TN 1 (10-08)

DI 23022.205 Kidney Cancer




Kidney Cancer is cancer that forms in tissues of the kidneys. Kidney cancer develops most often in people over 40, but no one knows the exact causes of this disease. Smoking and misuse of certain pain medicines including over-the-counter pain medicines for a long time can affect the risk of developing renal cell cancer. Also, certain genetic conditions, such as von Hippel-Lindau disease or hereditary papillary renal cell carcinoma put a person at risk for this disease. Clear Cell Sarcoma of the Kidney is a rare type of kidney cancer, in which the inside of the cells look clear when viewed under a microscope. Clear cell sarcoma can spread from the kidney to other organs, most commonly the bone, but also including the lungs, brain, and soft tissues of the body.
There may be no symptoms of kidney cancer in the early stages. Symptoms may appear as the tumor grows. The following symptoms may be caused by kidney cancer: blood in the urine, a lump in the abdomen, a pain in the side that doesn't go away, loss of appetite, weight loss for no known reason, and anemia.


Kidney Carcinoma, Renal Cell Cancer (RCC), Renal Cell Carcinoma, Wilms Tumor, Renal Pelvis Carcinoma, Renal Adenocarcinoma, Clear Cell Sarcoma of the Kidney, Rhabdoid Tumor of the Kidney, Neuroepithelial Tumor of the Kidney, Diffuse Hyperplastic Perilobar Nephroblastomatosis


Diagnostic testing may include: physical exam and history, blood chemistry studies, urinalysis, liver function tests, Intravenous pyelogram (IVP), ultrasound exam, CT scan, MRI and biopsy.
There is no specific diagnostic testing that permits a tumor to be designated inoperable or unresectable. Inoperable is a physician opinion, made by a qualified physician, after reviewing sufficient imaging studies and laboratory values and physical examination findings to permit the physician to confidently reach the opinion that surgery would be useless. Unresectable is a designation indicating that surgery was attempted but the cancer was incompletely removed. Documentation of unresectable cancer will be found in the surgeon's operative report, in which the surgeon will state that the cancer was not completely removed, or in the pathology report, in which the surgical specimen will be noted to have a positive margin (cancer involvement at the cut surgical margin).


Standard treatment for kidney carcinoma includes: surgery to remove part or all of the kidney), radiation therapy, chemotherapy, biologic therapy, and targeted therapy. Targeted therapy uses drugs or other substances that can find and attack specific cancer cells without harming normal cells. Antiangiogenic agents are a type of targeted therapy that may be used to treat advanced kidney carcinoma. They keep blood vessels from forming in a tumor, causing the tumor to starve and stop growing or to shrink.


An individual can live with part of one working kidney, but if both kidneys are removed or not working, the person will need dialysis (a procedure to clean the blood using a machine outside of the body) or a kidney transplant (replacement with a healthy donated kidney). A kidney transplant may be done when the disease is in the kidney only and a donated kidney can be found.



Suggested MER for Evaluation: Clinical note from a surgeon that the cancer is inoperable. Surgical pathology report that the cancer was not completely removed and that the surgical margins were positive for malignancy.

Suggested Listings for Evaluation:




Meets Listing

13.21 A

Biopsy proof of Kidney Cancer and clinical note stating tumor is inoperable or pathology report or operative note indicating tumor was unresectable.

Medical Equals



* Adjudicators may, at their discretion, use the Medical Evidence of Record or Listings suggested to evaluate the claim. However, the decision to allow or deny the claim rests with the adjudicator.

Last Updated: 10/2/08

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DI 23022.205 - Kidney Cancer - 10/24/2008
Batch run: 03/14/2014