of certain chemicals, such as calcium, sodium, glucose chloride, and bicarbonate.
Medical history and examination
A doctor will conduct a medical history and an examination of a person, to check for abnormalities or concerning symptoms.
Additional tests will be ordered if there is a concern that kidney cancer may be present.
Certain imaging tests can be helpful to see where the cancer is, if it has spread, or if it has come back.
Examples of radiologic imaging tests used to diagnose kidney cancer include:
- Computed tomography scan (CT scan), which uses X-rays to take pictures of the body in slices, as the CT machine rotates around the individual. People will often drink or receive contrast dye through a vein before the scan, to make sure organs and tumors are seen properly.
- Magnetic resonance imaging (MRI), which uses magnetic radio waves to take pictures of the body. For people with healthy kidneys, gadolinium is received through the vein during the test to provide better images.
- Positron emission tomography (PET scan), which can show cancer using a radioactive sugar. Cancer cells are known to absorb more of the radioactive sugar than healthy cells. This test is not used as standard in diagnosing kidney cancer.
- Intravenous pyelogram (IVP), which involves an X-ray and a dye that is injected. This test is also not commonly used for kidney cancer diagnosis.
- Angiography may be recommended alone or with an MRI or CT scan. An angiograph uses contrast dye, an X-ray, and a catheter, which is inserted into an artery in the leg to reach the renal artery in the kidney.
- Chest X-rays may be used to see if kidney cancer has spread to the lungs.
- Bone scans are helpful to see if the cancer has spread to the bones and are done using radioactive material and a special camera.
Ultrasound is another type of imaging test that maybe used. Instead of radiation, it uses sound waves to evaluate if a kidney mass is solid, fluid-filled, or cancerous.
A biopsy may be used to evaluate for kidney cancer.
Although uncommon, a biopsy may be recommended to evaluate for kidney cancer. It is more likely to be used to confirm the presence of cancer.
During a biopsy, a sample of cells from the kidney will be looked at under a microscope. There are two types of biopsy used to check for kidney cancer:
- Fine needle aspiration: A small sample of cells is removed from an area, using suction. This is done through the skin using a thin needle attached to a syringe.
- Needle core biopsy: A larger sample of cells is removed with this method. It is done through the skin, using a thicker needle to create a cylinder-sized sample of an area of concern.
Biopsies may be performed, with imaging assistance, using ultrasound or CT scan during the procedure for guidance.
After the sample is obtained, it is evaluated under a microscope. In cases of cancer, it is given a grade known as a Fuhrman grade to help determine how advanced the cancer is and what the prognosis will be.
What is known as cancer staging helps determine how far a cancer has spread, which determines treatment options and prognosis.
To decide the stage of a cancer, the tests mentioned above may be used during the process of staging.
There are two types of staging used to describe kidney cancer: clinical and pathologic staging.
- Clinical stage: Doctors are often able to determine the stage of kidney cancer by using the results of a person's physical exam, lab tests, and imaging. This is referred to as the clinical stage.
- Pathologic stage: This uses information in addition to the clinical stage, from surgery findings, including microscopic evaluation of tissue removed during the procedure. This is the most accurate way to stage kidney cancer.
There are two staging systems for kidney cancer:
- the American Joint Committee on Cancer (AJCC) TNM system
- the University of California Los Angeles (UCLA) Integrated Staging System
- T indicates the size of the main (primary) tumor and whether it has grown into nearby areas.
- N describes the extent of spread to nearby (regional) lymph nodes. Lymph nodes are small bean-sized collections of immune system cells to which cancers often spread first.
- M indicates whether the cancer has spread (metastasized) to other parts of the body. (The most common sites of spread are to the lungs, bones, liver, brain, and distant lymph nodes.)
This is not the AJCC staging system used for renal pelvis cancers.
The UCLA Integrated Staging System uses stage, Fuhrman grade, and overall health to categorize people into risk groups. These risk groups include low, intermediate, and high-risk populations.
Five-year survival rate
Survival is based on a few different factors and once these factors are no longer displayed, a good prognosis can be expected.
The National Cancer Institute defines the 5-year survival rate as the percentage of people who are still living 5 years, following diagnosis or standard treatment.
Survival is based on several factors. In addition to the stage of the kidney cancer, other factors that affect survival rates include:
- high levels of blood lactate dehydrogenase (LDH)
- high levels of blood calcium
- low red blood cells
- two or more sites of cancer spread
- less than 1 year from diagnosis to having systemic treatment
- poor performance status
A good prognosis is expected when a person does not display any of the factors stated above. An intermediate prognosis is expected in people with one or two factors, while the presence of three or more factors has a poorer prognosis.
The 5-year survival rates for kidney cancer are based on several of the factors noted above and are outlined by the American Cancer Society by stage:
|Stage||5-Year Survival Rate|
Outlook and coping
An individual's long-term outlook after being diagnosed with kidney cancer is likely to be determined by the stage of the disease and its response to treatments.
People may find it helpful to speak to their doctors about long-term outlook, lifestyle tips, and coping strategies.