Renal Cell Carcinoma (RCC)

Symptoms, Doctors, Treatments, Advances & More

Renal cell carcinoma (RCC) is the most common type of kidney cancer (90%) and originates in the lining of the renal tubules (small tubes in the kidney) that filter and clean the blood, remove waste products, and produce urine. Renal cell carcinoma occurs more often in men, people who smoke, or who have other kidney disorders, as well as individuals with a family history of kidney cancer or inherited disorders that increase the risk of renal cell carcinoma (see Causes below). Renal cell carcinoma is categorized by the following stages: Stage I – Tumor is in kidney, has not spread (metastasized), and is 7 centimeters or less. Stage II – Tumor is in kidney, has not spread, and is larger than 7 centimeters. Stage III –  The kidney cancer is any size and has spread to near lymph nodes (metastasis); or the cancer has spread to blood vessels in the kidney or nearby blood vessels (renal vein or vena cava), to the parts of the kidney that collect urine, or to the layer of fat surrounding the kidney and may have spread to nearby lymph nodes. Stage IV – The cancer has spread outside the fat surrounding the kidney, and may have spread to the adrenal gland on top of the kidney or nearby lymph nodes; or the cancer has spread to other areas of the body, such as the adrenal glands, distant lymph nodes, liver, lungs, brain, or bone. The stage of renal cell carcinoma determines its treatment and outcome (prognosis).

Alternative names for renal cell carinoma include adenocarcinoma of renal cells, hypernephroma, kidney cancer, renal adenocarcinoma, RCC, and renal cell cancer.

While the exact causes of renal cell carcinoma are unknown, researchers believe that there may be a genetic predisposition for developing the disease. Several risk factors also increase the chances of developing renal cell carcinoma, especially smoking and overuse of pain medicines, both prescribed and over-the-counter, use of diuretics (water pills), being male, African American, or between the ages of 50-70,  obesity, hypertension (high blood pressure), and workplace exposure to asbestos, cadmium, or herbicides. Additional risk factors include patients with a history of other kidney diseases, such as adult polycystic kidney disease, horseshoe kidneys, Hippel-Lindau disease (kidney tumors and cysts), Birt-Hogg-Dube Syndrome (kidney cysts and lesions), hereditary papillary renal cell carcinoma, hereditary leiomyoma-renal cell cancer, hereditary oncocytoma, advanced kidney disease, kidney failure, end-stage kidney disease (ESKD), and patients on long-term hemodialysis (treatment for long-term kidney failure).

For early renal cell carcinoma, some patients may not experience any symptoms. The most common early symptom is blood in the urine (hematuria). Other symptoms of renal cell carcinoma may include fatigue, loss of appetite, rapid, unexplained weight loss, pale skin, excessive hair growth in women, abnormal vision, persistent pain in the side (flank), low back pain, abdominal pain, enlargement of a testicle or varicose veins (varicocele) of the testicle, swelling of the ankles and lower legs (edema), a lump in the abdomen or back, recurring fevers, hypertension (high blood pressure), and anemia.

Treatment for renal cell carcinoma is determined by the stage of the disease and the patient’s overall health. Current treatments for renal cell carcinoma include nonsurgical treatments (cryoablation and radiofrequency ablation), surgery, arterial embolization, chemotherapy, radiation therapy, immunotherapy (biological therapy or biologics), and targeted therapy. Non-Surgical treatments – Non-surgical treatments can be used in some patients with renal cell carcinoma to kill small tumors and include cryoablation (freezes cancer cells) and radiofrequency ablation (burns cancer cells). Surgery – Types of surgery used for renal cell carcinoma may include partial nephrectomy (removal of the cancer and some of the surrounding tissue), simple nephrectomy (removal of only the kidney), radical nephrectomy (removal of the kidney, adrenal gland, surrounding tissue, and near lymph nodes), and kidney transplantation (removal of the diseased kidney and replacement with a donor kidney). Arterial embolization – If the renal cell carcinoma cannot be removed with surgery (unresectable), then arterial embolization may be used to reduce the size of the tumor. In this procedure, a tube is inserted into the main blood vessel supplying the kidney and small pieces of gelatin sponge are inserted to block the blood flow and prevent the tumor from growing. Chemotherapy – Chemotherapy uses drugs that kill cancer cells or stop them from growing and can be administered systemically via pill or intravenously (IV). Radiation therapy – Radiation therapy for renal cell carcinoma uses directed or whole body high-energy X-rays or protons or other types of radiation to kill cancer cells or stop them from growing, and may also be used to help improve the patient’s quality of life by reducing or relieving symptoms (palliative therapy). Immunotherapy (Biological therapy or Biologics) – Immunotherapy uses a patient’s immune system to kill the cancer or stop it from growing and includes immune checkpoint inhibitors, which block proteins on cancer cells to allow T cells (immune cells) to kill the cancer cells and are used for advanced renal cell cancer that cannot be removed by surgery (unresectable). Immunotherapy drugs for renal cell carcinoma include ipilimumab (CTLA-4 inhibitor), nivolumab (Opdivo), pembrolizumab, and avelumab (PD-1 inhibitors), interferon (slows tumor growth), and interleukin-2 (boosts immune cells; IL-2). Targeted therapy – Targeted therapy for renal cell carcinoma is often the first-line treatment for renal cell carcinoma and uses drugs that have been designed to target certain substances on cancer cells to kill them. Types of targeted therapy include antiangiogenic agents that stop tumor blood vessels from growing, monoclonal antibodies, and kinase inhibitors. Monoclonal antibody therapy, such as bevacizumab (Avastin), is administered via infusion and uses antibodies from an immune cell designed in a lab that can kill cancer cells or stop them from growing or spreading (metastasis). Kinase inhibitors, such as vascular endothelial growth factor (VEGF) and mTOR inhibitors, stop cancer cells or the blood vessels that supply tumors from growing, and include sunitinib (Sutent), pazopanib (Votrient), cabozantinib (CaboMetyx), axitinib (Inlyta), sorafenib (Nexavar; VEGF inhibitors) and everolimus (Afinitor) and temsirolimus (Torisel; mTOR inhibitors). Some patients may also want to consider participating in clinical trials to gain access to new, experimental drugs for renal cell carcinoma.

There are a variety of support groups for individuals with renal cell carcinoma: CancerCare - https://www.cancercare.org/support_groups/137-kidney_cancer_patient_support_group Cancer Support Community - https://www.cancersupportcommunity.org/kidney-cancer KC Cure - https://kccure.org/kidney-cancer-patient-support-communities/ Stanford Health, Bladder and Kidney Cancer Support Group - https://stanfordhealthcare.org/events/kidney-cancer-support-group.html

The outcome (prognosis) for renal cell carcinoma depends on the stage of the cancer, whether it has spread (metastasis), and the patient’s overall health. Early stage renal cell carcinoma that has not spread outside of the kidney is easier to treat, has a better survival rate, and may be curable. Renal cell carcinoma can spread (metastasize) to the lungs and other organs, such as liver, brain, and bones. In one-third of patients diagnosed with renal cell carcinoma, the cancer has spread to the lungs. Later stage renal cell carcinoma that has spread outside of the kidney has a lower survival rate, may not be curable, and may only be controlled.

Possible complications of renal cell carcinoma may include hypertension (high blood pressure), high red blood cell count, high blood calcium (hypercalcemia), liver and spleen disorders, and cancer spread (metastasis). Renal cell carcinoma may also recur after treatment. Cancer treatment-related complications may also occur, such as fatigue, skin and nail changes, hair loss, and others, for which treatment is an essential part of cancer care.

If you experience any of the following symptoms of renal cell carcinoma, such as fatigue, loss of appetite, rapid, unexplained weight loss, pale skin, excessive hair growth in women, abnormal vision, persistent pain in the side (flank), low back pain, abdominal pain, enlargement of a testicle or varicose veins (varicocele) of the testicle, swelling of the ankles and lower legs (edema), a lump in the abdomen or back, recurring fevers, hypertension (high blood pressure), blood in the urine (hematuria), and anemia, contact your doctor as soon as possible.

Reducing risk factors most associated with developing renal cell cancer, such as not smoking, maintaining a healthy weight, and controlling high blood pressure (hypertension), can help decrease the risk of developing the disease. If you have a history of other kidney diseases, have a family history of kidney cancer, have long-term kidney disease, or have been on long-term hemodialysis (treatment for long-term kidney failure), it is important to speak with your doctor about being examined for renal cell carcinoma. Renal cell carcinoma that is diagnosed and treated in the early stage can be curable.