Kidney Cancer 

Kidney Cancer (Renal Cancer)

Kidney cancer begins in the kidneys. The kidneys are two bean-shaped organs, each about the size of a fist. They are located behind the abdominal organs, with one kidney on each side of the spine.

In adults, renal cell carcinoma (RCC) is the most common type of kidney cancer. The incidence of kidney cancer seems to be increasing. This potentially is due to improved diagnostics. If the kidney tumor is discovered at an early stage, and confined to the kidney, surgical intervention can cure the patient. The prognosis depends on the histological appearance of the removed tumor, and if there are signs of metastases in the follow up computer tomography scans. If there are metastases, the patient is offered active therapies to slow the progression of the disease.

Urgent need for new, efficient treatments
Kidney cancer is more common among men than women. 80 percent of the patients are between the age of 40 and 69 at diagnosis and the median age for diagnosis is 63 years.

In one third of the kidney cancer patients, in approx. 140.000 patients per year, the cancer has spread outside the kidney at time for diagnosis (source: WHO). For these patients, the prognosis is poor, and the cancer is considered as incurable. In clinical studies of approved medicines, the median survival time seem to have increased from 1 to 4 years. For various reasons, real-world evidence seems to indicate less impressive results of median survival time from 1 to 2 years.

Unfortunately, current treatment options are based on randomized clinical trials where patients with moderate to severe (stage 3-5) chronic kidney disease have been excluded. The therapies have considerable side effects and are not tolerated by all patients. Importantly, the approved drugs reduce progression – but there is low probability of complete remission.

As the incidence rates and healthcare costs of metastatic renal cancer are projected to increase in the future due to the aging population, the development of more effective, and potentially curative, treatment represents an urgent and major unmet clinical need.

“The biggest challenge in advanced renal cell carcinoma is that most patients cannot be cured with current medical therapy. Developing treatments that induce disease remission and eventually lead to cure is the highest priority for these patients.”

David F. McDermott, MD, professor, Harvard Medical School

It is not clear what causes most kidney cancers, but it begins when some kidney cells develop changes (mutations) in their DNA. A cell’s DNA contains the instructions that tell a cell what to do. The mutations cause the cells to grow and divide rapidly. The accumulating abnormal cells form a tumor that can grow beyond the kidney. Some cells can break off and spread (metastasize) for instance, via the bloodstream to grow in several distant parts of the body.

Typical symptoms and signs of kidney cancer include blood in urine, persistent back pain, loss of appetite, unexplained weight loss, tiredness, and fever. Kidney cancer may have few and vague symptoms early in the development of the illness and symptoms may be over-looked.

Current treatments
If the tumor is detected early, then surgical removal can be curative. Unfortunately, the diagnosis is sometimes made when the tumor has spread to other organs and established metastases. Today, the disease is treated with various types of targeted drugs, often with severe side effects, and standard chemotherapy, or radiotherapy, have limited effect.

Metastatic renal cancer
If the kidney cancer is discovered before it has spread, it can be cured using surgery to remove the tumor including a part of, or the entire, kidney. Kidney cancer is called metastatic when it has spread outside of the kidney to other parts of the body. The cancer may be metastatic already when the patient is first diagnosed. In other cases, a primary kidney cancer may relapse after initial treatment. Kidney cancer can spread to almost all parts of the body, including the lungs, liver, and brain.