What is advanced kidney cancer?

Kidney cancer is called advanced if it has spread to another part of the body. Where the cancer has spread to is called a secondary cancer or metastasis.

The cancer may have already spread when you're first diagnosed. Or it may come back or spread after you've had treatment. The aim of treatment depends on whether the cancer has spread near the kidney (locally advanced), or to other parts of the body (advanced).

Not all cancers spread. Aches and pains may not be caused the cancer. But check with your doctor about any symptoms that are worrying you.

Where can kidney cancer spread to?

Kidney cancer can spread to one or more areas of the body. The most common places are the:

• lymph nodes
• lungs
• bones
• brain
• liver
• adrenal glands

The stage of kidney cancer tells you if it has spread and where to.

Locally advanced kidney cancer

Locally advanced kidney cancer is different to advanced kidney cancer.

Locally advanced means the cancer has grown into surrounding tissues or blood vessels. It may have spread to the nearby lymph nodes. It hasn't spread to distant parts of the body such as the lungs and bones.

It may be possible to have surgery for locally advanced kidney cancer if your surgeon can remove all the cancer. You may have an immunotherapy drug after surgery to reduce the chance of the cancer coming back.

Advanced kidney cancer

Advanced kidney cancer means it has spread beyond the lymph nodes and to other areas of the body such as the lungs. This is also called metastatic kidney cancer.

Unfortunately, advanced kidney cancer can't usually be cured. Treatment aims to control the cancer and relieve symptoms.

Symptoms of advanced kidney cancer

Advanced kidney cancer can cause symptoms such as:

• high temperature (fever)

• weight loss

• heavy sweating at night

• weakness

Other symptoms depend on where the cancer has spread to. For example, if it has spread to the lungs you might have shortness of breath. A secondary cancer in the liver may cause discomfort and pain on the right side of your tummy (abdomen).

If advanced kidney cancer is found when you are first diagnosed, you may have symptoms caused by the cancer in your kidney (primary cancer). These can include pain in your back or side and blood in your urine.

Decisions about your treatment

Which treatment is best for you depends on:

• the size of the cancer and where it is

• how much the cancer cells look like normal cells (the grade of the cancer)

• the treatment you have already had

• any symptoms you have

• your general health

Your doctor will explain what your treatment options are and how they may affect you. It’s a good idea to find out:

• whether treatments have side effects that affect your quality of life
• what the treatment involves, such as travelling back and forth to the hospital
• if there is a clinical trial you can take part in
• what happens if you decide not to have treatment

Take your time to think about the treatment your doctor recommends. You might find it helpful to talk to your specialist nurse (CNS) about any worries you have about it. This can help you chose what is best for you.

You may also want to talk things over with a close friend or family member. Or there may be a counsellor you can discuss your feelings with.

Treatment for advanced kidney cancer

Local treatment such as surgery or radiotherapy may be best if the cancer has only spread to one area of the body. Targeted or immunotherapy cancer drugs might be an option if the cancer is in more than one area. Or you doctor might recommend a different treatment.

It may not be helpful to repeat a treatment you've had before. And it isn't usually possible to give more radiotherapy to an area that has already been treated.

If the cancer is growing very slowly and not causing symptoms, your doctor may want to delay starting treatment. This is called active surveillance. Your doctor may recommend this because:

• treatment can cause side effects that affect your quality of life
• in a few people the cancer may not grow for some time - so it can be safe to wait to start treatment for these people

Your doctor monitors the cancer regularly with scans. They will discuss treatment when there are changes to the cancer or you start to get symptoms.

Some people who have been having treatment for many years may be recommended to stop it by their doctor. They have the cancer monitored instead. This is normally if the cancer has stopped growing. Your doctor will discuss this with you if this happens.

It can be difficult to know you have advanced cancer but are not having treatment. You can talk this through with your CNS. They can explain how often you will have follow up appointments and what treatment you may have if the cancer grows.

How you might feel

When kidney cancer has spread to other areas of the body it is unlikely to be cured. But treatment can control it for some time, and help you maintain a good quality of life for as long as possible.

Finding out your cancer can't be cured can be a shock and devastating news. It's common to feel uncertain and anxious, and it can be difficult to think about anything else.

It can help some people to find out more about the cancer and the treatments they can have. Many people find that knowing more about their situation can make it easier to cope. Your healthcare team will help support you and give you the information you need.

Survival

Many people want to know what the outlook is and how their cancer will develop. This is different for each person. Your cancer specialist has all the information about you and your cancer. They're the best person to discuss this with.

You can also talk to your specialist nurse.