Renal Cell Carcinoma

What is renal cell carcinoma (RCC)?

Renal cell carcinoma (RCC) is the most common type of kidney cancer. RCC forms in tiny tubes inside your kidneys called tubules. Tubules direct substances your body needs, like water and nutrients, to your bloodstream, while filtering waste through your urine (pee). Up to 85% of kidney cancers are RCC.

RCC usually starts as a single clump of cancer cells — called a mass or a tumor — inside a single kidney. But you may have multiple tumors in one or both kidneys.

Types of renal cell carcinoma

Clear cell renal cell carcinoma (ccRCC) is the most common type of RCC. There are more than 50 types of RCC in addition to ccRCC. Many are rare. Scientists classify them based on various factors, including how tumor cells look under a microscope and their DNA, or genetic material.

More widely known types of RCC include:

• Clear cell renal cell carcinoma (ccRCC): Up to 85% of RCCs are clear cell renal carcinoma. ccRCC gets its name from the way tumor cells look underneath a microscope — clear-colored.
• Papillary renal cell carcinoma: Ten percent to 15% of RCCs are papillary renal cell carcinoma. It gets its name from the finger-like projections (papillae) visible on most tumors.
• Chromophobe renal cell carcinoma: Five percent to 10% of RCCs are chromophobe renal cell carcinoma. The cells are usually light-colored (like clear cell carcinoma) but tend to be larger.
• Unclassified RCC: Up to 6% of RCCs don’t fit into any category. Increasingly, scientists are discovering new ways to classify this undefined group of RCCs based on the microscopic characteristics of cancer cells, including cell DNA.

Your healthcare provider may refer to RCC as localized or advanced (metastatic). Localized RCC remains in your kidney and (in some cases) nearby surrounding structures. Metastatic RCC has spread to other parts of your body. Treatments and outcomes differ depending on which type you have.

How common is renal cell carcinoma?

Healthcare providers diagnose approximately 80,000 new cases of RCC each year in the U.S. and 400,000 new cases worldwide. Anyone can develop RCC, but it’s most common in men and people assigned male at birth aged 60 to 80.

What are the symptoms of renal cell carcinoma?

Most people don’t notice symptoms in the early stages. When symptoms appear, they usually relate to how tumor growth impacts nearby tissue or organs.

Renal cell carcinoma symptoms include:

• Blood in your urine (hematuria).
• Pain in your flank (the sides of your body between your hips and ribs).
• A firm lump in your abdomen, low back or flank.
• Fever.
• Night sweats.
• Unexplained weight loss.

You may also experience symptoms of anemia, like shortness of breath and fatigue. Or you may experience symptoms of paraneoplastic syndromes. With paraneoplastic syndromes, tumors may release substances, like hormones, that cause changes in your body.

What causes renal cell carcinoma?

RCC develops when abnormal cells multiply out of control inside kidney tubules. Exact causes are unknown. Still, scientists have discovered several risk factors that may make a person more likely to develop RCC.

Risk factors

Risk factors of renal cell carcinoma include:

• Smoking (the more you smoke, the greater your risk).
• Obesity (the higher your BMI, the greater your risk).
• High blood pressure (hypertension).
• Chronic kidney disease (which may include long-term dialysis treatment).
• Chronic hepatitis C infection.
• Long-term use of certain pain medicines (including NSAIDs and acetaminophen).
• Prior radiation therapy directed at your abdomen.
• Exposure to cancer-causing substances (carcinogens), like cadmium and asbestos.
• Sickle cell disease (associated with a rare form of RCC).
• Family history of kidney cancer.
• Genetic mutations (changes in your cell DNA).
• Tuberous sclerosis complex.
• Von Hippel-Lindau disease (VHL).

If you have a condition or a family history that puts you at risk of developing RCC, your healthcare provider may recommend regular screenings to catch tumors early.

How is renal cell carcinoma diagnosed?

Up to 25% of people with RCC don’t receive a diagnosis until the cancer’s more advanced. This is when symptoms usually become noticeable.

Increasingly, providers are catching tumors incidentally during unrelated imaging procedures before symptoms start. As a result, more people are receiving treatment in the early stages, when cancer responds best to treatment.

Tests done to diagnose renal cell carcinoma

Providers use imaging tests to identify tumors and plan treatment. The most common tests include:

• Ultrasound: A test that sends high-frequency sound waves through body tissues to create images displayed on a monitor. An ultrasound shows if tumors consist mostly of fluid (likely cysts) or solid material (more common in cancerous tumors).
• Computed tomography (CT) scan: A test that creates a series of images that show a detailed picture of the inside of your body. You’ll likely receive a scan before and after receiving a contrast (dye) injected into a vein. The dye travels to the tumor and shows it in detail.
• Magnetic resonance imaging (MRI): A test that uses a large magnet, radio waves and a computer to create detailed images of the inside of your body. You may need an MRI if you’re unable to have a CT scan (for example, if you’re allergic to the dye) or if the results of an ultrasound and CT scan are inconclusive.

While healthcare providers usually perform biopsies as a part of a cancer diagnosis, this isn’t often the case with renal cell carcinoma. During a biopsy, a provider removes a tumor tissue sample and uses a microscope to look for cancer cells.

Often, biopsies are too risky with RCC because they may cause kidney damage. Instead, providers examine tumor cells after they’ve removed the entire tumor as part of treatment. If imaging shows that cancer has spread, they may remove tumor cells from a location other than your kidney for testing.

Providers examine the cells to determine the specific type of RCC (if it’s unclear from imaging). Examining the cells also helps providers identify treatments that may work particularly well on that cancer type.

Renal cell carcinoma staging

Cancer staging helps your healthcare provider determine how advanced your cancer is. It can show if your cancer is localized or metastatic. This information helps your provider plan treatment. It also helps determine the likely outcomes of your treatment (prognosis).

Providers use the TNM (tumor, lymph node, metastasis) system to stage RCC. They assign a stage, ranging from I to IV. Stage I through Stage III cancers are localized, while stage IV is metastatic RCC.

• Stage I RCC: The tumor is smaller than 7 centimeters and hasn’t spread beyond your kidney.
• Stage II RCC: The tumor is larger than 7 centimeters and hasn’t spread beyond your kidney.
• Stage III RCC: The tumor may be any size. It has spread into nearby structures surrounding your kidney.
• Stage IV RCC: Cancer has spread outside of your kidney, to areas such as your lymph nodes and other organs.

Where does renal cell carcinoma spread first?

Metastatic RCC often spreads to your lymph nodes, lungs, bone, liver and brain. It can also spread to your ovaries or testicles.

What is the treatment for renal cell carcinoma?

Treatment depends on many factors, including cancer stage and your overall health. Treatment for localized RCC is different from treatments for metastatic RCC.

Localized renal cell carcinoma treatment

Treatments include removing the cancer or destroying it using ablation techniques (destroying cells using extreme heat or cold).

Surgery is the most common treatment for localized RCC.

• Radical nephrectomy: Surgery that removes the affected kidney and some surrounding tissue, like lymph nodes or your adrenal glands (which may also contain cancer cells). Most people only need one healthy kidney.
• Partial nephrectomy: Surgery that removes only the affected part of your kidney. You may have a partial nephrectomy if you have a smaller tumor. A partial nephrectomy allows you to keep some kidney function. This is especially important if you don’t have two healthy kidneys.

If you’re not a candidate for surgery, your healthcare provider may recommend ablation procedures instead. These include:

• Cryotherapy: Freezing cancer cells to kill them.
• Radiofrequency ablation: Burning cancer cells to kill them.

Metastatic renal cell carcinoma treatment

Metastatic RCC treatments fight cancer cells throughout your body. You may still receive surgery to remove tumors, but that won’t be enough to eliminate metastatic cancer. Still, removing tumors may help with symptom relief, and surgery may allow you to delay starting other treatments.

The most common treatments include immunotherapy and targeted therapy. Depending on a variety of factors, these medications are either given as single agents or as combination therapy.

Immunotherapy treatments

Immunotherapy strengthens your immune system so it’s better at detecting and fighting cancer cells. Immunotherapy drugs include:

• Avelumab (Bavencio®).
• Ipilimumab (Yervoy®).
• Nivolumab (Opdivo®).
• Pembrolizumab (Keytruda®).

Targeted therapy treatments

Targeted therapy interferes with the process that allows cancer cells to multiply. This treatment restricts the blood supply to tumors, slowing their growth. Targeted therapy drugs include:

• Axitinib (Inlyta®).
• Bevacizumab (Avastin®).
• Cabozantinib (Cabometyx®).
• Everolimus (Afinitor®).
• Lenvatinib (Lenvima®).
• Pazopanib (Votrient®).
• Sorafenib (Nexavar®).
• Sunitinib (Sutent®).
• Temsirolimus (Torisel®).
• Tivozanib (Fotivda®).

Your healthcare provider may recommend other cancer treatments, including radiation therapy, depending on the cancer’s location, its severity and your response to other treatments.

Can renal cell carcinoma be prevented?

Renal cell carcinoma isn’t always preventable, but you can reduce your risk. For example, choosing not to smoke (and quitting if you do) is one of the best things you can do to reduce your cancer risk.

Is renal cell carcinoma curable?

It can be, but it depends on your specific diagnosis. People with localized RCC that’s been surgically removed generally have a very good long-term prognosis. People with higher-risk localized RCC may be offered immunotherapy after the cancer is removed to improve long-term outcomes.

There isn’t a cure for advanced RCC that’s spread beyond your kidney. Still, people with metastatic RCC are living longer as scientists discover better treatments targeting specific cancer cells.

What is the outlook for renal cell carcinoma?

Increasingly, providers are detecting RCC in earlier stages, when the cancer is more treatable. Early detection and better treatments have increased the survival rate. The five-year survival rate for Stage I RCC is 90%. And while the life expectancy for people with Stage IV renal cell carcinoma was once a matter of months, many people are now living for several years.

How do I take care of myself?

Talk to your healthcare provider about a care plan that can help you manage cancer symptoms and any treatment side effects. For example, some people will need to start dialysis treatment following surgery if one or more kidneys can’t do their job. It’s important to know how these treatments will impact you.

You may need help managing targeted therapy or immunotherapy side effects. Ask your healthcare provider what to expect before starting treatment.

What questions should I ask my doctor?

• What type of RCC do I have?
• How advanced is my cancer?
• What are the benefits and risks of potential treatments?
• What side effects or complications should I be aware of before receiving treatment?
• How often will I need follow-up visits following treatment?
• What lifestyle changes should I expect during treatment?
• What’s my prognosis?

A note from Cleveland Clinic

Your renal cell carcinoma (RCC) cancer treatment experience depends on various factors, including your overall health, the type of RCC, its stage and your response to treatment. But anyone with a kidney cancer diagnosis can benefit from developing a close relationship with their care team. Don’t hesitate to ask questions about your unique diagnosis, including the benefits and risks of potential treatment options. Ask about likely treatment outcomes. Your provider is your best resource for explaining what having RCC means for you.