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Kidney Cancer/Adrenal Cancer

Johns Hopkins experts at the Brady Urological Institute and Kimmel Cancer Center work together to provide comprehensive, coordinated care for kidney cancer. 

Kidney Cancer Experts

Pioneering surgeons, innovative oncologists and world-class researchers use their skills to develop personalized treatment plans for kidney cancer patients.  Kidney cancer experts from a variety of departments and specialties at Johns Hopkins are available to add their knowledge and expertise to the care of patients.

About Kidney Cancer

Kidney cancer is also known as renal cell carcinoma. The kidneys are two large organs in the abdomen that filter blood and rid the body of excess water, salt and waste products. Kidney cancer is the result of certain kidney cells growing uncontrollably, resulting in a malignant mass in the organ.

If the cancer is not removed, it can interfere with the function of the organ and spread to other tissue and organs. When detected early, kidney cancer is curable most of the time. Even in more advanced stages, new therapies and procedures have led to much improved, overall cure rates.

From breakthroughs in basic research to cutting edge clinical trials and the latest in surgical techniques, Johns Hopkins offers the best in the continuum of care for kidney cancer patients.

Risks Factors

Risks associated with kidney cancer include:

  • Smoking
  • Overuse of some over-the-counter pain killers
  • Exposure to heavy metals, such as lead and cadmium

Diagnostic Tests

A kidney tumor can become quite large without causing any symptoms. Many tumors are found by chance when a procedure or radiology study is done for vague symptoms. Sometimes a physician can feel a mass during a physical examination.

Urinalysis can detect blood or cancer cells in the urine. Other blood tests, such as ones that measure creatinine levels, evaluate kidney function and can indicate a problem with the organ.

Advanced technology has made it possible both to detect kidney cancer earlier and devise the best treatment options. Multiple imaging tools, including intravenous pyelogram (IVP), ultrasound, computerized tomography (CT) scans, and magnetic resonance imaging (MRI), provide very detailed images of the kidney, uncovering masses and allowing physicians to precisely tailor treatment options and recommendations.

Cancer Symptoms

Kidney cancer often does not cause many obvious symptoms. Signs and symptoms that should be brought to the attention of a doctor include:

  • Blood in the urine
  • A mass in the abdomen
  • Swelling of the legs
  • Fever not associated with infection
  • Weight loss
  • Fatigue
  • Persistent low back pain
  • A general feeling of poor health

Current Treatments

Many of the therapies used to treat kidney cancer were developed entirely or in part at Johns Hopkins.

The James Buchanan Brady Urological Institute at Johns Hopkins is staffed by physicians with an expertise in surgical approaches, especially laparoscopic, minimally-invasive techniques, and in situations that require extensive surgery.

Surgery to remove the cancer is the primary treatment for kidney cancer. The most common surgery is a radical nephrectomy, in which the entire affected kidney, the adrenal gland, and some surrounding tissue are removed. In most cases, the remaining, healthy kidney takes over the entire kidney function of the organs, preventing the need for dialysis.

A newer procedure called a partial nephrectomy is becoming more common, particularly with small tumors. In a partial nephrectomy, only the portion of the kidney that contains the tumor is removed, preserving the function of both kidneys.

Larger tumors, once considered inoperable because they extended into the vena cava and heart, are now treatable via a procedure developed by a Johns Hopkins team of surgeons and cardiovascular experts. The patient is put on a cardiopulmonary bypass and his or her body temperature is cooled, similar to techniques used in open heart surgery. Blood is temporarily drained from the body to allow the surgeons to remove the tumor that extends in areas that would otherwise have led to life-threatening bleeding. Because the entire procedure takes less than an hour and the body is cooled, there are no lasting effects to the brain, heart, or other vital organs.

For the patient whose kidney cancer has metastasized to the brain, Johns Hopkins surgeons can perform state-of-the-art neurosurgery and administer radiation via the Gamma Knife.

When the cancer has spread beyond the kidney and cannot be surgically removed, chemotherapy may be used to treat the kidney cancer. Anticancer drugs are given by mouth and/or intravenously and travel through the bloodstream to all parts of the body, destroying the remaining cancer cells.

Unfortunately, kidney cancer cells tend to be resistant to chemotherapy. However, new strategies which cause the immune system to fight the disease are now being studied and offer new hope for patients whose tumors cannot be surgically removed.

New Treatment Approaches

There are several types of diagnostic tests and treatments for kidney cancer currently being studied. A gene linked to the most common type of kidney cancer has been identified and may lead to earlier detection of the disease. A new surgical procedure known as a laparascopic radical nephrectomy, which allows the cancerous kidney to be removed through a tiny incision, has been used in patients with small cancers. To date, patients treated with this new procedure have the same cure rates, shorter hospital stays, less pain, and overall quicker recovery than those who undergo a laparoscopy or an open procedure to remove the kidney.

Along with using the latest surgical techniques, Johns Hopkins clinicians can help patients with recurrent disease who need further treatment. Kidney cancer clinical trials are primarily for patients with metastatic disease. For these patients, the focus has shifted from surgery to new drug therapies: immunotherapy and angiogenesis inhibitors. The goal of immunotherapy is to boost the body's immune system, causing it to seek out and destroy kidney cancer cells. Interleukin-2, was approved in 1992 for the treatment of advanced kidney cancer for selected patients. The agents work by supercharging the immune system and by interfering with cell division and growth.

Researchers in laboratories at Johns Hopkins are currently investigating new strategies to synergize with standard immunotherapy for kidney cancer patients. New biologic approaches to treatment include the use of angiogenic inhibitors to fight kidney cancer. Angiogenesis inhibitors stop the formation of new blood vessels that commonly accompany malignant tissue growth. At Johns Hopkins, our goal is to test drugs in combination with other drugs in order to boost the strength of each drug, so that, working together, their effect on destroying the cancer will be even greater.

View a unique resource, the Translocation Renal Cell Carcinoma website where Dr. Pete Argani shares information about a rare form of renal cell carcinoma

Kidney Cancer Survivorship

Kidney cancer survivors should be patient when recovering after treatment: Your body needs time to heal and adjust. You may have long-term side effects like pain at the site of surgery incision, numbness/tingling/pain in the hands and feet (peripheral neuropathy), difficulty concentrating, fatigue, and night sweats. Fatigue can last for up to a year, especially if you had treatments following surgery. Always discuss any health concerns and symptoms with your doctor.

As you recover, take charge of your health by eating healthy, exercising and reducing stress. Avoid tobacco and limit alcohol intake. Keep up with screenings for other cancers, like mammograms and colonoscopies.

The Brady Urological Institute at Johns Hopkins has a website devoted to kidney cancer.The Kidney Cancer Association provides information and resources about kidney cancer including a website for survivors