Renal Cell Carcinoma

Renal cell carcinoma (RCC) is the most common type of kidney cancer. It happens when cancer cells form tumors in your tubules. These are tiny tubes in your kidneys. They recycle water and nutrients back to your bloodstream. They also remove waste, which leaves your body as pee (urine).

Anyone can develop RCC, but it’s most common in men aged 60 to 80. Experts don’t know the exact cause. But some medical conditions, medication and other issues may increase your risk.

This disease may not cause symptoms. One study found 6 out of 10 people didn’t have symptoms when they were diagnosed. Often, imaging tests to check for another issue spot the tumor. Early diagnosis and surgery to remove the tumor may cure RCC. Other treatments may help you live longer.

Types of renal cell carcinoma

There are more than 50 RCC types. The three most common types are:

• Clear cell renal cell carcinoma (ccRCC): This is the most common type. Cancerous cells look clear under a microscope.
• Papillary renal cell carcinoma: This type causes tumors with finger-like projections (papillae).
• Chromophobe renal cell carcinoma: Tumor cells may look like larger forms of clear cell renal carcinoma.

Symptoms of renal cell carcinoma

RCC doesn’t cause symptoms right away. The first symptom may be blood in your urine (pee). This happens when a tumor puts pressure on fragile blood vessels in your kidney so they leak blood. Other symptoms are:

• Pain in the sides of your body between your hips and ribs (flank)
• A firm lump you can feel in your belly, or side or lower back
• Fever for no obvious reason
• Night sweats
• Unexplained weight loss
• Fatigue and shortness of breath

Renal cell carcinoma causes and risk factors

RCC develops when abnormal cells in your tubules divide and multiply uncontrollably. Experts don’t know why this happens. But there are issues that increase your risk, including:

• Genetic or inherited disorders: Having tuberous sclerosis, von Hippel Lindau disease or sickle cell disease may cause RCC.
• Lifestyle: Smoking and exposure to asbestos or cadmium are examples of lifestyle activities that may increase your risk.
• Medical conditions: You may develop RCC if you have obesity, high blood pressure, chronic kidney disease or chronic hepatitis C infections.
• Medical treatments: Long-term use of pain medications or having radiation therapy are risk factors.

A family history of kidney cancer may also increase your risk.

Complications of renal cell carcinoma

RCC may cause complications like:

• Spreading from your kidney to your bones, brain, liver, lungs or lymph nodes
• Causing a type of paraneoplastic syndrome (these disorders develop next to cancerous tumors)

How doctors diagnose renal cell carcinoma

Healthcare providers will do a physical exam and imaging tests to diagnose this disease. Imaging tests may include:

• CT scan: Your provider may inject a dye into a vein before doing this test. The dye helps show more tumor detail.
• Kidney ultrasound: This test may show if a change in your tubules is a cyst or a cancerous tumor.
• MRI: You may have this test if you can’t have a CT scan with dye. It’s an option if providers want to see more details.
• Biopsy: Your provider may do a needle biopsy after doing imaging tests.

Renal cell cancer staging

Cancer staging helps your provider plan treatment and set a prognosis. A prognosis is what you can expect after treatment. Your provider may say you have localized or metastatic cancer.

With localized cancer, the tumor hasn’t spread outside your kidney. Metastatic cancer is when the tumor has spread to places like lymph nodes, tissues or organs outside your kidney. RCC cancer stages range from I (1) to IV (4):

• Stage I: The tumor is 7 centimeters (about 2 3/4 inches) and hasn’t spread outside your kidney.
• Stage II: The tumor still hasn’t spread, but it’s larger than 7 cm.
• Stage III: The tumor has spread to nearby large veins, tissues or lymph nodes.
• Stage IV: The tumor is in lymph nodes, tissues and organs far from your kidney.

How is renal cell carcinoma treated?

Factors like the cancer stage, age and health steer treatment:

RCC stages I/II treatment

This is localized RCC. Most people have surgery to remove the tumor:

• Partial nephrectomy: This is an option if there’s a single small tumor in your kidney.
• Radical nephrectomy: Your surgeon removes your kidney, the surrounding fatty tissue and nearby lymph nodes.

There are other treatments if you can’t have surgery or don’t want surgery. Those are:

• Active surveillance: This is an option if you have a small tumor that doesn’t cause symptoms. You’ll have regular checkups to watch for cancer signs.
• Cryotherapy: This treatment uses very cold gases that freeze and destroy cancer cells. It’s an option if the tumor measures up to 4 cm (about 1 1/2 inches).
• Radiofrequency ablation: This treatment uses electric currents to heat the tumor.
• Radiation therapy: This treatment involves external beam radiation therapy. It’s an option if cryotherapy or radiofrequency ablation doesn’t work.

RCC stage III treatment

Your surgeon will do a radical nephrectomy. You may have immunotherapy to lower the risk that RCC will come back. Immunotherapy helps your immune system fight cancer. Checkpoint inhibitors are a common immunotherapy for kidney cancer. This treatment can shrink the tumor or slow down how fast it grows.

RCC stage IV treatment

Treatment for stage IV RCC depends on where cancer has spread. Surgery may be an option to remove small tumors. But most people have immunotherapy or targeted therapy.

Targeted therapy focuses on specific genetic changes or proteins in cancer cells. Providers typically use tyrosine kinase inhibitors. The medications block proteins that help cancer cells grow. They also block new blood vessel growth in the tumor.

Recovery time

It takes time to recover from surgery, the most common treatment for renal cell carcinoma. Full recovery may take three to six months. Your surgeon will explain how to care for yourself as you heal. For example, they may recommend that you:

• Get rest. You may feel very tired for the first two weeks after surgery.
• Fuel your recovery. The right combination of protein, vitamins and minerals can build your strength. Your provider may recommend food that helps you heal.
• Take short walks. When you feel up to it, regular walks can help prevent blood clots. But take it slow.
• Ask for help. For example, let others do the heavy lifting when something weighs more than 10 pounds.

When should I see my healthcare provider?

Let your provider know right away if you have:

• Heavy bleeding at your incision
• Infection symptoms, including a fever over 100 degrees Fahrenheit (37.38 degrees Celsius) or higher, or pus draining from your incision
• Blood in your pee
• Cancer treatment side effects that are stronger than you expect

Renal cell carcinoma can come back. You’ll have regular follow-up tests, like CT scans, blood tests and urine tests to check for signs of recurring cancer.

What are RCC survival rates?

A survival rate estimates what you can expect after treatment. Surgery to remove small tumors may cure most RCC cases, but everyone’s situation is different.

The National Cancer Institute (NCI) tracks the five-year relative survival rate for kidney and other cancer types. Experts compare five-year survival rates of people with kidney cancer and people who don’t have it. For example, if the five-year relative survival is 80%, people with kidney cancer are 80% as likely to be alive five years after diagnosis as people without the disease.

NCI classifies cancer as being local, regional or distant:

• With local kidney cancer, the tumor is in your kidney only (93% survival rate).
• With regional cancer, the tumor is in nearby tissues, lymph nodes or veins (76% survival rate).
• With distant cancer, the tumor may be in your brain, liver or lungs (19% survival rate).

How long can you live with renal cell carcinoma?

Your age, health, the cancer stage and how well treatment works affect life expectancy. Ask your healthcare provider what you can expect. They know your health situation and are your best source for this information.

Is renal cancer aggressive?

Some types are more aggressive than others. Clear cell renal carcinoma is an example of a fast-growing RCC.