Renal cell cancer is a disease in which malignant (cancer) cells
form in tubules of the kidney.
Renal cell cancer (also called kidney cancer or renal
adenocarcinoma) is a disease in which malignant (cancer) cells are found in the
lining of tubules (very small tubes) in the kidney. There are 2 kidneys, one on
each side of the backbone, above the waist. The tiny tubules in the kidneys
filter and clean the blood, taking out waste products and making urine. The
urine passes from each kidney into the bladder through a long tube called a
ureter. The bladder stores the urine until it is passed from the body.
Cancer that starts in the ureters or the renal pelvis (the part
of the kidney that collects urine and drains it to the ureters) is different
from renal cell cancer.
Smoking and misuse of certain pain medicines can affect the risk
of developing renal cell cancer.
Risk factors include the following:
- Smoking
- Misusing certain pain medicines, including over-the-counter pain
medicines, for a long time.
- Having certain genetic conditions, such as von Hippel-Lindau disease or
hereditary papillary renal cell carcinoma.
- Possible signs of renal cell cancer include blood in the urine and a
lump in the abdomen.
These and other symptoms may be caused by renal cell cancer.
Other conditions may cause the same symptoms. There may be no symptoms in the
early stages. Symptoms may appear as the tumor grows. A doctor should be
consulted if any of the following problems occur:
- 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
- Anemia
Tests that examine the abdomen and kidneys are used to detect
(find) and diagnose renal cell cancer.
The following tests and procedures may be used:
- Physical exam and history: An exam of the body to check
general signs of health, including checking for signs of disease, such as lumps
or anything else that seems unusual. A history of the patient’s health habits
and past illnesses and treatments will also be taken.
- Blood chemistry studies: A procedure in which a blood sample
is checked to measure the amounts of certain substances released into the blood
by organs and tissues in the body. An unusual (higher or lower than normal)
amount of a substance can be a sign of disease in the organ or tissue that makes it.
- Urinalysis: A test to check the color of urine and its
contents, such as sugar, protein, red blood cells, and white blood cells.
- Liver function test: A procedure in which a sample of blood
is checked to measure the amounts of enzymes released into it by the liver. An
abnormal amount of an enzyme can be a sign that cancer has spread to the liver.
Certain conditions that are not cancer may also increase liver enzyme levels.
- Intravenous pyelogram (IVP): A series of x-rays of the
kidneys, ureters, and bladder to find out if cancer is present in these organs.
A contrast dye is injected into a vein. As the contrast dye moves through the
kidneys, ureters, and bladder, x-rays are taken to see if there are any blockages.
- Ultrasound exam: A procedure in which high-energy sound
waves (ultrasound) are bounced off internal tissues or organs and make echoes.
The echoes form a picture of body tissues called a sonogram.
- CT scan (CAT scan): A procedure that makes a series of
detailed pictures of areas inside the body, taken from different angles. The
pictures are made by a computer linked to an x-ray machine. A dye may be
injected into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a
magnet, radio waves, and a computer to make a series of detailed pictures of
areas inside the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI).
- Biopsy: The removal of cells or tissues so they can be
viewed under a microscope by a pathologist to check for signs of cancer. To do a
biopsy for renal cell cancer, a thin needle is inserted into the tumor and a
sample of tissue is withdrawn.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the disease.
- The patient's age and general health.
Stages of Renal Cell Cancer
After renal cell cancer has been diagnosed, tests are done to
find out if cancer cells have spread within the kidney or to other parts of the body.
The process used to find out if cancer has spread within the
kidney or to other parts of the body is called staging. The information gathered
from the staging process determines the stage of the disease. It is important to
know the stage in order to plan treatment. The following tests and procedures
may be used in the staging process:
- CT scan (CAT scan): A procedure that makes a series of
detailed pictures of areas inside the body, taken from different angles. The
pictures are made by a computer linked to an x-ray machine. A dye may be
injected into a vein or swallowed to help the organs or tissues show up more
clearly. This procedure is also called computed tomography, computerized
tomography, or computerized axial tomography.
- MRI (magnetic resonance imaging): A procedure that uses a
magnet, radio waves, and a computer to make a series of detailed pictures of
areas inside the body. This procedure is also called nuclear magnetic resonance
imaging (NMRI).
- Chest x-ray: An x-ray of the organs and bones inside the
chest. An x-ray is a type of energy beam that can go through the body and onto
film, making a picture of areas inside the body.
- Bone scan: A procedure to check if there are rapidly
dividing cells, such as cancer cells, in the bone. A very small amount of
radioactive material is injected into a vein and travels through the
bloodstream. The radioactive material collects in the bones and is detected by a scanner.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
- Through tissue. Cancer invades the surrounding normal tissue.
- Through the lymph system. Cancer invades the lymph system and
travels through the lymph vessels to other places in the body.
- Through the blood. Cancer invades the veins and capillaries and
travels through the blood to other places in the body.
When cancer cells break away from the primary (original) tumor
and travel through the lymph or blood to other places in the body, another
(secondary) tumor may form. This process is called metastasis. The secondary (metastatic)
tumor is the same type of cancer as the primary tumor. For example, if breast
cancer spreads to the bones, the cancer cells in the bones are actually breast
cancer cells. The disease is metastatic breast cancer, not bone cancer.
Stage I
In stage I, the tumor is 7 centimeters or smaller and is found only in the kidney.
Stage II
In stage II, the tumor is larger than 7 centimeters and is found only in the kidney.
Stage III
In stage III, cancer is found:
- in the kidney and in 1 nearby lymph node; or
- in an adrenal gland or in the layer of fatty tissue around the kidney,
and may be found in 1 nearby lymph node; or
- in the main blood vessels of the kidney and may be found in 1 nearby
lymph node.
Stage IV
In stage IV, cancer has spread:
- beyond the layer of fatty tissue around the kidney and may be found in 1
nearby lymph node; or
- to 2 or more nearby lymph nodes; or
- to other organs, such as the bowel, pancreas, or lungs, and may be found
in nearby lymph nodes.
Recurrent Renal Cell Cancer
Recurrent renal cell cancer is cancer that has recurred (come
back) after it has been treated. The cancer may come back many years after
initial treatment, in the kidney or in other parts of the body.
Treatment Option Overview
There are different types of treatment for patients with renal cell cancer.
Different types of treatments are available for patients with
renal cell cancer. Some treatments are standard (the currently used treatment),
and some are being tested in clinical trials. A treatment clinical trial is a
research study meant to help improve current treatments or obtain information on
new treatments for patients with cancer. When clinical trials show that a new
treatment is better than the standard treatment, the new treatment may become
the standard treatment. Patients may want to think about taking part in a
clinical trial. Some clinical trials are open only to patients who have not
started treatment.
Five types of standard treatment are used:
Surgery
Surgery to remove part or all of the kidney is often used to
treat renal cell cancer. The following types of surgery may be used:
- Partial nephrectomy: A surgical procedure to remove the cancer
within the kidney and some of the tissue around it. A partial nephrectomy
may be done to prevent loss of kidney function when the other kidney is
damaged or has already been removed.
- Simple nephrectomy: A surgical procedure to remove the kidney only.
- Radical nephrectomy: A surgical procedure to remove the kidney, the
adrenal gland, surrounding tissue, and, usually, nearby lymph nodes.
A person can live with part of 1 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. If the
patient has to wait for a donated kidney, other treatment is given as needed.
When surgery to remove the cancer is not possible, a treatment
called arterial embolization may be used to shrink the tumor. A small incision
is made and a catheter (thin tube) is inserted into the main blood vessel that
flows to the kidney. Small pieces of a special gelatin sponge are injected
through the catheter into the blood vessel. The sponges block the blood flow to
the kidney and prevent the cancer cells from getting oxygen and other substances
they need to grow.
Even if the doctor removes all the cancer that can be seen at
the time of the surgery, some patients may be given chemotherapy or radiation
therapy after surgery to kill any cancer cells that are left. Treatment given
after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy
x-rays or other types of radiation to kill cancer cells or keep them from
growing. There are two types of radiation therapy. External radiation therapy
uses a machine outside the body to send radiation toward the cancer. Internal
radiation therapy uses a radioactive substance sealed in needles, seeds, wires,
or catheters that are placed directly into or near the cancer. The way the
radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the
growth of cancer cells, either by killing the cells or by stopping them from
dividing. When chemotherapy is taken by mouth or injected into a vein or muscle,
the drugs enter the bloodstream and can reach cancer cells throughout the body
(systemic chemotherapy). When chemotherapy is placed directly into the spinal
column, an organ, or a body cavity such as the abdomen, the drugs mainly affect
cancer cells in those areas (regional chemotherapy). The way the chemotherapy is
given depends on the type and stage of the cancer being treated.
Biologic therapy
Biologic therapy is a treatment that uses the patient's immune
system to fight cancer. Substances made by the body or made in a laboratory are
used to boost, direct, or restore the body's natural defenses against cancer.
This type of cancer treatment is also called biotherapy or immunotherapy.
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 renal
cell cancer. They keep blood vessels from forming in a tumor, causing the tumor
to starve and stop growing or to shrink.
New types of treatment are being tested in clinical trials.
Below describes treatments that are being studied in clinical
trials. It may not mention every new treatment being studied.
Stem cell transplant
Stem cells (immature blood cells) are removed from the blood or
bone marrow of a donor and given to the patient through an infusion. These
reinfused stem cells grow into (and restore) the body's blood cells.
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the
best treatment choice. Clinical trials are part of the cancer research process.
Clinical trials are done to find out if new cancer treatments are safe and
effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on
earlier clinical trials. Patients who take part in a clinical trial may receive
the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the
way cancer will be treated in the future. Even when clinical trials do not lead
to effective new treatments, they often answer important questions and help move
research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet
received treatment. Other trials test treatments for patients whose cancer has
not gotten better. There are also clinical trials that test new ways to stop
cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to
find out the stage of the cancer may be repeated. Some tests will be repeated in
order to see how well the treatment is working. Decisions about whether to
continue, change, or stop treatment may be based on the results of these tests.
This is sometimes called re-staging.
Some of the tests will continue to be done from time to time
after treatment has ended. The results of these tests can show if your condition
has changed or if the cancer has recurred (come back). These tests are sometimes
called follow-up tests or check-ups.
Treatment Options for Renal Cell Cancer
Stage I Renal Cell Cancer
Treatment of stage I renal cell cancer may include the following:
- Surgery (radical nephrectomy, simple nephrectomy, or partial nephrectomy).
- Radiation therapy as palliative therapy to relieve symptoms in patients
who cannot have surgery.
- Arterial embolization as palliative therapy.
- A clinical trial of a new treatment.
Stage II Renal Cell Cancer
Treatment of stage II renal cell cancer may include the following:
- Surgery (radical nephrectomy or partial nephrectomy).
- Surgery (nephrectomy), before or after radiation therapy.
- Radiation therapy as palliative therapy to relieve symptoms in patients
who cannot have surgery.
- Arterial embolization as palliative therapy.
- A clinical trial of a new treatment.
Stage III Renal Cell Cancer
Treatment of stage III renal cell cancer may include the following:
- Surgery (radical nephrectomy). Blood vessels of the kidney and some
lymph nodes may also be removed.
- Arterial embolization followed by surgery (radical nephrectomy).
- Radiation therapy as palliative therapy to relieve symptoms and improve
the quality of life.
- Arterial embolization as palliative therapy.
- Surgery (nephrectomy) as palliative therapy.
- Radiation therapy before or after surgery (radical nephrectomy).
- A clinical trial of biologic therapy following surgery.
Stage IV and Recurrent Renal Cell Cancer
Treatment of stage IV and recurrent renal cell cancer may include the following:
- Targeted therapy alone or after biologic therapy.
- Biologic therapy alone or after surgery (nephrectomy) to reduce the size
of the tumor.
- Arterial embolization as palliative therapy to relieve symptoms and
improve the quality of life.
- Radiation therapy as palliative therapy to relieve symptoms and improve
the quality of life.
- Surgery (nephrectomy) as palliative therapy.
- Surgery (radical nephrectomy, with or without removal of cancer from
other areas where it has spread).
- A clinical trial of chemotherapy.
Check for U.S. clinical trials from NCI's PDQ Cancer Clinical
Trials Registry that are now accepting patients with stage IV renal cell cancer
and recurrent renal cell cancer. For more specific results, refine the search by
using other search features, such as the location of the trial, the type of
treatment, or the name of the drug. General information about clinical trials is
available from the NCI Web site.
For more information from the NCI, please write to this address:
NCI Public Inquiries Office
Suite 3036A
6116 Executive Boulevard, MSC8322
Bethesda, MD 20892-8322
U.S. residents may call the National Cancer Institute's (NCI's) Cancer
Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through
Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY
equipment may call 1-800-332-8615. Information about ongoing clinical trials is available from the NCI Web site
Source: National Institutes of Health; National Cancer Institute
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 6/18/2008...#6176
