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Types of kidney cancer

The information on this page was reviewed and approved by
Maurie Markman, MD, President, Medicine & Science at CTCA.

This page was updated on September 21, 2021.

Kidney cancer is one of the 10 most commonly diagnosed cancers, according to the American Cancer Society (ACS). There are many types of kidney cancers, such as renal cell carcinomas, transitional cell carcinomas, Wilms tumors and renal sarcomas. You and your care team can work closely to determine what type of kidney cancer you have and decide together on a treatment approach that matches your cancer and preferences.

Your kidneys are two fist-sized organs located on the back wall of your abdomen, on either side of your spine, at about waist level. The kidneys are made of a lot of small tubules, called the renal tubules. (Most kidney cancers develop in these tubules.) They’re surrounded by a layer of fat and connective tissue. They filter blood and remove excess minerals, salts and wastes by excreting these substances as urine. They also help control your blood pressure.

Kidney cancer types

Renal cell carcinoma (RCC) is the most common type of kidney cancer. The cancerous cells typically develop in the lining of very small tubes in the kidney, called tubules. Over time, these cells may grow into a mass and cause an obstruction. The cancer may form in one or both kidneys.

Risk factors for RCC include:

  • Smoking tobacco
  • Being obese or overweight
  • Having hypertension (high blood pressure)
  • Overusing pain medications, including over-the-counter medications, for extended periods of time
  • Having a family history of renal cancer
  • Having certain genetic conditions, such as von Hippel-Lindau disease (VHL), tuberous sclerosis, or hereditary leiomyomatosis and renal cell carcinoma (HLRCC) 
  • Being exposed to certain environmental toxins, such as trichloroethylene

Symptoms of RCC may or may not occur in early stages. But as the tumor grows, symptoms may include:

  • Blood in the urine
  • Persistent back or side pain
  • Abdominal lump
  • Low red blood cell count (anemia) and fatigue
  • Unexplained weight loss

Diagnosis of RCC may require a few different tests, including:

  • Physical examination of the abdomen and body to check for lumps and general health
  • Ultrasound
  • Computed tomography (CT) scan
  • Magnetic resonance imaging (MRI) scan
  • Blood chemistry studies or urine chemistry studies (urinalysis), which analyze a sample of either of these fluids for abnormal protein levels or signs that a tumor may be present
  • Biopsy, which is the main way to confirm a cancer diagnosis after a tumor is found. In this procedure, a needle is inserted into the tumor and a small sample of cells is taken and examined under a microscope for signs of kidney cancer. The sample may also be taken during surgery to remove the tumor, or with a small tube called a ureteroscope that feeds up the urethra.

Subtypes of RCC

Clear cell renal cell carcinomas (ccRCC) accounts for approximately 80 percent of all renal cell carcinomas, according to the National Cancer Institute (NCI). The tumor cells appear very pale or clear when observed under a microscope. Most clear cell RCCs are random, but some may be associated with inherited disorders, such as von Hippel-Lindau disease. Metastasis (spread) is fairly common, so this subtype carries a worse prognosis than some others. Immunotherapy and targeted therapy are medications that shrink tumors by killing cancer cells and are appropriate treatment options for clear cell RCCs. Surgery may also be an option.

Papillary renal cell carcinoma (PRCC) is the second most common type of RCC and accounts for 15 percent of all renal cell carcinomas, according to the NCI. The cancerous cells develop finger-like projections in the tumor. Most papillary RCCs are sporadic, but some are associated with inherited disorders. Some papillary RCCs don’t spread and can be removed with surgery. Others may metastasize and are treated with a combination of options, such as clinical trials or blood vessel blocking agents, to prevent spread.

Chromophobe RCC, like clear cell RCC, has tumor cells that appear pale or clear under a microscope. However, cells related to this type of cancer tend to be larger in size. This type of cancer rarely metastasizes and has a better prognosis than some other types. It occurs most often in people in their 50s, according to an article in the journal Radiologia Brasileira. Clinical trials are commonly used to treat chromophobe RCC.

Collecting duct RCC is a rare and aggressive type of RCC, accounting for less than 1 percent of renal cell carcinomas. The cancerous cells form irregular tubes inside the tumor. As many as 70 percent of patients die within two years, according to Radiologia Brasileira. This cancer tends to affect people between the ages of 20 and 30, according to the American Society of Clinical Oncology. Combinations of chemotherapy and surgery are often used for treatment, but it is a difficult cancer to control.

Unclassified RCC is another rare type of kidney cancer. These cells cannot be classified based on their appearance under a microscope. Alternatively, cancers that have more than one subtype may be grouped in this category. Non-classified kidney cancers tend to have a high mortality rate and the worst prognosis.

Renal medullary carcinoma (RMC) is a more rare form of kidney cancer that affects mostly teenagers and young adults of African descent, according to the National Organization for Rare Disorders. It’s highly associated with sickle cell disease or sickle cell trait (having a parent with sickle cell disease). A very rare subtype of this cancer affects individuals without sickle cell disease and is called RCC Unclassified with Medullary phenotype. These cancers are quite aggressive and usually have spread to other organs by the time of diagnosis. Males are more often affected. Common symptoms are pain in the side and blood in the urine. Treatment includes chemotherapy, surgery and/or radiation therapy.

Clear cell papillary RCC may come in conjunction with end-stage renal disease or may occur randomly. Clear cell papillary RCC is usually less aggressive than other subtypes and typically is asymptomatic. A tumor may be found during screening for a different condition. These tumors may be treated through active watching or minimally invasive surgeries such as ablation.

Other types of kidney tumors include:

Transitional cell carcinoma (TCC) develops in the region where the kidney and the ureters join. The ureters are tubes that carry urine from the kidneys to the bladder. The tumor cells may begin to look more like bladder cancer cells than kidney cancer cells when observed under a microscope. This cancer type may also be referred to as urothelial cancer or renal pelvis carcinoma.

TCC is considered a form of bladder cancer that primarily affects older adults.

  • Risk factors for TCC include smoking cigarettes, having a history of bladder cancer, taking excess painkillers or being exposed to certain environmental toxins.
  • These cancers tend to have the same symptoms as RCC, such as blood in the urine or back pain. They may also cause extreme tiredness or painful or frequent urination.
  • Testing for TCC is a little different because your bladder is affected. Your doctor may look at urine samples or perform a ureteroscopy. Imaging tests such as CT scans, ultrasounds or MRI screenings may also be used.
  • Surgery is the main type of treatment for TCC, but clinical trials may also be recommended.

Wilms tumor is a childhood kidney cancer, usually occurring between the ages of 3 and 4. Tumors are usually in one kidney, but may be in both. About 90 percent of kidney cancers in children are Wilms tumors, according to the ACS. The tumors tend to be very large when found. Many Wilms tumors occur randomly. African-American children are at slightly higher risk than white children. Certain syndromes (such as WAGR syndrome, Denys-Drash syndrome or Beckwith-Wiedemann syndrome) and birth defects may also increase risk.

There are two groups of Wilms tumors:

  • Favorable Wilms tumors are more common, making up about 90 percent of most Wilms tumors, according to the ACS, and are more easily treated. The cells in these tumors look odd under a microscope, but their nuclei (the part of the cell that holds the DNA) are less distorted than the other subtype of Wilms tumors.
  • Anaplastic Wilms tumors have cells with very abnormal-looking nuclei. This is called anaplasia. Anaplasia in the tumor may either be diffuse (spread out in random cells throughout) or focal (anaplastic cells are grouped in one location). Diffuse anaplastic tumors are more difficult to treat.

Treatment for Wilms tumor usually includes a combination of surgery and chemotherapy or radiation therapies. Nine out of 10 children with Wilms tumors are successfully treated, according to the ACS.

Benign kidney tumors may also cause complications and many similar symptoms to renal cancers. A benign tumor is noncancerous. It doesn’t spread, but it may grow large enough to cause symptoms. There may be one tumor or many small tumors, in one or both kidneys. Surgery or ablation may be used to remove these tumors, similar to treatment for cancerous tumors. Treatment decisions depend on whether the tumors are causing symptoms, their size, and your general health.

  • Angiomyolipomas are the most common type of benign tumors. They may occur randomly, though some occur as a result of tuberous sclerosis. These are seen more frequently in women. Symptoms are similar to renal cancer symptoms, including pain and blood in the urine. They may be carefully watched and, if symptoms develop, treated appropriately.
  • Oncocytomas are rare and may grow very large. They’re more common in men. Some may be a result of genetic conditions such as tuberous sclerosis or Birt-Hogg-Dubé syndrome. They may not cause symptoms in early stages, in which case they may be monitored instead of treated. It’s difficult to distinguish these cancers from RCC, so patients and their care team may opt for surgery to remove the tumor. Surgical treatment can completely remove them in many cases.

Renal sarcoma is a rare type of kidney cancer that develops in the connective tissue of the kidney. This is a type of soft tissue sarcoma, which is different from RCCs or TCCs.

Risk factors for soft tissue sarcomas include having genetic disorders such as tuberous sclerosis, or being exposed to radiation, such as from treatment for a different cancer. Symptoms may include abdominal pain or a lump that is getting bigger. Imaging tests such as MRI scans, CT scans or X-rays can determine whether there is a tumor. A biopsy may be taken to confirm cancer if a tumor is found. There are several options for treatment, or a combination may be used. Surgery, chemotherapy, radiation and targeted drug therapies are common treatments for soft tissue sarcomas.

Metastatic kidney cancer occurs when a kidney cancer metastasizes to other parts of your body. When kidney cancer spreads, it usually goes to distant lymph nodes, the bones, liver, lungs or brain. Different symptoms may develop depending on where a new tumor grows. Even though the new tumor (the metastatic tumor) is in another body part, it’s still considered kidney cancer and will be made of the same type of cells as the original cancer.

Learn more about treatments for kidney cancer

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