Clear Cell Renal Cell Carcinoma

What is clear cell renal cell carcinoma?

Clear cell renal cell carcinoma (ccRCC) is a subtype of renal cell carcinoma (RCC), which is a type of kidney cancer. It starts in the cells that line the small tubes in your kidneys that filter waste from your blood. Clear cell renal cell carcinoma cells rapidly multiply, forming one or more tumors. It usually only affects one kidney, but can affect both.

What are the symptoms of clear cell renal cell carcinoma?

Clear cell renal cell carcinoma usually doesn’t cause any noticeable symptoms during the early stages. But as the condition progresses, you may experience:

• Blood in your pee (hematuria)
• Feeling very tired, even if you get a lot of sleep (fatigue)
• Fever
• A lump on your affected kidney
• Flank pain on the side of your affected kidney
• Unexplained weight loss

What causes clear cell renal cell carcinoma?

Most kidney cancers, including ccRCC, develop for no known reason. But certain factors may increase your risk, like:

• Using tobacco products, including smoking and vaping
• Having a body mass index (BMI) greater than 25 (having overweight/obesity)
• High blood pressure (hypertension)
• Chronic kidney disease that requires dialysis
• Exposure to workplace toxins, like the solvent trichloroethylene
• Long-term use of pain relievers (analgesics) like acetaminophen (Tylenol®)

Who gets clear cell renal cell carcinoma?

Anyone can get clear cell renal cell carcinoma. But it affects twice as many people assigned male at birth as people assigned female at birth. It also most commonly appears in people between 50 and 70 years old.

According to the American Cancer Society, more than 81,000 people in the U.S. get a kidney cancer diagnosis each year. Of these, ccRCC is the most common type.

Is clear cell renal cell carcinoma inherited?

You’re at a greater risk of kidney cancer if you have a biological (blood-related) sibling with renal cell carcinoma. Medical professionals aren’t sure why.

Some people have genetic conditions that make them more likely to have clear cell renal cell carcinoma, such as Von Hippel-Landau (VHL) disease.

With these conditions, an inherited gene variation causes cysts and tumors to form in different areas of your body. The cysts and tumors usually aren’t cancerous. But ccRCC can occur more often in these biological families, and it often develops at an earlier age than average.

If you receive a ccRCC diagnosis at a young age or have multiple tumors, your healthcare provider may recommend genetic testing.

How is clear cell renal cell carcinoma diagnosed?

Kidney cancer doesn’t usually cause symptoms. Healthcare providers discover most kidney tumors while looking for a cause of other conditions. For example, they may see a kidney tumor on imaging tests like an MRI or CT scan to check for conditions like kidney stones.

Imaging tests can detect a tumor. But it can be difficult to determine whether the mass is noncancerous (benign) or cancerous (malignant) according to imaging tests. To make an accurate diagnosis, a provider may recommend a kidney biopsy or surgery to remove the tumor.

If a provider surgically removes the tumor, they’ll examine the tumor tissue for cancer. The results can confirm a cancer diagnosis and determine whether it’s the clear cell subtype. As many as 4 in 10 small kidney tumors (less than 4 centimeters) are noncancerous tumors, like renal oncocytomas.

After diagnosing ccRCC, a provider will use cancer staging to determine the size of the tumor and if it has spread to other areas of your body.

What are the stages of clear cell renal cell carcinoma?

There are four stages of clear cell renal cell carcinoma. The lower the stage, the less aggressive the cancer. A healthcare provider will talk to you about:

• Your cancer stage
• The risk it’ll spread to other areas of your body
• Your next steps

How is clear cell renal cell carcinoma treated?

Most treatment options depend on whether the cancer spreads outside of your kidney.

If the cancer hasn’t spread outside your kidney, treatments may include:

• Surgery (nephrectomy). A surgeon removes the cancerous part of your kidney (partial nephrectomy) or your entire kidney (radical nephrectomy).
• Ablative therapies. These treatments typically use a percutaneous (needle through the skin) approach to kill cancer cells. The different methods include cryoablation (which uses cold temperatures) or thermal ablation (which uses hot temperatures) to destroy cancer cells.

If the cancer has spread or is at high risk for spreading, treatment options may include:

• Immunotherapy. Immunotherapy engages your body’s immune system to destroy cancer cells. Medications include pembrolizumab (Keytruda®) or nivolumab (Opdivo®).
• Targeted therapy. This treatment stops cancer cells from growing and multiplying. Drugs include axitinib (Inlyta®) and cabozantinib (Cabometyx®).

Is clear cell renal cell carcinoma aggressive?

Like all carcinomas, clear cell renal cell carcinoma can spread (metastasize) to other parts of your body. Metastatic cancer is more difficult to treat. Compared to other kidney cancers, ccRCC tends to be more aggressive and spreads faster.

Renal cell carcinoma most commonly spreads to the:

• Lymph nodes
• Lungs
• Adrenal glands
• Liver
• Brain
• Bones

How fast does clear cell renal cell carcinoma grow?

Clear cell renal cell cancer growth rates vary a lot. One study noted that they may range from 0.2 to 6.5 centimeters (0.07 to 2.5 inches) per year, with an average growth rate of 2.13 centimeters per year (0.83 inches).

What is the survival rate of clear cell renal cell carcinoma?

The overall five-year ccRCC survival rate is 50% to 69%.

But survival rates depend on the size of your tumor. In general, treatment is less effective on large tumors or if ccRCC spreads to other areas of your body. In those cases, the five-year survival rate if you have a large tumor or if ccRCC spreads to other areas of your body is around 10%.

How do I take care of myself?

Learning you have clear cell renal cell carcinoma can inspire a lot of different feelings — fear, anger, depression, anxiety and others. Many people find it helpful to learn as much as they can about ccRCC and ask their loved ones for their support. It’s also a good idea to connect with ccRCC support groups who understand exactly what you’re experiencing.

It’s also important to lean on your care team. Ask them any questions that come to mind, including about your treatment options and recovery.

Other ways you can help take care of yourself include:

• Taking all medications exactly as your providers prescribe them
• Preventing weight loss by eating and drinking foods higher in protein and calories
• Sleeping as much as you can
• Trying to manage your stress through steps like deep breathing, meditation, yoga, art therapy or other relaxing activities, like puzzles
• Getting as much physical activity as your energy levels allow

When should I see a healthcare provider?

Call a healthcare provider if you experience:

• Blood in your pee
• A lump or pain in your side that doesn’t go away
• Unexplained fever or weight loss

If you’re receiving treatment for ccRCC, call a provider if you experience new or worsening symptoms. They can tell you how to manage the symptoms, change your dosage or even recommend a new type of treatment. Maintaining your well-being as much as possible is an important part of your treatment.

What questions should I ask a healthcare provider?

You may want to ask your provider:

• What’s the best treatment for me?
• What are the side effects of your recommended treatment?
• Am I at risk of metastatic cancer?
• How can I lower my risk of ccRCC spreading?
• Are any of my biological family members at risk for ccRCC?
• Should I look out for any specific signs of complications?

What is the difference between clear cell renal carcinoma and papillary renal cell carcinoma?

Clear cell and papillary renal cell carcinomas are types of kidney cancer that cause similar symptoms. Treatments are also similar. The main difference between the two is how the kidney cancer cells look under a microscope. Papillary cancer cells look like long, thin, fingerlike growths. ccRCC cancer cells look like clear bubbles. About 1 in 10 people with renal cell carcinoma have the papillary type.