Renal Cancer Recurrent
Kidney cancer can return even years after successful surgery, affecting about 1 in 5 people who undergo treatment for localized disease. Understanding the risk factors, warning signs, and available treatments helps patients navigate this challenging possibility with their medical team.
Table of contents
- What Is Recurrent Renal Cancer
- How Common Is Recurrence
- Factors That Affect Recurrence Risk
- When Cancer May Return
- Where Cancer May Come Back
- Treatment Options for Recurrent Disease
- Follow-Up and Surveillance
- Signs to Watch For
What Is Recurrent Renal Cancer
Recurrent kidney cancer means that the cancer has come back after it has been treated[4]. This happens when cancer cells remain in the body after surgery or other treatments and begin growing again. The cancer may return in the same location where it was originally found, in the remaining kidney tissue, or it may spread to different parts of the body[1].
When kidney cancer spreads to other organs, this is called metastatic disease, which means cancer cells have traveled from the kidney to distant sites in the body[1]. Recurrence can happen at any time after treatment, though patterns vary based on individual factors.
How Common Is Recurrence
Studies show that approximately 20% of people who have surgery to remove kidney cancer that has not spread beyond the kidney will develop cancer again[1][5]. This means that among patients who undergo a nephrectomy (surgical removal of all or part of the kidney) for localized disease, about 1 in every 5 people will experience a recurrence[1].
The type of kidney removal surgery does not significantly change the overall risk of recurrence[1]. However, patients who have a partial nephrectomy may have a slightly higher chance of local recurrence at the surgical site compared to those who have the entire kidney removed[1].
Factors That Affect Recurrence Risk
Several factors help doctors estimate a person’s risk of kidney cancer returning after surgery. Healthcare providers use tools like the ASSURE Nomogram, which is a mathematical model that estimates the chances of different kidney cancer outcomes based on specific information about the cancer[1].
Age at diagnosis plays a role in recurrence risk for two main reasons. First, younger patients have more years ahead for cancer to potentially return. Second, anyone diagnosed with kidney cancer before age 50 may have a genetic condition that increases risk[1].
Family history matters significantly. If biological family members have had kidney cancer, or certain other cancers like pancreatic cancer or uterine fibroids, there could be a genetic condition making recurrence more likely[1]. Conditions such as von Hippel-Lindau syndrome and Birt-Hogg-Dubé syndrome are examples of inherited disorders that increase kidney cancer risk[1].
The stage of cancer at the time of surgery strongly predicts recurrence risk. Among patients with organ-confined kidney cancer, the 10-year recurrence-free survival rates were 94.5% for stage T1a, 75.0% for stage T1b, and 57.9% for stage T2 disease[6]. Higher pathologic stage means more advanced cancer growth, which increases the likelihood of recurrence.
Tumor grade refers to how abnormal the cancer cells look under a microscope. Higher nuclear grade, meaning more abnormal-looking cells, is associated with increased recurrence risk[6].
The type of kidney cancer also matters. Clear cell renal cell carcinoma, the most common type, has different recurrence patterns compared to other subtypes[6]. The presence of certain cell features, such as sarcomatoid differentiation, increases recurrence risk[6].
Tumor size at the time of surgery influences outcomes. Larger tumors generally carry higher risk of cancer returning than smaller ones[1].
Male sex and older age are also associated with higher recurrence rates in some studies[6].
When Cancer May Return
About half of all kidney cancer recurrences happen within the first two years after surgery[1]. However, recurrence can occur at any time, even many years after treatment.
Late recurrence after 5 years is not uncommon with kidney cancer[6]. Studies have documented cases of kidney cancer recurring 10 years or longer after the initial nephrectomy[2]. One study found that among 211 patients who experienced recurrence, 67 cases occurred after 5 years, and 14 occurred after 10 years[6].
The interval between surgery and diagnosis of local recurrence can be quite variable, ranging from as short as 3 months to as long as 45 years[11]. This wide range highlights the importance of long-term follow-up care for kidney cancer survivors.
Where Cancer May Come Back
Recurrent kidney cancer can appear in several locations. The most common sites where kidney cancer returns include the lungs, bones, and the opposite kidney[6]. Other organs that may be affected include the liver, lymph nodes, adrenal glands, and brain[6].
Local recurrence means the cancer returns at or near the site of the original tumor or in remaining kidney tissue[1]. This is slightly more common in patients who had a partial nephrectomy, where only part of the kidney was removed[1]. If cancer cells remained in the kidney where the tumor was removed, these can grow back over time[1].
The cancer may also develop in the opposite kidney, appearing as new tumors rather than spread from the original site. This is particularly relevant for patients with bilateral or multifocal kidney cancer, who face higher risks of developing tumors in both kidneys[13].
Treatment Options for Recurrent Disease
Targeted therapy is the main treatment approach for recurrent kidney cancer[4][9]. These treatments use drugs to target specific molecules, such as proteins, on cancer cells or inside them that help cancer grow and spread[4].
One important protein that helps tumors grow larger by building new blood vessels is called vascular endothelial growth factor (VEGF). Several targeted therapy drugs work by blocking VEGF, including sorafenib, pazopanib, axitinib, sunitinib, and cabozantinib[4][9].
Another target is a protein called mammalian target of rapamycin (mTOR), which helps cells grow and divide. Drugs that work on this protein include temsirolimus and everolimus[4][9].
Immunotherapy helps strengthen the body’s immune system to find and destroy cancer cells[4][9]. This treatment may be used in specialized centers for patients whose kidney cancer no longer responds to targeted therapy. Immunotherapy drugs used for recurrent kidney cancer include nivolumab, which may be combined with ipilimumab[4][9].
Surgery may be offered in certain situations. Before starting targeted therapy, doctors might recommend a cytoreductive nephrectomy, where the surgeon removes the kidney with the tumor and as much of the cancer as possible[4][9]. This may improve response to targeted therapy.
When kidney cancer spreads to specific organs like the brain or lungs, surgery is sometimes used to remove those metastases[4][9]. If the recurrence is in the kidney area, repeat surgery such as completion nephrectomy or excision of the locally recurrent tumor may be considered[11]. Though these repeat surgeries can be complicated, they may offer reasonable outcomes for selected patients.
Radiation therapy may be recommended if a patient is not well enough for targeted therapy. External radiation therapy can help relieve pain, bleeding, and other symptoms[4][9]. If cancer spreads to the bones, radiation therapy is commonly used for treatment.
Ablation therapy uses heat or cold to destroy kidney tumors[4][9]. This may be an option for patients who cannot have targeted therapy or are not well enough for surgery.
The treatments offered depend on where the cancer has returned and what treatments were previously received[4][9]. Healthcare teams work with patients to develop individualized treatment plans based on their specific situation.
Follow-Up and Surveillance
Regular follow-up care is essential after kidney cancer treatment to detect any recurrence early. Long-term follow-up of perhaps 10 years or more is recommended, including imaging studies of the abdomen, lungs, and bones[6].
Patients are typically seen every 3 months for the first year after surgery, then every 6 months for the second and third years, and annually thereafter[2]. Assessment usually includes physical examinations, blood pressure measurements, blood tests to check kidney function, urinalysis, and imaging studies[2].
Abdominal ultrasound or CT scans help monitor for local recurrence in the kidney area. Chest x-rays or CT scans check for spread to the lungs. More frequent or intensive monitoring may be needed for patients with higher-risk disease[2].
Several guidelines recommend mandatory follow-up testing for up to 5 years, though continued surveillance beyond that timeframe is often advised, particularly for high-risk patients[6]. Because recurrence can happen even after 10 years, ongoing monitoring remains important for many patients.
Signs to Watch For
While many recurrences are detected through routine surveillance imaging before symptoms appear, patients should be aware of potential warning signs. Though the sources do not provide specific symptom lists for recurrent disease, any new or concerning symptoms should be reported promptly to the healthcare team.
Keeping the remaining kidney healthy is important after treatment. This includes stopping smoking, drinking less alcohol, eating a balanced diet, being physically active, keeping blood pressure in a healthy range, and managing other health conditions[4][9].
Regular kidney function tests, including urine and blood tests, are performed as part of follow-up appointments to ensure the remaining kidney is working well[19]. One kidney is enough to filter blood and keep it clean and healthy, as long as it works normally[19].