UK Kidney Cancer incidence statistics

This page presents statistics on kidney cancer incidence, including by age and sex, by site, histology and stage, geographic variation within the UK, the EU and worldwide, trends over time, and by deprivation group.

An overview of kidney cancer

Kidney cancer accounts for 3% of all new cases of cancer diagnosed in men and just over 2% of all cancers in women in the UK (excluding non-melanoma skin cancer). 1-4

Even though kidney cancer is a relatively rare cancer, there have been reports of increasing incidence and mortality across the world, including the UK. Some, but not all, of this increase is believed to be due to the wider application of diagnostic imaging techniques resulting in more kidney tumours being found incidentally.

Unless otherwise specified, the definition of kidney cancer used in this section includes cancers of the renal parenchyma, the renal pelvis and the ureter, plus other specified and unspecified cancers of the urinary organs ( Figure 1.1).

 

The ICD code for kidney cancer is ICD9 189 and ICD10, C64, C65, C66 and C68.5, 6

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Kidney cancer incidence by age and sex

In the UK kidney cancer is the eighth most common cancer in men, with 4,879 new cases diagnosed in 2006. This compares to 2,961 new cases of kidney cancer in women, giving a male:female ratio of 5:3. In women it is the tenth most common cancer.

The number of new cases and rates for kidney cancer in the UK and its constituent countries are shown in Table 1.1. 1-4 Overall, kidney cancers are responsible for almost 3% of all cancers in the UK and it is the eighth most common cancer.

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Figure 1.2 shows kidney cancer incidence by age-group. 1-4 There are very few cases of kidney cancer in early adulthood, but from age 40 the rates begin to rise steeply. The highest rates in both sexes are in the over 75s.

It has been estimated that the lifetime risk of developing kidney cancer is 1 in 75 for men and 1 in 128 for women in the UK. These were calculated on February 2009 using incidence and mortality data for 2001-2005. 8

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Around 90 cases of kidney cancer are diagnosed each year in children, with more than three-quarters of those occurring in children under five. The most common kidney cancer in childhood is Wilms’ tumour. More details on kidney cancer in children can be found in the childhood cancer section 7.

Kidney cancer incidence by site, histology and stage

In adults in England and Wales almost 90% of malignant kidney tumours arise in the renal parenchyma, whilst a further 5% arise in the renal pelvis and 5% in the ureter. 9 ( Figure 1.1)

Cancers of the renal parenchyma are also known as renal cell carcinomas (RCC). There are five subgroups of RCCs: conventional (clear cell, also called non papillary), which account for 75-80% of RCC tumours; papillary (chromophilic) accounting for 10-15% and chromophobe, collecting duct carcinoma and unclassified renal cell carcinoma which together make up the remainder of RCC tumours. Tumours in the renal pelvis consist mainly of transitional cell carcinomas (TCC). 10

Data from South East England for 2005 show that 36% of kidney cancers are diagnosed when at a local stage, about a quarter of cases are with distant metastases and a third of cases have unknown stage. 11

Geographic variations in kidney cancer incidence

Within the UK and Ireland there is a clear geographical distribution of kidney cancer incidence for both men and women, with higher rates of incidence in the north compared to the south. 12

Figure 1.3 shows the pattern of kidney cancer incidence for women, with age-standardised rates above the UK and Ireland average in Scotland, parts of Wales and Northern Ireland and below that average in Eastern and London regions.

The north/south divide of kidney cancer incidence follows the geographical pattern of two known risk factors for this disease - smoking and obesity (find out more on kidney cancer risk factors page).

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Around 208,500 new cases of kidney cancer are diagnosed in the world each year, accounting for just under 2% of all cancers. 10 The highest rates are recorded in Northern America and the lowest rates in Asian and African regions ( Figure 1.4). 13

Part of the observed geographical variation in kidney cancer incidence may be due to differences in the frequency of use of diagnostic imaging techniques and autopsy rates. 10

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Within the European Union (EU) there is less variation than there is worldwide. The rates for the UK are lower than the EU average for both males and females as can be seen in Figure 1.5. 1-4

The most recent estimates of incidence of kidney cancer suggest that there are 63,300 new cases annually in the EU25. In this region, kidney cancer accounts for nearly 3% of all cancer cases. 14

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Kidney cancer incidence trends over time

Increases in kidney cancer incidence have been reported in many different countries around the world. 15 There has been some debate as to how much this is due to the introduction of new imaging methods, such as ultrasound and computed tomography (CT), which leads to the incidental detection of asymptomatic disease. 16-18

Analysis of US data demonstrated a 73% increase in the use of abdominal or pelvic CT scans or magnetic resonance imaging (MRI) between 1986 and 1994. 19 Kidney cancer incidence trends by tumour stage in the US population between 1975-1995 recorded the greatest increase for localised tumours but also increases in more advanced and unstaged tumours, suggesting that detection of asymptomatic tumours by imaging does not fully explain the increases seen for kidney cancer overall. 19

A similar conclusion, that at least part of the increase in incidence is real and not solely contributable to incidentally-detected tumours, was reached by a British study of incidence and mortality trends from 1978 to 1997 in the Northern and Yorkshire region of England. 20

In Great Britain kidney cancer incidence has risen since the mid-1970s for both men and women ( Figure 1.6). 1-4

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Male kidney cancer incidence rates increased by more than 90% from 7.1 per 100,000 in 1975 to 13.9 per 100,000 in 2006. In women the rates have more than doubled over the same period from 3.2 to 7.0 per 100,000. Most of the increase has occurred in older men and women, with rates more than doubling between 1975 and 2006 for men in their 70s and 80s. Rates have doubled over the same period in women aged 45 and over, with the greatest increase (almost 170%) in women aged 85+ ( Figure 1.7 and Figure 1.8). 1-4

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The kidney cancer incidence trend for the UK can be seen in Figure 1.9.

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Kidney cancer incidence by deprivation group

A study in 2007 showed no significant gradient of kidney incidence or mortality by Carstairs index in Scotland 21 or in England and Wales. 9 This is perhaps surprising as most cancers that show an association with smoking also show an association with deprivation. 9

A study looking at data from Yorkshire found that for patients diagnosed with kidney cancer between 1978-82 incidence was higher among the most deprived groups than the least deprived groups (3.2 v 2.5 per 100,000) but for patients diagnosed between 1993-97 there was no such difference. 20 The latest report into kidney cancer incidence by deprivation quintile showed a small but significant difference between the least and most affluent groups. 22

UK Kidney Cancer mortality statistics

This page presents kidney cancer mortality statistics including, by age, trends over time and variations across the EU.

Kidney cancer mortality by age and sex

In the UK, kidney cancer is the tenth most common cause of cancer death in men and the thirteenth in women. 3,752 people died from kidney cancer in 2007, accounting for over 2% of all cancer deaths in the UK.

The number of deaths and the mortality rates for kidney cancer in the UK and its constituent countries in 2007 are shown in Table 2.1. 1-3

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Kidney cancer death rates rise with increasing age and most deaths (81% of male deaths and 85% of female deaths) occur after the age of 60 ( Figure 2.1). 1-3

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Kidney cancer mortality trends over time

Kidney cancer mortality rates for both men and women have increased since the early 1970s ( Figure 2.2).

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Male kidney cancer rates have shown a steady rise from around 4.3 per 100,000 in 1971 to around 6.2 per 100,000 in 2007; Female rates have increased over the same period from 2.1 to 3.0 per 100,000. The male:female ratio of age standardised rates has remained fairly constant at about 2.1:1. During the last five years, rates appear to be stabilising.

When rates are examined by age, ( Figure 2.3and 2.4) it is clear that the largest increases in mortality since 1971 were in men and women aged over 65, reflecting the incidence trends. The older age groups have experienced increases of more than 50%. For men and women aged 85 and older, death rates from kidney cancer more than doubled between 1971 and 2006, from 23.8 to 75.5 per 100,000 for men and from 12.8 to 30.5 per 100,000 for women.

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When mortality from kidney cancer is analysed by birth cohort, there are increases in death rates for those born up to the mid 1920s, a levelling off for those born from the 1930s to the early 1950s, and for subsequent birth cohorts there is a fall in mortality. This may mean in future that overall mortality rates will decline in the UK. 4

Such a decline has already occurred in some northern European countries, for example, Denmark, Sweden, Finland and Norway during the last two decades of the twentieth century. 5 The pattern of kidney cancer mortality by birth-cohort in Europe resembles that for lung cancer and for both cancers smoking is the primary risk factor. 5

Kidney cancer mortality in countries of the EU

Figure 2.5 shows estimates of kidney cancer mortality across the countries of the EU.

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Kidney Cancer survival statistics

This page presents kidney cancer survival statistics including by age, stage at diagnosis, and by deprivation group.

Kidney cancer survival trends

The latest figures for kidney cancer patients in England and Wales report one-year relative survival to be 68% for men and 65% for women, five-year relative survival to be 50% for men and 49% for women while ten-year relative survival rates fell slightly to 42% for men and 44% for women ( Figure 3.1). 1, 2

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Survival rates for kidney cancer patients have increased significantly since the early 1970s, with an increase of around 50% at one-year and 75% at five-years.

Kidney cancer is one of the few cancers where it is reported that men have a slight survival advantage over women, 1 although this does not appear to be true at ten years in England and Wales nor for Scottish patients. 3 Relative survival rates for Scottish patients diagnosed in 1997-2001 were 59.1% (males) and 63.9% (females) at one-year and 40.3% (males) and 46.4% (females) at five-years. 3

Kidney cancer survival rates by age at diagnosis

As with most cancers there is a steady fall in survival with advancing age at diagnosis. Relative survival rates for kidney cancer patients under 50 are more than twice as high as for patients over 80 ( Figure 3.2). 4

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Kidney cancer survival rates by stage

Survival from kidney cancer is also heavily dependent on the stage of disease at diagnosis. 5-7

Patients with very early stage kidney cancer have five year survival rates in excess of 90%, while only around 10% of patients, who present with distant metastases, are alive five years later. 5-7

Kidney cancer survival rates by deprivation score

There is a significant material deprivation gradient in survival from kidney cancer in England and Wales. Those living in the least deprived areas have significantly better survival than those living in the most deprived areas, using the Carstairs index of deprivation.

This gradient has been apparent since the early 1970s. 1 The same deprivation/survival gradient has also been seen in Scotland. 8

Kidney Cancer risk factors

This page presents information on risk factors for kidney cancer, including, age and sex, obesity, tobacco smoking, medical conditions and treatment and diet. There is also information on reproductive factors, occupation and family history and previous cancers.

Renal cell carcinoma accounts for the majority of kidney cancers diagnosed in UK adults and will be the main focus of this page. Cancer of the renal pelvis has an aetiology similar to bladder cancer and is covered in bladder cancer risk factors.1

The major risk factors for kidney cancer include age, sex, obesity, smoking, and several genetic and medical conditions. Smoking and obesity are both preventable causes. In Britain smoking has declined in both men and women while the proportion of the population who are obese or overweight is rising. 49 So although there may be a reduction in smoking-related kidney cancers there is likely to be a rise in obesity- related cases.

Age and sex and kidney cancer risk

The risk of kidney cancer increases with age: around three-quarters of all cases occur in men and women over the age of 60. The disease is more common in men than in women - three male cases for every two female cases.

Obesity and overweight and kidney cancer risk

Obesity is an established risk factor for kidney cancer. 2, 3 About 25% of kidney cancer cases in men and 24% in women in the EU are attributable to being overweight. 4

A summary analysis of studies published between 1966 and 1998 found that the risk of renal cell cancer increased by 7% for each unit increase of body mass index (BMI), which corresponds to a 35% risk increase for overweight individuals and a 70% risk increase for obese individuals. 5

Two cohort studies show a greater risk increase for obese women of about 120%. 6, 7 There is no consistent link between being overweight and tumours of the renal pelvis.

Tobacco smoking and kidney cancer risk

Cigarette smoking is a major risk factor for renal cell carcinoma and cancer of the renal pelvis. 8 It is estimated that 24-32% of renal cell cancer cases in men and 9-16% in women can be attributed to smoking. 7, 9

On average, current smokers have a 50% increase in risk of kidney cancer. 10 Risk increases with the number of cigarettes smoked per day. People who smoke more than 20 cigarettes per day increase their risk by 60-100% compared to non-smokers. 11

As a group, former smokers have a 25% higher risk of kidney cancer, 10 but people who have given up for more than 10 years have the same level of risk as life-long non-smokers. Risk for cancer of the renal pelvis is increased by more than three-fold in current smokers. 12

Medical conditions and treatment and kidney cancer

Acquired cystic kidney disease, which develops in association with long term kidney problems, is common in dialysis patients, and increases the risk of kidney cancer. 13, 14 Individuals receiving dialysis have a three- to four-fold increased risk of kidney cancer overall. 15, 16

Risk increases with years of dialysis, to almost seven-fold after the tenth year of dialysis. 15, 16 Renal transplant patients are at increased risk for cancer in the non-transplanted kidney. 13,17-19

The kidney may receive radiation during radiotherapy for testicular cancer, and the risk of kidney cancer is increased approximately two-fold following radiotherapy for testicular cancer. Risk increases with time since the first cancer, rising to three-fold after thirty years or more. 20

Radiotherapy for cervical cancer increases the risk of renal cancer by 30% and again, risk continues to increase with time since treatment, reaching almost two-fold for women who have survived for at least thirty years. 21

Although not considered major risk factors, urinary tract infections (UTI), kidney stones, kidney infection and radiation treatment for other cancers have also been positively associated with kidney cancer. 13

It has been estimated that 24% of renal cell cancer cases in women and 15% in men are due to hypertension. 7 Risk increases by up to two times in men and women with a history of hypertension, with a slightly stronger effect in women than men. 7,12,22

The kidneys play a vital role in controlling blood pressure by regulating extracellular fluid. When arterial pressure is high, the kidneys increase the rate at which both water and sodium are excreted. This in turn, results in less extracellular fluid and a decrease in blood pressure.

Studies have shown an increased risk with use of diuretics and other anti-hypertensive medication, although it is not possible to say whether the effects are independent of hypertension. 7,23-25

Phenacetin, an analgesic now banned in the UK and throughout Europe, increases the risk of renal pelvis cancer although its effect on renal cell carcinoma is less certain. 13,26-28

Diet and risk of kidney cancer

Evidence is growing that there is no overall association between intake of fruits and vegetables and renal cell carcinoma. 29-34 Two cohort studies show a reduced risk of renal cell carcinoma with higher intake of root vegetables. 30, 32

People drinking more than 15g/day of alcohol have a 30% reduced risk of renal cell cancer. 35 One unit, equivalent to a small glass of wine or half a pint of normal strength beer, contains 8 grams of alcohol

Reproductive factors and risk of kidney cancer

Although there is some evidence of an increased risk of kidney cancer with increasing parity, 33,36-39 the results may be confounded by body mass index. 38 There is limited evidence for an increased risk after hysterectomy. 38-40

Occupation and kidney cancer risk

A recent review concluded that the body of evidence does not support a link between asbestos, petrol or trichloroethylene and kidney cancer. 41

Family history and previous cancers and risk of kidney cancer

Siblings of patients with kidney cancer have a four to seven-fold increased risk of being diagnosed with kidney cancer. 42-44 Two studies have reported risk ratios of 1.6 and 4.0 for people with a parent diagnosed with kidney cancer, 42-43 although another study did not show an increased risk for parental history. 44

People with a previous thyroid cancer have between two and seven times increased risk of kidney cancer. 45-47 This may be due to genetic features common to both cancers. 48

Kidney cancer molecular biology and genetics

This page presents information on the molecular biology and genetics of kidney cancer.

Most cases of kidney cancer are sporadic, although it is a major feature of a number of inherited disorders ( Table 5.1).

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Von Hippel-Lindau (VHL) disease displays autosomal dominant inheritance and can be divided into three types depending on the tumours that develop in affected families. These include tumours of the kidney, brain, spinal cord, pancreas, adrenal gland and eye. The risk of an affected family member developing clear-cell renal cell carcinoma increases with age, reaching 70% by age 60. 1

The VHL gene was identified in 1993 on chromosome 3p25.5 and codes for a tumour suppressor gene. 2 To date, around 500 different mutations in VHL have been described. 3 Correlations between type of mutation and the phenotype of disease have been observed. 4

The protein product of VHL is involved in the ubiquitination of the hypoxia inducible factor alpha family proteins (eg HIF-1? and HIF-2?) through binding to elongin B, C and Cul2 subunits. 5-8 Loss of VHL function causes accumulation of HIF proteins and the transcriptional upregulation of genes normally expressed under hypoxic conditions. These encourage cell growth and survival, and include angiogenic (eg VEGF) and mitogenic (eg TGF-?, PDGF-B) factors. 9

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Hereditary papillary renal cell carcinoma (HPRCC) is characterised by occurrence of type 1 papillary RCC as well as tumours in other organs. HPRCC is inherited in an autosomal dominant manner with incomplete penetrance. It is caused by mutations in the c-MET proto-oncogene, which maps to chromosome 7q34. 10

HPRCC renal tumours often show trisomy of chromosome 7 and two of these chromosomes have been shown to harbour c-MET mutations. 11 c-MET codes for a receptor for the hepatocyte growth/scatter factor involved in various cancer-related processes including angiogenesis. 12

Hereditary leiomyomatosis renal cell cancer (HLRCC) is an inherited syndrome, 13 caused by mutation in the fumarate hydratase (FH) gene. 14 Affected individuals develop benign skin and uterine leiomyomas and, in some cases, highly aggressive type-2 papillary renal cell cancer. The exact mechanism by which mutations in FH cause disease is not known, however, it is thought that lack of fumarate hydratase may activate hypoxia signalling pathways under normal oxygen conditions. 15

Birt-Hogg-Dubé (BHD) syndrome is characterised by an increased risk of a number of different types of renal cancer. The BHD gene has been mapped to chromosome 17p11.2. It encodes a protein called folliculin, that has been linked to mTOR and AMPK signalling pathways. 16

A wide number of genes that appear to play a role in the development of sporadic cases of renal cancer have been identified. 9 These include genes involved in familial cancer, such as VHL, MET and BHD. However, FH does not appear to play a role in sporadic tumours. 15 The VHL gene is now known to be disabled through mutation or hypermethylation in the majority of sporadic clear cell RCCs, the most common type of kidney cancer. 2,17, 18

Sporadic RCC patients whose tumours carry mutations of the VHL gene do not exhibit any of the other VHL symptoms. While genes that control cell division such as TP53, RB and RAS may play a role in the development of RCC, mutations of these genes have only rarely been reported in RCC patients. 19-21

Around 5-10 per cent of sporadic kidney cancers are papillary RCCs; these often exhibit trisomy of chromosomes 7, 16 or 17, or loss of the Y chromosome. 22 Mutations in c-MET have also been reported in a subset of sporadic papillary RCC patients. 10

Studies in the Icelandic population indicate that renal cell carcinoma can cluster in families not affected by VHL. This suggests that there may be an inherited component to some "sporadic" cases of RCC, at least in this population. 23

The identification of the VHL gene fifteen years ago has led to substantial advances in the understanding of kidney cancer. 2 Continuing research is providing a better knowledge of the role of the VHL protein in normal cell growth and is unravelling the wider molecular pathways involved in the disease. This will lead to improved methods of diagnosis and treatment as well as, potentially, the development of prevention strategies for some types of kidney cancer. 5-8

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Kidney cancer symptoms and treatment

This page presents information on the symptoms and treatment of kidney cancer.

Early kidney cancer may have no symptoms and is increasingly being diagnosed incidentally following abdominal imaging.

About half of all renal cell cancer(RCC) patients and 90% of renal pelvis cancer patients present with haematuria (blood in the urine). 1 A more common cause of haematuria is infection but all cases should be investigated, with urgent referral to a specialist for those over 50 with unexplained haematuria (microscopic or macroscopic). 2

Other common symptoms of kidney cancer include back pain, palpable mass, fatigue, weight loss, sweats and anaemia. About 25% of patients have distant spread at diagnosis, presenting with symptoms such as bone pain, pathological fracture or cough. 1

Diagnostic tests include intravenous urogram (IVU) with CT and/or ultrasound scanning of the abdomen and chest. MRI may give additional useful information. At present there is no reliable screening test available for kidney cancer. For inherited genetic susceptibility, annual ultrasound or MRI scanning is available for those over 40.

Surgery remains the most effective treatment for renal cell cancer. Laparoscopic nephrectomy is possible for all but the largest tumours, resulting in less post-operative morbidity and better cosmetic result. 3

Small tumours (less than 3cm) may be suitable for nephron-sparing surgery (partial nephrectomy). 4 For those refusing or unfit for surgery, tumour ablation with radio frequency ablation (RFA) or cryotherapy are an alternative for small tumours of 4cm or less. 5, 6

There is increasing recognition that a subset of renal cell tumours may have a slow natural progression with only 1% progressing to metastatic disease. 7, 8 This has resulted in the suggestion that elderly or unfit patients who have small renal lesions could undergo active surveillance, having been given full appreciation of the risks.

In patients fit for surgery presenting with metastatic disease, nephrectomy controls the primary tumour most effectively and may also control symptoms such as haematuria and renal pain. Renal artery embolism or occlusion leads to partial or complete infarction of the kidney and offers a chance of temporary control of symptoms where surgical resection is not possible. Metastectomy can be offered, particularly for isolated metastases. Reports of delayed disease progression after this type of surgery (5-year survival rates between 14% and 47%) are common, but there is no randomised clinical trial evidence to support this.

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Advanced RCC is largely resistant to both chemo- and hormone-therapy so other approaches are being tried. 9 Cytokine-based immunotherapy with either interferon-a or interleukin-2 show overall response rates of between 4% and 31% for metastatic RCC. 10 Interferon is used following nephrectomy for metastatic disease, or as first line treatment.

Newer agents for metastatic disease are oral multi tyrosine kinase inhibitors, sunitinib and sorafenib. 11 Sunitinib has been reported to extend progression-free survival with better quality of life than cytokine therapy and is recommended in Europe as first line therapy for metastatic disease. 12 However, these agents have yet to be approved by NICE, which is due to publish guidance on sunitinib, sorafenib, bevacizumab and temsirolimus for renal cell cancer in January 2009.

Radiotherapy can reduce the size of renal cell tumours before surgery, control local pain and bleeding, or relieve bone pain. Since RCCs are usually chemotherapy- and endocrine-insensitive, such treatments are not routinely recommended.

Treatment for renal pelvis cancer is similar to that for invasive transitional bladder cancer - typically surgery. TCCs are chemosensitive and treatment with regimes used for bladder TCCs may be helpful in the palliative setting. 13 Radiotherapy may be used palliatively for inoperable or recurrent disease. 10% of patients with renal pelvis cancer have synchronous TCC of the bladder and 50% will develop bladder cancer in the future, so repeated cystoscopies and cytological examination of the urine are important in follow-up.

Increasingly kidney cancers are being diagnosed at earlier stages and smaller sizes due to the increased use of imaging techniques. 14 Such tumours are more easily treated though for some patients with co-morbid conditions, active surveillance may be a better option. 15 For patients with advanced disease, new treatment options have become available both with immunotherapy and new molecular-targeted anti-angiogenesis drugs. 14, 16

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