Metastatic Renal Cell Carcinoma
Metastatic renal cell carcinoma is kidney cancer that has spread beyond the kidney to other parts of the body, most commonly to the lungs, bones, liver, or brain. While this advanced stage cannot be cured, modern treatments can help control the disease, manage symptoms, and improve quality of life.
Table of contents
- What is metastatic renal cell carcinoma?
- How does the cancer spread?
- Symptoms
- Diagnosis
- Treatment options
- Living with metastatic renal cell carcinoma
- Support and coping
What is metastatic renal cell carcinoma?
Metastatic renal cell carcinoma is the most common type of kidney cancer that has spread to other parts of the body. Renal cell carcinoma forms in tiny tubes inside your kidneys called tubules, which filter your blood and make urine. When this cancer spreads beyond the kidney, doctors call it metastatic or stage IV kidney cancer.[1][2]
About one-third of people with renal cell cancer develop metastatic spread. The cancer may have already spread when first diagnosed, or it may come back sometime after treatment for early-stage disease. More than one organ system is often involved in the metastatic process, which means the cancer has traveled to multiple locations in the body.[4][5]
Typically, treatment for metastatic renal cell carcinoma focuses on slowing the disease down and managing symptoms to help you feel as good as possible. Although advanced kidney cancer is unlikely to be cured, treatment can often control the cancer and help relieve symptoms.[1][5]
How does the cancer spread?
As the tumor grows in the kidney, it can spread into the fat or major blood vessels around the organ. It may also extend into the adrenal gland, which sits right on top of the kidney.[1]
From there, cancer cells can travel through your body in two main ways. First, they can enter your blood vessels and travel through your veins and arteries to reach many different body parts. Second, they can get into your lymph system, which is a network that runs throughout your body like your blood vessels and helps you fight disease. Cancer cells that get into lymph nodes can travel to other organs.[1]
Kidney cancer most often spreads to the lungs and bones. However, it can also travel to the brain, liver, adrenal gland, ovaries, and testicles. Because renal cell carcinoma often has no symptoms early on, it can spread before you even know you have it.[1][4]
Symptoms
The symptoms of metastatic renal cell carcinoma are different for each person. In most cases, you may notice general symptoms related to the cancer itself or specific symptoms depending on where the cancer has spread.[1]
Common symptoms include:
- Blood in your urine
- Pain in your back or side that won’t go away
- A lump in your belly or side
- Feeling generally sick and tired
- Not wanting to eat much
- Unexplained weight loss
- A fever that comes and goes
- Night sweats so severe you need to change your clothes or sheets
You might also experience symptoms related to where the cancer has spread. If it’s in your bones, you might feel pain there. In your lungs, it can give you a cough or trouble breathing. You may also experience symptoms of anemia (low red blood cell count), like shortness of breath and fatigue.[1][6]
Diagnosis
Tests that examine the abdomen and kidneys are used to diagnose renal cell cancer and determine if it has spread. After renal cell cancer has been diagnosed, doctors perform additional tests to find out if cancer cells have spread within the kidney or to other parts of the body.[3]
Diagnostic tests may include:
- CT scans (computed tomography), which use x-rays to create detailed pictures of the inside of your body
- MRI scans (magnetic resonance imaging), which use magnets and radio waves to image soft tissues
- Blood tests to check kidney function and look for other abnormalities
- Bone scans or PET scans to identify where the cancer has spread
- Biopsy, where a small sample of tissue is removed to examine under a microscope
Your healthcare team will also assess your overall health and use a system called the International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) criteria to determine your prognosis and help guide treatment decisions. This system looks at factors like how quickly the cancer developed, your overall physical condition, and certain blood test results.[8]
Treatment options
Even though metastatic renal cell carcinoma cannot be cured, you and your doctor have many treatment options. Treatments can help control the cancer, slow its growth, and manage symptoms.[10]
Surgery
Surgery may still be an option even if the cancer has spread. A radical nephrectomy is one of the main operations for kidney cancer. During this procedure, your surgeon removes the kidney that has the tumor, the adrenal gland above it, nearby lymph nodes, and fat around the organ. If the cancer hasn’t spread far, surgery may help you live longer and can also help relieve symptoms like pain and bleeding.[10]
Immunotherapy
Immunotherapy uses your own immune system to help fight cancer cells. Several newer immunotherapies, particularly drugs called checkpoint inhibitors, have become an integral part of managing advanced or metastatic kidney cancer. These drugs help your immune system recognize and attack cancer cells more effectively.[10][11]
Targeted therapy
Targeted therapy uses drugs that target specific features of cancer cells. These medications work differently than traditional chemotherapy and often have different side effects. Many target blood vessel growth around tumors or specific pathways that cancer cells use to grow.[10][13]
Combination treatments
Often, doctors combine immunotherapy drugs with other immunotherapy drugs or with targeted therapy drugs. These combinations have shown promising results in controlling advanced kidney cancer. Your doctor will consider many factors when deciding which treatment or combination is best for you.[8][11]
Radiation therapy
Radiation therapy uses high-energy x-rays to kill cancer cells. It’s most often used for advanced kidney cancer to control symptoms, especially if the cancer has spread to bones or the brain. The aim is to control the cancer and help relieve symptoms like pain.[5][10]
Other treatments
Other treatment options may include chemotherapy (though kidney cancer tends to be resistant to it), ablation therapy, and arterial embolization. Your doctor will discuss all options with you, explaining how each treatment can help and what side effects it might cause.[10]
Living with metastatic renal cell carcinoma
No matter which treatments you receive, healthy lifestyle choices can help you make the most of them and improve your quality of life.[14]
Diet and nutrition
A healthy diet with plenty of fresh fruits and vegetables, whole grains, and lean proteins like chicken and fish is important. Eating a variety of foods helps ensure you get the nutrients you need. After cancer treatment, good nutrition is one of the best things you can do for yourself.[14][17]
If you’ve had a kidney removed, your dietary needs may change depending on how well your remaining kidney works. You may need to limit protein, salt, phosphorus, and potassium. If you’re on dialysis, you’ll need to eat more protein than normal but limit liquids and certain minerals. A dietitian who specializes in kidney disease can help you understand what foods to eat and which to limit.[14]
Physical activity
Exercise lifts your energy and helps you fight off anxiety, depression, and stress. Even light physical activity like walking or gardening can improve your energy levels, mood, and overall well-being. Ask your doctor what’s safe for you to do, and work with a physical therapist if needed to develop an appropriate exercise routine.[1][17]
Managing symptoms and side effects
Your doctor can help with all kinds of common problems from cancer and its treatments, like constipation, upset stomach, pain, and fatigue. But you need to speak up about your symptoms. Check in with your doctor often to get the care you need. Keeping a journal can help you track symptoms, when they happen, and what you’re doing.[1][16]
Energy management
Cancer and its treatments can leave you feeling exhausted. Try to keep your days simple and save your energy for important activities. Don’t be shy about resting when you need to. Getting enough sleep and finding ways to relax can help keep your mood and energy up.[1][16]
Support and coping
Coping with advanced kidney cancer can be extremely difficult, both physically and emotionally. Finding out that you cannot be cured is distressing and can be a shock. It’s common to feel uncertain and anxious, and it’s normal to not be able to think about anything else for a while.[15]
As well as family and friends, there are many people at the hospital and in your community who can help support you:
- Specialist nurses can help if you’re finding it difficult to cope or if you have any problems. They can get you the help you need and provide information about support in your local area.
- Counselors can provide emotional support if you find it easier to talk to someone outside your family and friends.
- Support groups and online communities allow you to connect with others facing similar challenges.
- Palliative care specialists (also called symptom control nurses) can work with you and your doctor to help control any cancer symptoms and improve your physical and emotional well-being.
Talking to others who understand what you’re going through can be very helpful. Many people find that knowing more about their situation makes it easier to cope. Don’t hesitate to ask your healthcare team questions about your diagnosis, treatment options, and what to expect.[15][16]
It’s important to feel as well as you possibly can. If you have any symptoms, tell your doctor or nurse so they can help you get the treatment you need to relieve them. Always attend follow-up appointments to ensure your doctor knows about any new or worsening symptoms.[16]
